PubMed · 9326005
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P Brecht. 1997-07-30. Mud, glorious mud.. https://pubmed.ncbi.nlm.nih.gov/9326005/
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Misuse of accident and emergency (A&E) departments is a problem throughout the world. Staffing A&E departments with general practitioners has been reported as successful in a few prospective studies. A medical audit of all A&E charts during one week was carried out. The audit-panel included two orthopaedic surgeons and two general practitioners. The charts were divided in two groups: 1) true A&E cases, 2) inappropriate A&E users, who should have visited the general practitioners' acute consultation instead. There was substantial agreement between audit-panel groups that 57% of attenders could visit the general practitioner instead. Ten percent of attenders received no treatment in the A&E department, but were transferred to other departments within the hospital. It is concluded that two-thirds of the A&E department attenders could have visited the general practitioners instead, for treatment or for referral to the relevant hospital department.
CONTEXT: The cost of treating gunshot injuries imposes a financial burden on society. Estimates of such costs are relevant to evaluation of gun violence reduction programs and may help guide reimbursement policies. OBJECTIVES: To develop reliable US estimates of the medical costs of treating gunshot injuries and to present national estimates for the sources of payment for treating these injuries. DESIGN AND SETTING: Cost analysis using E-coded discharge data from hospitals in Maryland for 1994-1995 and New York for 1994 and from emergency departments in South Carolina for 1997. Other sources of data included the National Electronic Injury Surveillance System for 1994 incidence of nonfatal gun injuries, the National Spinal Cord Injury Statistical Center database for 1988-1992 estimates of lifetime medical costs of gun injuries, and the 1994 Vital Statistics census for incidence of fatal gun injuries. MAIN OUTCOME MEASURES: Estimated national acute-care and follow-up treatment costs and payment sources for gunshot injuries. RESULTS: At a mean medical cost per injury of about $17000, the 134445 (95% confidence interval [CI], 109465-159425) gunshot injuries in the United States in 1994 produced $2.3 billion (95% CI, $2.1 billion-$2.5 billion) in lifetime medical costs (in 1994 dollars, using a 3% real discount rate), of which $1.1 billion (49%) was paid by US taxpayers. Gunshot injuries due to assaults accounted for 74% of total costs. CONCLUSIONS: Gunshot injury costs represent a substantial burden to the medical care system. Nearly half this cost is borne by US taxpayers.
Many GDPs are confused about which emergency drugs they should stock. There is a lack of uniform advice on this topic. Most recommended lists of emergency drugs contain superfluous medications which GDPs would never be expected to use. This paper rationalises the content of the emergency drugs box and provides clear, standardised guidance. A list of ten essential emergency drugs is presented, all of which can be administered by simple routes. Every GDP should be trained and competent to use these essential emergency drugs.