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At least 343 records · Page 19Linked to original sources
PubMed2004

Emergency medicine resident rotation in pediatric emergency medicine: what kind of experience are we providing?

OBJECTIVES: To characterize emergency medicine (EM) residents' clinical experience during a pediatric emergency medicine (PEM) rotation. METHODS: Prospective observational study of EM resident-patient encounters in a children's hospital emergency department (ED). RESULTS: Fifty-six residents participated in the study. The mean (+/-SD) patient age was 6.3 (+/-5.6) years. Ambulatory infectious disease, respiratory illness, and wound management represented almost 50% of final diagnoses. Six and a half procedures/resident were performed per rotation, mainly nonemergent procedures, whereas resuscitations and child abuse evaluations were rare. A minority of patients required data interpretation: 34.4% had laboratory testing, 24.6% had radiographic studies, and 2.3% had electrocardiograms. CONCLUSIONS: Analysis of patient encounters during a PEM rotation showed deficiencies in critical care procedures, resuscitations, child abuse evaluations, and neonatal evaluations. Quantitative data of skills utilized during rotations can be used by residency programs to identify and correct deficiencies in their residents' PEM education.

Child↗
PubMed2000

Emergency physician attitudes concerning intervention for alcohol abuse/dependence delivered in the emergency department: a brief report.

Emergency Medicine (EM) physicians frequently see patients with alcohol abuse or dependence (AA/AD). Brief interventions delivered in the Emergency Department (ED) have been advocated for these patients, however, little is known regarding EM physician willingness to support such interventions. We conducted a study to determine EM physicians' attitudes toward the use of interventions for AA/AD in the ED. All members of the Michigan College of Emergency Physicians (n = 569) were mailed a survey to assess their attitudes toward the use of intervention for AA/AD in the ED. Of the 257 respondents (45.9%), a total of 76% agreed that AA/AD is a treatable illness and only 15% would not agree to support of ED interventions. Both supporters and non-supporters thought that the lack of sufficient time was an impediment to treating AA/AD in the ED. Our study suggests that the majority of ED physicians would support the implementation of brief intervention for AA/AD in the ED.

Adult↗
PubMed2001

Comparative practice patterns of emergency medicine physicians and pediatric emergency medicine physicians managing fever in young children.

BACKGROUND/OBJECTIVE: The management of fever in young children is a controversial topic. This study seeks to compare the management approaches between general emergency medicine physicians (GEMPs) and pediatric emergency medicine physicians (PEMPs) and correlate them to existing practice guidelines. DESIGN/METHODS: All charts of children age 3 to 36 months presenting with the complaint of fever at both a children's hospital emergency department (ED) and a general ED from June 1, 1998 to September 1, 1998; December 1, 1998 to April 1, 1999; and June 1, 1999 to September 1, 1999 were retrospectively reviewed. Fever was defined as >/=39 degrees C. Patients with a history of immunodeficiency, chronic illness, ventriculoperitoneal shunt, antibiotic use in the past 48 hours, or focal infection noted on examination were excluded. Data collected included focal exam findings, laboratory tests, diagnosis, treatment, and disposition. Variances from the practice guidelines were tabulated and compared. RESULTS: One thousand three hundred twenty-three eligible children met exclusion criteria and were seen by PEMPs; 755 were eliminated because of exclusion criteria (526 because of focal infection). Twenty-two (4%) of 568 remaining patients were admitted to the hospital. Two hundred twenty-eight eligible children were seen by GEMPs; 147 were excluded (109 because of focal infection). No patients were admitted to the hospital. PEMPs ordered more complete blood counts (324/568 vs 27/81), more blood cultures (321/568 vs 27/81), and more urine cultures (208/568 vs 20/81) than GEMPs. GEMPs ordered more chest radiographs and cerebrospinal fluid analyses than PEMPs; GEMPs ordered less complete blood counts, blood cultures, and urine cultures than PEMPs. GEMPs diagnosed more focal infections (109/228 vs 526/1323), and conflicted more often with the practice guidelines (66/79 vs 225/498) than PEMPs. Patients spent an average of 2.26 +/- 0.16 hours in the pediatric ED versus 3.0 hours +/- 0.18 hours in the general ED. CONCLUSIONS: Significant differences in the management of the young child with fever and no source exist between these two groups of physicians. These variations affect both cost and standard of care. Future studies assessing whether these strategies affect patient outcomes would further elucidate their clinical implication.

Bacterial Infections↗
PubMed1999

How urgent are emergency admissions? An evaluation of emergency admissions to general hospitals in a Norwegian county.

OBJECTIVES: To assess necessary treatment and degree of urgency for patients admitted to emergency rooms, and potential health consequences of transfer to nearest alternative hospital. METHODS: During 1 month, we included all 1,300 emergently admitted patients in all seven general hospitals in a Norwegian county with a population of 236,921 inhabitants. The number of patients in need of surgical and/or intensive medical treatment, the urgency of the necessary treatment, and the risk to each patient of adverse permanent health consequences of further transport to nearest alternative hospital were assessed by a multidisciplinary expert panel. RESULTS: Ninety-four patients (7.2% of 1300 patients) were considered in need of either surgical (n = 22) or intensive medical treatment (n = 70) or both (n = 2) within 8 hours of arrival in hospital. Medical treatment had the greatest urgency, while surgery most often could be postponed. In cases where the patients were initially to be given only stabilizing treatment and then transported (assisted by qualified personnel) to another hospital, the panel estimated the risk of losing health benefit to be high for 14 patients. In six of these cases the risk was linked to delay of thrombolytic treatment. CONCLUSIONS: Fewer than 10% of the patients who are admitted as emergency cases to general hospitals in Norway need surgical or intensive medical treatment within 8 hours of their arrival. The medical consequences of transport of patients to the nearest alternative hospital are generally small and can often be further reduced by simple means.

Adolescent↗
PubMed2003

Rescuing the emergency--multiple expertise and IT in the emergency field.

OBJECTIVES: The rapid growth, both in technical and social approaches to the innovation phenomenon in health care suggests that profound changes are occurring. The focus of the project was to evaluate these changes through the case study of the French emergency field. METHODS: The consequences of information technology implementations in the Emergency Services are presented as models to investigate the importance of technical expertise, with both the involvement of all the stakeholders from the beginning of the design and the test of the new tool in real settings. RESULTS AND CONCLUSION: A new form of work resulted for the management of the crisis, which questioned the status of the actors and their actions, and the characteristics of the protocols of rescue. The outcome of this project was a new model built for the rescue of the emergency field which encompasses alternative forms of expertise.

Cooperative Behavior↗
PubMed1992

Sources of stress for emergency nurses in four urban Canadian emergency departments.

The results of this study indicate that emergency nurses experience work-related stress originating from a variety of sources. Although the study included a group of emergency nurses committed to achieving a high standard of patient care, many of the key stressors they confront hinder their sense of achievement. Repeatedly, nurses described inadequate staffing and resources, too many nonnursing tasks, changing trends in ED use, and patient transfer problems as having considerable impact on their ability to provide quality patient care. Nurses were also stressed by continual confrontation with patients and families who exhibited crisis or problematic behavior. In addition to strategies dealing directly with these stressors, the creation of a workplace that fosters more support and recognition of nurses and promotes professional growth may also help to reduce the impact of work stress for emergency nurses.

Adult↗
PubMed2005

[Cardiac arrest management in outpatient clinics: integration between hospital emergency care and the 118 emergency system in the model of Turin ASL 3].

The incidence of sudden cardiac death ranges from 0.4 to 1.28 every 1000 inhabitants per year. Sudden cardiac death is responsible for about 10% of all deaths in Italy in 2000. It is unpredictable and is related to malignant ventricular arrhythmias that may be interrupted in more than 70% of cases. Survival rates generally do not exceed 5% in out-of-hospital cardiac arrest, but, as previously reported, early defibrillation may increase survival rate by 3 times. The Italian law of April 3, 2001, and its recent amendments authorized healthcare providers and trained lay rescuers to use automated external defibrillators either for in-hospital or out-of-hospital settings. We planned a program for early defibrillation in ASL 3 in four outpatient clinics where a transit of 300,000 patients was expected in 2004. Defibrillators were placed in wall-mounted boxes. Opening of these boxes enable an automatic calling to the 118 emergency service that is able to dispatch an advanced cardiac life support team to the pertinent outpatient clinic. The system of wall-mounted boxes automatically communicates by modem with a programmable rate, the state of repair and efficiency of the single boxes, in order to simplify the control of the whole system of defibrillators. This plan of Turin ASL 3 is innovative in the metropolitan area and emphasizes the central role of the 118 emergency system in the management of out-of-hospital cardiac arrest, even in hospital settings such as outpatient clinics with a high number of old users at higher risk of cardiac events. This plan with the availability of automatic calling of the 118 emergency service will be proposed to remaining local hospital utilities for their outpatient settings as well as to other public utilities such as general stores, drugstores, airports where a significant transit mat be expected. The plan will include a specific training for the use of automated external defibrillators by first responders.

Ambulatory Care Facilities↗
PubMed1987

Emergency delivery: prehospital care, emergency department delivery, perimortem salvage.

The incidence of high-risk conditions complicating pregnancy is greater than one would suspect. Many times a pregnancy does not become high risk until labor starts. Prehospital and Emergency Department protocol should be directed at getting the mother to the labor and delivery suite as soon as possible. Most complications resulting in maternal-fetal morbidity and mortality are handled best in that setting. Prehospital and Emergency Department personnel should, however, be prepared to handle imminent delivery because it cannot be avoided when it occurs. Emergency Department personnel also should be familiar with the technique of perimortem cesarean delivery and use this technique when indicated for fetal-maternal salvage.

Cesarean Section↗
PubMed1993

Problems of suicide risk management in the emergency department without fixed, full-time emergency physician.

Attempted suicide is an often neglected emergency care problem in Taiwan. Using rotating subspecialty residents on emergency room duty and providing them with "Suicide Risk Assessment" sheets and clear disposition criteria, we wished to see if we could improve patient management while at the same time compiling demographic data. From December 1990 to May 1991 we prospectively collected 96 cases. The majority were female, ages 19-40. Twelve patients died, with agricultural poisonings the major cause. The SAD PERSONS scale consistently underestimated the suicide risk, and disposition plans were rarely followed. Only 20% of low risk patients were seen by social service. In the intermediate risk group 64% were discharged despite meeting admission criteria. In the high risk group 33% were also discharged and only one transferred to a psychiatric facility. Without fixed, full time physicians willing to establish and comply with standards of care, the management is unlikely to improve. Well trained Emergency attendings would be an appropriate solution.

Adolescent↗
PubMed2006

Patient- and family-centered care and the role of the emergency physician providing care to a child in the emergency department.

Patient- and family-centered care is an approach to health care that recognizes the role of the family in providing medical care; encourages collaboration between the patient, family, and health care professionals; and honors individual and family strengths, cultures, traditions, and expertise. Although there are many opportunities for providing patient- and family-centered care in the emergency department, there are also challenges to doing so. The American Academy of Pediatrics and the American College of Emergency Physicians support promoting patient dignity, comfort, and autonomy; recognizing the patient and family as key decision-makers in the patient's medical care; recognizing the patient's experience and perspective in a culturally sensitive manner; acknowledging the interdependence of child and parent as well as the pediatric patient's evolving independence; encouraging family-member presence; providing information to the family during interventions; encouraging collaboration with other health care professionals; acknowledging the importance of the patient's medical home; and encouraging institutional policies for patient- and family-centered care.

Child↗
PubMed2003

[Emergency cricothyrotomy--puncture or anatomical preparation? Peculiarities of two methods for emergency airway access demonstrated in a cadaver model].

OBJECTIVES: The aim of the study was a demonstration of peculiarities of two invasive airway management methods performed by anesthesiology residents as a subgroup of emergency physicians. METHODS: During an airway management training seminar,2 groups including 18 anaesthesiology residents and 2 students performed a simulated emergency surgical cricothyrotomy on unfixed cadavers. The more experienced physicians in group 2 started with a puncture technique preceding a blind surgical approach. The time needed to perform each procedure and resulting complications were analyzed. RESULTS: The time taken ranged from 75 to 280 s (median 180 s) in group 1 and from 53 to 255 s (median 73 s) in group 2. The surgical approach caused "bleeding" in 40% (group 1) and 30% (group 2) and damage to the cartilages occurred in 20% and 30%, respectively. Punctures were performed within 10-36 s (median 25 s) and 70% were successful without complications. CONCLUSIONS: Puncture of the cricothyroid membrane can serve as initial emergency approach or as intermediate airway access until a surgical method is available.

Anesthesiology↗
PubMed2005

The cost of an emergency department visit and its relationship to emergency department volume.

STUDY OBJECTIVE: This article addresses 2 questions: (1) to what extent do emergency departments (EDs) exhibit economies of scale; and (2) to what extent do publicly available accounting data understate the marginal cost of an outpatient ED visit? Understanding the appropriate role for EDs in the overall health care system is crucially dependent on answers to these questions. The literature on these issues is sparse and somewhat dated and fails to differentiate between trauma and nontrauma hospitals. We believe a careful review of these questions is necessary because several changes (greater managed care penetration, increased price competition, cost of compliance with Emergency Medical Treatment and Active Labor Act regulations, and so on) may have significantly altered ED economics in recent years. METHODS: We use a 2-pronged approach, 1 based on descriptive analyses of publicly available accounting data and 1 based on statistical cost models estimated from a 9-year panel of hospital data, to address the above-mentioned questions. RESULTS: Neither the descriptive analyses nor the statistical models support the existence of significant scale economies. Furthermore, the marginal cost of outpatient ED visits, even without the emergency physician component, appear quite high--in 1998 dollars, US295 dollars and US412 dollars for nontrauma and trauma EDs, respectively. These statistical estimates exceed the accounting estimates of per-visit costs by a factor of roughly 2. CONCLUSION: Our findings suggest that the marginal cost of an outpatient ED visit is higher than is generally believed. Hospitals thus need to carefully review how EDs fit within their overall operations and cost structure and may need to pay special attention to policies and procedures that guide the delivery of nonurgent care through the ED.

Ambulatory Care↗
PubMed2006

Emerging and re-emerging infectious diseases: influenza as a prototype of the host-pathogen balancing act.

To respond to emerging and re-emerging infections, it is necessary to understand the interactions between microbial pathogens and their hosts and the impact of environmental and social factors on these interactions. The importance of understanding host-pathogen interactions is underscored by the emergence of virulent H5N1 avian influenza viruses and their transmission to humans, and the potential pandemic threat they pose.

Animals↗
PubMed2005

Drivers for the emergence and re-emergence of vector-borne protozoal and bacterial diseases.

In recent years, vector-borne parasitic and bacterial diseases have emerged or re-emerged in many geographical regions causing global health and economic problems that involve humans, livestock, companion animals and wild life. The ecology and epidemiology of vector-borne diseases are affected by the interrelations between three major factors comprising the pathogen, the host (human, animal or vector) and the environment. Important drivers for the emergence and spread of vector-borne parasites include habitat changes, alterations in water storage and irrigation habits, atmospheric and climate changes, immunosuppression by HIV, pollution, development of insecticide and drug resistance, globalization and the significant increase in international trade, tourism and travel. War and civil unrest, and governmental or global management failure are also major contributors to the spread of infectious diseases. The improvement of epidemic understanding and planning together with the development of new diagnostic molecular techniques in the last few decades have allowed researchers to better diagnose and trace pathogens, their origin and routes of infection, and to develop preventive public health and intervention programs. Health care workers, physicians, veterinarians and biosecurity officers should play a key role in future prevention of vector-borne diseases. A coordinated global approach for the prevention of vector-borne diseases should be implemented by international organizations and governmental agencies in collaboration with research institutions.

Animals↗
PubMed1998

Can primary care and community-based models of emergency care substitute for the hospital accident and emergency (A & E) department?

This systematic review assesses the extent to which primary-secondary substitution is possible in the field of emergency care where the range of options for the delivery of care is increasing in the UK and elsewhere. Thirty-four studies were located which met the review inclusion criteria, covering a range of interventions. This evidence suggested that broadening access to primary care and introducing user charges or other barriers to the hospital accident and emergency (A & E) department can reduce demand for expensive secondary care, although the relative cost-effectiveness of these interventions remains unclear. On a smaller scale, employing primary care professionals in the hospital A & E department to treat patients attending with minor illness or injury seems to be a cost-effective method of substituting primary for secondary care resources. Interventions that addressed both sides of the primary-secondary interface and recognised the importance of patient preferences in the largely demand-driven emergency service were more likely to succeed in complementing rather than duplicating existing services. The evidence on other interventions such as telephone triage, minor injuries units and general practitioner out of hours co-operatives was sparse despite the fact that these interventions are growing rapidly in the UK. Quantifying the scope for substitution in any one health system is difficult since the evidence comes from international research studies undertaken in a variety of very different health settings. Simply transferring interventions which succeed in one setting without understanding the underlying process of change is likely to result in unexpected consequences locally. Nevertheless, the review findings clearly demonstrate that shifting the balance of care is possible. It also highlights a persistent gap in professional and lay perceptions of appropriate sources of care for minor illness and injury.

Community Health Services↗
PubMed1980

An expanded emergency service: role of telephone services in the emergency department.

The Medical Information Center at The Hospital for Sick Children in Toronto began in March 1977 to improve triage, provide an improved poison information center, improve response to telephone callers seeking medical advice, and establish a telephone consultation service for physicians. It employs specially trained nursing staff and integrates functionally related services. To determine program effectiveness we studied the records of patients triaged, telephone calls to the poison information center, and calls for other medical information, for periods both before and after the center's opening. We analyzed in detail a sample of telephone calls about acute illness, and surveyed parents who had made such calls. Unnecessary emergency visits have decreased; more patients are sent to a walk-in clinic. Use of the poison information center, especially by physicians, has increased, but fewer poisonings are treated in the emergency department or hospitalized. The Medical Information Center telephone service ensures that more children are managed at home rather than (unnecessarily) treated in the emergency department. Most parents express satisfaction with this service. Few physicians have used the telephone consultation service.

Emergency Service, Hospital↗
PubMed1989

The emerging role of echocardiography in the emergency department.

Cardiac ultrasound quickly provides both anatomic and physiologic assessment of the heart at the bedside, permitting rapid diagnosis and triage of patients presenting to the emergency department with chest pain, hypotension, or dyspnea. The identification and quantification of left ventricular dysfunction by ultrasound allows effective determination of prognosis and, thus, may supplant the ECG in patient triage. Transesophageal echocardiography definitively identifies the presence of thoracic aortic dissections, and this information may be obtained more immediately than by other imaging methods. Emergency physicians should have, at a minimum, sufficient knowledge of echocardiography to know when it is applicable to a patient problem. It may be feasible for noncardiologists to gain sufficient proficiency in echocardiography to use the technique as a screening procedure in the emergency department setting.

Chest Pain↗
PubMed1999

Chemical warfare agents: emergency medical and emergency public health issues.

The threat of exposure to chemical warfare agents has traditionally been considered a military issue. Several recent events have demonstrated that civilians may also be exposed to these agents. The intentional or unintentional release of a chemical warfare agent in a civilian community has the potential to create thousands of casualties, thereby overwhelming local health and medical resources. The resources of US communities to respond to chemical incidents have been designed primarily for industrial agents, but must be expanded and developed regarding incident management, agent detection, protection of emergency personnel, and clinical care. We present an overview of the risk that chemical warfare agents presently pose to civilian populations and a discussion of the emergency medical and emergency public health issues related to preparedness and response.

Chemical Warfare↗