Articles: emergency-services.
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Adherence to physician-developed process criteria is critical to the medical and legal acceptance of algorithm-directed nonphysician care of acute non-life-threatening illnesses seen in the emergency department. It is generally assumed that adherence to prescribed medical process criteria results in acceptable patient outcomes. ⋯ Our evaluation indicated that, under ideal circumstances of daily audit and supervisory feedback, a conformance rate of 80% was achieved. This is a 100% improvement over a group in which neither element was operative.
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The resuscitation experience of a large teaching hospital during 1973-77 was reviewed. Resuscitation was attempted on 2091 victims of cardiac arrest; 261 patients (12.5%) survived to be discharged from hospital. Coronary heart disease caused about one half of all the cardiac arrests, but was associated with a better survival rate (14.4%) than the other causes. ⋯ Patients whose arrest occurred outside hospital, where only basic life support was available, had a survival rate of just 6.3%, whereas those whose arrest occurred in the emergency room had a survival rate of 31.9%. Since these two patient groups were similar in terms of age and diagnosis, we believe that the potential survival rate for victims of cardiac arrest outside of hospital that are optimally treated is close to 30%. These data suggest that increased survival from cardiac arrest can be expected with extension of the resuscitation services both inside and outside of hospital, but particularly with increased emphasis on emergency cardiac care outside of hospital.