Articles: emergency-services.
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Gen Hosp Psychiatry · Sep 1990
Factors affecting length of stay in a psychiatric intensive care unit.
As a response to the challenge posed by an increasing number of agitated and violent patients, there is in Canada a growing number of psychiatric intensive care units (PICUs), in both general and psychiatric hospital settings. In this article, the functioning of such a unit in a general hospital context is reviewed. ⋯ The factors influencing the functioning and LOS of this PICU are analyzed. A possible "deskilling" of the staff in other wards is discussed, and alternative explanations are hypothesized in an attempt to shed light on the interaction between this unit and its environment.
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The undergraduate medical curriculum does not include supervised training in emergency services. Medical students and residents are expected to acquire skills and experience related to emergency medicine during their clerkships in the clinical wards. Consequently, Israeli medical graduates often have difficulty in coping with common situations in primary care and emergency medicine. ⋯ Both the positive feedback of the trainees and the practical relevance of the program and its feasibility, suggest that it may be a worthwhile addition to the undergraduate and graduate clinical curriculum. However, we have no data for evaluating the outcome. We feel that all aspects of emergency medicine should be included in the teaching programs of the various clinical specialties, and suggest that the emergency room should be used as a teaching setting during the clinical clerkship, the internship and residency training.
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A hospital's emergency physician billing procedures and fee schedules may not have kept pace with changes in the make-up of emergency room personnel. Revisions require thorough analysis of coding procedures, payer and patient data, Medicare rates, and breakdowns of collections. A successful analysis may yield improved collections, increased physician compensation, and separate billing by emergency physicians.
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J Hand Surg Eur Vol · Aug 1990
Why all finger fractures should be referred to a hand surgery service: a prospective study of primary management.
The quality of the treatment of finger fractures by Accident and Emergency Department staff has been prospectively assessed during a six-month period. 678 finger fractures were seen in the A. & E. Department. ⋯ Most management errors were elementary; they included failure to prescribe antibiotics for compound fractures, failure to reduce displaced fractures accurately and unsatisfactory splintage. It is recommended that all finger fractures should be assessed and treated by surgeons with training in the management of hand injuries.
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Clinical cardiology · Aug 1990
The earliest thrombolytic treatment of acute myocardial infarction: ambulance or emergency department?
Because the effectiveness of thrombolytic therapy is inversely related to the time interval before it is given, prehospital thrombolytic administration has been proposed and implemented to shorten the time between acute myocardial infarction (AMI) symptom onset and definitive therapy. Regardless of how effective these prehospital approaches prove to be, they have the potential to shorten the time to thrombolytic therapy in only a minority of the affected U. S. population because only approximately half of AMI patients are transported by the Emergency Medical Services (EMS) system. ⋯ If prehospital treatment were to become standard care in the United States, half of the 1.5 million AMI patients per year (750,000) who are transported by paramedics would be candidates for prehospital treatment. Assuming a 30% treatment rate (225,000), a 5% major bleed and a 1% stroke complication rate, then 11,250 major bleeds and 2,250 strokes would occur in field-treated AMI patients. If we assume that the absence of physician screening might increase the incidence of complications between 1% and 10%, then 113 to 1,125 extra bleeds and 23 to 225 extra strokes would result from prehospital treatment compared with treatment in the emergency department (ED).(ABSTRACT TRUNCATED AT 250 WORDS)