Articles: emergency-services.
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Primary health care in the accident and emergency department has been a philosophy of care that reacts to more than a client's presenting complaint (reactive care). It aims not only to manage the presenting complaint, but also to integrate continuing care with disease prevention and health promotion. Primary health care in the AED is intended to build fences around the cliffs forming our healthcare problems. At the same time it also encourages the provision of intensive care ambulances for those clients unfortunate to fall before the fences are finished or who fall over the fences.
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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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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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As a result of the lorry explosion on the Fengate Industrial Estate, Peterborough on 22nd March 1989, 82 casualties arrived at Peterborough District Hospital. Despite the fact that casualties arrived at the A&E Department in large numbers before the Major Accident Plan could be implemented, all of the casualties had been assessed and either admitted or sent home within 3 h of the explosion. In the process several valuable lessons were learned, and their implications are discussed in this paper.
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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.