Articles: emergency-services.
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Inappropriate attendances at Accident and Emergency departments is a problem affecting all such services around the UK. Different approaches have been and are being tried. We report the results of a detailed study of this subject and discuss the main cause of the abuse of this facility.
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A team approach to the initial assessment, investigation and management of potentially seriously injured patients has been instituted. Team members are alerted through an emergency paging system which is activated when a patient fulfills one of a predetermined list of criteria relating to the injury incident, physiological status of the patients and anatomic injuries. Medical members of the team include surgical, intensive care, anaesthetic, and accident and emergency staff. ⋯ Although a false alarm rate of 46% is higher than desirable, the number of calls per day would still only average 2 in a hospital with a high trauma patient load. The checklist criteria were highly sensitive (97%) in identifying those patients who should have been evaluated by the trauma team. Although hospitals differ in workload and staffing, this trauma team model is recommended for more widespread use and for further evaluation and modification.
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Emergency department staff at Valley View Medical Center, a 48-bed rural hospital in Utah, implemented a computerized log and integrated a quality assessment program within their small department. A microcomputerized relational data base format is used to keep and cross-reference patient logs and audits. ⋯ It also provides rapid, flexible reporting functions for staff and patient feedback and aids in the collection and dissemination of data to regulatory agencies. The system minimizes physician and nurse time spent in recording and collecting data, while simultaneously increasing their QA involvement.