Articles: emergency-services.
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Hospital and emergency department overcrowding is a serious and growing problem nationwide. Although EDs are organized around the goals of rapid patient assessment, stabilization, and prompt admission to the hospital, an increasing number are being required to hold admitted floor and critical care patients for extended periods due to lack of vacant inpatient beds. ⋯ The initial focus of management strategies to resolve this problem is the inpatient area and includes evaluation of length of stay, "intent to discharge" policies, flexible bed designations, restriction of in-house transfers, and the use of "over-census beds." If in-hospital management strategies fail, modifications in ED management may include staffing contingency plans, definition of physician responsibility, inpatient charts, revised pharmacy formulary, new floor plans, and modified accounting systems. Successful resolution of hospital and ED overcrowding may be the greatest challenge facing emergency medicine today.
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Emerg. Med. Clin. North Am. · Feb 1991
ReviewPsychological reaction to hospitalization and illness in the emergency department.
Each personality type presents with different methods of coping. Physicians should be aware of the impact on a patient's psychological functioning and ability to cope with illness and hospitalization, to understand and more effectively manage the patient. The physician must try to assess the patient's baseline personality from their past and present behavior. ⋯ The stress of medical illness and/or hospitalization can be overwhelming for some patients and is usually followed by some form of psychological response. Current understanding of the psychological impact of illness is based upon psychological defenses, coping mechanisms, and individual personality. It is the ability of the emergency physician to identify defenses, coping skills and personality types that will aid him or her in the medical management of the patients in their time of illness and hospitalization.
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Nursing home residents are frequently transferred to hospital emergency departments. Delayed transfer may lead to poor outcomes. However, inappropriate transfer of the frail elderly may cause social and financial problems. ⋯ The results indicate that the problems of nearly half the study group could have been treated at the nursing home by a visiting physician with minimal medical equipment. Those admitted to the hospital (52%) were seriously ill, had prolonged lengths of stay (23.6 days), and had a high mortality rate (11%). Complex issues of physician reimbursement, proprietary nursing home budgeting, and day-to-day expediency appear to be involved in decisions to transport patients by ambulance to VA emergency departments.
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Short-term psychiatric hospitalization, developed during the past 2 decades, needs thorough evaluation with regard to its advantages. It is important to be able to identify those patients who might be aided by such treatment. Therefore the psychiatric emergency room physician should have at hand a model which would enable quick and relatively accurate decisions in identifying such patients. ⋯ This data may aid the physician during the initial interview in the psychiatric emergency room in deciding on further treatment. We also found that psychiatric emergency room diagnoses are usually reliable; and that those whose only diagnosis was "for observation" had a fair chance of a successful result after short-term hospitalization (discharge directly from the emergency room unit). We therefore presume that a sharper characterization of patients referred to the psychiatric emergency room may aid in tailoring the most suitable treatment for any particular patient, thus reserving short-term hospitalization only for those who would benefit the most.(ABSTRACT TRUNCATED AT 250 WORDS)