Articles: emergency-services.
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Violence in the emergency department, a not uncommon but complex phenomenon, may become more serious when patients possess weapons. Searches are used frequently to reduce this danger, though guidelines for searches are not well delineated. We examined our practices in order to formalize our guidelines. ⋯ Although various factors contributed to a clear bias toward searching psychiatric patients, we believe that the rate of weapons possession did not support this bias.
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The Quick Response Team, consisting of physicians, nurses and social workers in an emergency room setting, conducted a five month pilot project whose overall goal was to eliminate unnecessary admissions to an acute care hospital. This paper reports on the three social work objectives of the program: high risk screening and direct intervention, including assessment, short-term counselling, information, and referral; follow-up services; and social work coverage to all units after hours. Over a 4 month period 11.6% of all patients in the emergency room were assessed by the social work staff and 24 non-acute admissions were deferred. The results of the study confirm the effectiveness of a social work presence in the emergency department in reducing non-acute admissions and in providing continuity of care for patients at high social risk.
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This article is a continuation of a series that provides guidelines for documentation in the medical record. See QRC Advisor 6:3 (January) for general charting guidelines, 6:4 (February) for obstetrics charting, 6:6 (April) for perioperative charting, and 6:12 (December) for Documentation of Medications and i.v.'s--I.
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Patients generally have the right to refuse medical care, a right based on certain legal precedents. Its application in the emergency department leads to difficult decisions for the emergency physician. ⋯ These include psychiatric patients, narcotics abusers, alcoholics, "street people," and some patients with migraine headaches. They represent some of our most difficult decisions because the treatment required for the patient is often clear and the patient refuses care or demands inappropriate care.
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Emergency center (ER) trauma evaluations often include leukocyte count (LC), serum amylase (SA), electrolytes (EL), and urine analysis. We reviewed records of 100 pediatric ER patients to determine utility of these tests in management of blunt injury. SA was evaluated in 65 patients and ranged from 30-146 U/L (mean 50.6 U/L); 14 patients with normal CT scans had SA from 30-68 U/L (mean 49.1 U/L). ⋯ DA predicted injury with sensitivity 60.0 per cent (specificity 79.2%). DA accurately represented LA results (sensitivity 100%, specificity of 94.5%). DA is a rapid and effective replacement of LA in evaluation of trauma patients in the emergency center.