Articles: emergency-services.
-
Previous studies of emergency department management of bacterial meningitis have indicated that there are often long delays before initiation of antibiotics. The purpose of our study was to determine whether these delays were related to specific aspects of patient management. From 1981 through 1988, we retrospectively reviewed the medical records of 122 patients primarily evaluated in the ED and admitted for suspected bacterial meningitis at a university (55) and a community (67) hospital. ⋯ Time to antibiotics was significantly (P less than .00005) longer for patients in whom computed tomography scan and/or laboratory analysis of cerebrospinal fluid preceded initiation of antibiotics compared with patients in whom antibiotic administration was not contingent on the results of these procedures (4.3 [3.2 and 6.0] versus 1.9 [1.2 and 3.4] hours, respectively). Also, time to antibiotics was significantly (P less than .00005) longer for patients in whom antibiotics were initiated on the ward as compared with in the ED (4.5 [3.5 and 6.8] versus 2.2 [1.4 and 3.5] hours, respectively). We conclude that long delays exist in the ED before initiation of antibiotics for cases of suspected bacterial meningitis, and that in general these delays appear to be physician generated and to a great extent potentially avoidable.
-
We have done a prospective study of the emergencies that arrived to a Children's Hospital from 8 to 15 hours in labour day 987 enquires were filled, which represents 53.53% of those who came. Males were predominant and also the younger ones with 24.58% less than 1 year of age, and progressively diminishing with age. Frequency was higher on Mondays, Thursdays and Fridays, with a significant reduction on Tuesdays. ⋯ The socioeconomic status was slightly higher than that of the Madrid Community in which the hospital is situated. Our data show that the majority of children that come to the emergency department present problems that could have been solved in another level of care. We also found indirect signs, may evidentiate that the family members are conscious in many cases that they are making an unjustified use of this level of care.
-
Observation wards have not been discussed in the Australian literature. In the United Kingdom, the few published reports suggest that they are an essential part of the function of emergency departments. ⋯ Nearly half the remaining hospitals wanted to establish an observation ward. Our concept of observation wards is discussed.
-
Paramedics and EMTs nationwide are facing roadblocks to quality care as ambulances are diverted from overcrowded ERs to less impacted hospitals, sometimes miles away. The consequences can be serious.