Articles: emergency-services.
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Because cases of unrecognized carbon monoxide (CO) poisoning have been described among patients admitted to the hospital with other diagnoses, screening hospital admissions with carboxyhemoglobin testing has the potential for preventing morbidity among patients as well as among their cohabitants. Carboxyhemoglobin levels were obtained on 753 patients admitted to the hospital from the emergency department over a 3-month period during the winter. Patients in whom CO poisoning was diagnosed in the emergency department prior to admission were excluded. ⋯ The carboxyhemoglobin levels of the two patients were only marginally elevated, with levels of 10.9% and 11.3%. The cost of the carboxyhemoglobin screening program was $2.26 per patient result, or approximately $2,100 over a 3-month winter heating season. A program for screening emergency department admissions with carboxyhemoglobin testing, although feasible in terms of cost, detected few cases of unrecognized CO poisoning.
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From July through September 1987, our emergency department registered 17,214 patients, of whom 569 (3%) returned within two days of initial registration. Cases were reviewed to identify factors associated with return visits. Patient-related factors were responsible for a majority of repeat visits (267 cases, 53%). ⋯ Problems with our public health-care system prompted return in 18 cases (4%). Eighty-seven returning patients (19%) required emergency hospitalization, including 28 discharged due to physician errors. Regular case review of short-term returns to the ED should be included in a comprehensive ED-based program of quality assurance.