Emergency Care (emergency + care)

Distribution by Scientific Domains

Kinds of Emergency Care

  • pediatric emergency care
  • prehospital emergency care
  • rural emergency care

  • Terms modified by Emergency Care

  • emergency care setting

  • Selected Abstracts


    Peace through Health: The Role of Health Workers in Preventing Emergency Care Needs

    ACADEMIC EMERGENCY MEDICINE, Issue 12 2006
    Mark Davis MD
    First page of article [source]


    Geriatric Emergency Medicine and the 2006 Institute of Medicine Reports from the Committee on the Future of Emergency Care in the U.S. Health System

    ACADEMIC EMERGENCY MEDICINE, Issue 12 2006
    Scott T. Wilber MD
    Abstract Three recently published Institute of Medicine reports, Hospital-Based Emergency Care: At the Breaking Point, Emergency Medical Services: At the Crossroads, and Emergency Care for Children: Growing Pains, examined the current state of emergency care in the United States. They concluded that the emergency medicine system as a whole is overburdened, underfunded, and highly fragmented. These reports did not specifically discuss the effect the aging population has on emergency care now and in the future and did not discuss special needs of older patients. This report focuses on the emergency care of older patients, with the intent to provide information that will help shape discussions on this issue. [source]


    Emergency Care of the Pregnant Patient

    JOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 6 2009
    Vicki A. Keough Guest Editor
    No abstract is available for this article. [source]


    A New Diagnosis Grouping System for Child Emergency Department Visits

    ACADEMIC EMERGENCY MEDICINE, Issue 2 2010
    Evaline A. Alessandrini MD
    Abstract Objectives:, A clinically sensible system of grouping diseases is needed for describing pediatric emergency diagnoses for research and reporting. This project aimed to create an International Classification of Diseases (ICD)-based diagnosis grouping system (DGS) for child emergency department (ED) visits that is 1) clinically sensible with regard to how diagnoses are grouped and 2) comprehensive in accounting for nearly all diagnoses (>95%). The second objective was to assess the construct validity of the DGS by examining variation in the frequency of targeted groups of diagnoses within the concepts of season, age, sex, and hospital type. Methods:, A panel of general and pediatric emergency physicians used the nominal group technique and Delphi surveys to create the DGS. The primary data source used to develop the DGS was the Pediatric Emergency Care Applied Research Network (PECARN) Core Data Project (PCDP). Results:, A total of 3,041 ICD-9 codes, accounting for 98.9% of all diagnoses in the PCDP, served as the basis for creation of the DGS. The expert panel developed a DGS framework representing a clinical approach to the diagnosis and treatment of pediatric emergency patients. The resulting DGS has 21 major groups and 77 subgroups and accounts for 96.5% to 99% of diagnoses when applied to three external data sets. Variations in the frequency of targeted groups of diagnoses related to seasonality, age, sex, and site of care confirm construct validity. Conclusions:, The DGS offers a clinically sensible method for describing pediatric ED visits by grouping ICD-9 codes in a consensus-derived classification scheme. This system may be used for research, reporting, needs assessment, and resource planning. ACADEMIC EMERGENCY MEDICINE 2010; 17:204,213 2010 by the Society for Academic Emergency Medicine [source]


    Global Crowding: Opportunities for Regionalization in Emergency Care

    ACADEMIC EMERGENCY MEDICINE, Issue 12 2009
    Sandra M. Schneider MD
    No abstract is available for this article. [source]


    Quality Indicators for Geriatric Emergency Care

    ACADEMIC EMERGENCY MEDICINE, Issue 5 2009
    Kevin M. Terrell DO
    Abstract Objectives:, Emergency departments (EDs), similar to other health care environments, are concerned with improving the quality of patient care. Older patients comprise a large, growing, and particularly vulnerable subset of ED users. The project objective was to develop ED-specific quality indicators for older patients to help practitioners identify quality gaps and focus quality improvement efforts. Methods:, The Society for Academic Emergency Medicine (SAEM) Geriatric Task Force, including members representing the American College of Emergency Physicians (ACEP), selected three conditions where there are quality gaps in the care of older patients: cognitive assessment, pain management, and transitional care in both directions between nursing homes and EDs. For each condition, a content expert created potential quality indicators based on a systematic review of the literature, supplemented with expert opinion when necessary. The original candidate quality indicators were modified in response to evaluation by four groups: the Task Force, the SAEM Geriatric Interest Group, and audiences at the 2007 SAEM Annual Meeting and the 2008 American Geriatrics Society Annual Meeting. Results:, The authors offer 6 quality indicators for cognitive assessment, 6 for pain management, and 11 for transitions between nursing homes and EDs. Conclusions:, These quality indicators will help researchers and clinicians target quality improvement efforts. The next steps will be to test the feasibility of capturing the quality indicators in existing medical records and to measure the extent to which each quality indicator is successfully met in current emergency practice. [source]


    Racial and Ethnic Differences in Emergency Care for Acute Exacerbation of Chronic Obstructive Pulmonary Disease

    ACADEMIC EMERGENCY MEDICINE, Issue 2 2009
    Chu-Lin Tsai MD ScD
    Abstract Objectives:, The objective was to investigate racial and ethnic differences in emergency care for patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Methods:, The authors performed a prospective multicenter cohort study involving 24 emergency departments (EDs) in 15 U.S. states. Using a standard protocol, consecutive ED patients with AECOPD were interviewed, their charts reviewed, and 2-week telephone follow-ups were completed. Results:, Among 330 patients, 218 (66%) were white, 84 (25%) were African American, and 28 (8%) were Hispanic. A quarter of the 24 EDs cared for 59% of all minority patients. Compared with white patients, African American and Hispanic patients were more likely to be uninsured or with Medicaid (19, 49, and 52%, respectively; p < 0.001), were less likely to have a primary care provider (93, 81, and 82%, respectively; p = 0.005), and had more frequent ED visits in the past year (medians = 1, 2, and 3, respectively; p = 0.002). In the unadjusted analyses, minority patients were less likely to receive diagnostic procedures, more likely to receive systemic corticosteroids in the ED, less likely to be admitted, and more likely to have a relapse. After adjustment for patient and ED characteristics, these many racial and ethnic differences in quality of care were nearly completely eliminated. Conclusions:, Despite pronounced racial and ethnic differences in stable COPD, all racial and ethnic groups received comparable quality of emergency care for AECOPD and had similar short-term outcomes. [source]


    Interobserver Agreement in Assessment of Clinical Variables in Children with Blunt Head Trauma

    ACADEMIC EMERGENCY MEDICINE, Issue 9 2008
    Marc H. Gorelick MD
    Abstract Objectives:, To be useful in development of clinical decision rules, clinical variables must demonstrate acceptable agreement when assessed by different observers. The objective was to determine the interobserver agreement in the assessment of historical and physical examination findings of children undergoing emergency department (ED) evaluation for blunt head trauma. Methods:, This was a prospective cohort study of children younger than 18 years evaluated for blunt head trauma at one of 25 EDs in the Pediatric Emergency Care Applied Research Network (PECARN). Patients were excluded if injury occurred more than 24 hours prior to evaluation, if neuroimaging was obtained at another hospital prior to evaluation, or if the patient had a clinically trivial mechanism of injury. Two clinicians independently completed a standardized clinical assessment on a templated data form. Assessments were performed within 60 minutes of each other and prior to clinician review of any neuroimaging (if obtained). Agreement between the two observers beyond that expected by chance was calculated for each clinical variable, using the kappa (,) statistic for categorical variables and weighted kappa for ordinal variables. Variables with a lower 95% confidence limit (LCL) of , > 0.4 were considered to have acceptable agreement. Results:, Fifteen-hundred pairs of observations were obtained. Acceptable agreement was achieved in 27 of the 32 variables studied (84%). Mechanism of injury (low, medium, or high risk) had , = 0.83. For subjective symptoms, kappa ranged from 0.47 (dizziness) to 0.93 (frequency of vomiting); all had 95% LCL > 0.4. Of the physical examination findings, kappa ranged from 0.22 (agitated) to 0.89 (Glasgow Coma Scale [GCS] score). The 95% LCL for kappa was <0.4 for four individual signs of altered mental status and for quality (i.e., boggy or firm) of scalp hematoma if present. Conclusions:, Both subjective and objective clinical variables in children with blunt head trauma can be assessed by different observers with acceptable agreement, making these variables suitable candidates for clinical decision rules. [source]


    Revisiting the Emergency Medicine Services for Children Research Agenda: Priorities for Multicenter Research in Pediatric Emergency Care

    ACADEMIC EMERGENCY MEDICINE, Issue 4 2008
    Steven Zane Miller MD
    Abstract Objectives:, To describe the creation of an Emergency Medical Services for Children (EMSC) research agenda specific to multicenter research. Given the need for multicenter research in EMSC and the unique opportunity afforded by the creation of the Pediatric Emergency Care Applied Research Network (PECARN), the authors revisited existing EMSC research agendas to develop a PECARN-specific research agenda. They sought to prioritize PECARN research efforts, to guide investigators planning to conduct research in PECARN, and to describe the creation of a prioritized EMSC research agenda specific for multicenter research. Methods:, The authors used the Nominal Group Process and Hanlon Process of Prioritization (HPP), which are recognized research prioritization methods incorporating both quantitative and qualitative data collection in group settings. The formula used to generate the final priority list heavily weighted practicality of conduct in a multicenter research network. By using size, seriousness, and practicality measures of each health priority, PECARN was able to identify factors that could be scored individually and were weighted relative to each other. Results:, The prioritization processes resulted in a ranked list of 16 multicenter EMSC research topics. Top among these priorities were 1) respiratory illnesses/asthma, 2) prediction rules for high-stakes/low-likelihood diseases, 3) medication error reduction, 4) injury prevention, and 5) urgency and acuity scaling. Conclusions:, The PECARN prioritization process identified high-priority EMSC research topics specific to multicenter research. PECARN has the capacity to answer long-standing, important clinical controversies in EMSC, largely due to its ability to conduct randomized controlled trials and observational studies on a large scale. [source]


    Closing Evidence to Practice Gaps in Emergency Care: The Australian Experience

    ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
    BAppSci, ICUCert, Susan Huckson RN
    The National Institute of Clinical Studies (NICS) was established in 2000 by the Australian government to improve health care by closing evidence-practice gaps. Improving emergency care through use of evidence is a priority area of work for NICS. This article describes the NICS Emergency Care Program and the current application of a "Community of Practice" to support emergency clinicians to implement best practices research. This approach combines aspects of evidence implementation science, quality improvement techniques, and knowledge management within a social network model to provide a mechanism for rapid sharing of explicit and tacit knowledge. Through the Community of Practice, the clinical community guides the priorities for the Emergency Care Program and is actively engaged in the development and implementation of initiatives. [source]


    Variation in Ancillary Testing among Pediatric Asthma Patients Seen in Emergency Departments

    ACADEMIC EMERGENCY MEDICINE, Issue 6 2007
    MHSA, Rachel M. Stanley MD
    Background:Variation in the management of acute pediatric asthma within emergency departments is largely unexplored. Objectives:To investigate whether ancillary testing for patients with asthma would be associated with patient, physician, and hospital characteristics. Methods:The authors performed an analysis of a subset of patients from an extensive retrospective chart review of randomly selected charts at all 25 member emergency departments of the Pediatric Emergency Care Applied Research Network. Patients with a diagnosis of asthma were selected for supplemental review and included in this study. Ancillary tests analyzed were chest radiographs and selected blood tests. Hierarchical analyses were performed to describe the associations between ancillary testing and the variables of interest. Results:A total of 12,744 chart abstractions were completed, of which 734 (6%) were patients with acute exacerbations of asthma. Overall, 302 patients with asthma (41%) had ancillary testing. Of the 734 patients with asthma, 198 (27%) had chest radiographs and 104 (14%) had blood tests. Chest radiographs were more likely to be ordered in patients with fever. Less blood testing was associated with physician subspecialty training in pediatric emergency medicine, patients treated at children's hospitals, higher patient oxygen saturation, and patient disposition to home. Conclusions:Ancillary testing occurred in more than one third of children with asthma, with chest radiographs ordered most frequently. Efforts to reduce the use of chest radiographs should target the management of febrile patients with asthma, whereas efforts to reduce blood testing should target providers without subspecialty training in pediatric emergency medicine and patients treated in nonchildren's hospitals who are more ill. [source]


    Improving Rural Access to Emergency Physicians

    ACADEMIC EMERGENCY MEDICINE, Issue 6 2007
    Daniel A. Handel MD
    The recent Institute of Medicine report entitled The Future of Emergency Care in the United States Health System acknowledges workforce issues in rural America but does not adequately address the current shortage of emergency medicine residency,trained and board-certified emergency physicians in rural America. Areas worthy of further attention to ameliorate this threat include 1) government and hospital support of emergency medicine resident educational debt load, 2) modification of residency review committee for emergency medicine guidelines to permit modified training programs that are rural focused, and 3) support of pilot projects designed to modify the delivery of rural emergency care under remote supervision by academic medical center,based practitioners. The authors discuss these potential solutions to help guide policy makers seeking to enhance rural emergency care delivery through a stronger emergency medicine workforce. [source]


    Revised Pediatric Emergency Assessment Tool (RePEAT): A Severity Index for Pediatric Emergency Care

    ACADEMIC EMERGENCY MEDICINE, Issue 4 2007
    MSCE, Marc H. Gorelick MD
    Abstract Objectives: To develop and validate a multivariable model, using information available at the time of patient triage, to predict the level of care provided to pediatric emergency patients for use as a severity of illness measure. Methods: This was a retrospective cohort study of 5,521 children 18 years of age or younger treated at four emergency departments (EDs) over a 12-month period. Data were obtained from abstraction of patient records. Logistic regression was used to develop (75% of sample) and validate (25% of sample) models to predict any nonroutine diagnostic or therapeutic intervention in the ED and admission to the hospital. Data on ED length of stay and hospital costs were also obtained. Results: Eight predictor variables were included in the final models: presenting complaint, age, triage acuity category, arrival by emergency medical services, current use of prescription medications, and three triage vital signs (heart rate, respiratory rate, and temperature). The resulting models had adequate goodness of fit in both derivation and validation samples. The area under the receiver operating characteristic curve was 0.73 for the ED intervention model and 0.85 for the admission model. The Revised Pediatric Emergency Assessment Tool (RePEAT) score was then calculated as the sum of the predicted probability of receiving intervention and twice the predicted probability of admission. The RePEAT score had a significant univariate association with ED costs (r= 0.44) and with ED length of stay (r= 0.27) and contributed significantly to the fit of multivariable models comparing these outcomes across sites. Conclusions: The RePEAT score accurately predicts level of care provided for pediatric emergency patients and may provide a useful means of risk adjustment when benchmarking outcomes. [source]


    Institute of Medicine Report "The Future of Emergency Care": "Too Much, Too Little, Too Late?"

    ACADEMIC EMERGENCY MEDICINE, Issue 3 2007
    What Is the Society for Academic Emergency Medicine's Answer to the Message?
    No abstract is available for this article. [source]


    Geriatric Emergency Medicine and the 2006 Institute of Medicine Reports from the Committee on the Future of Emergency Care in the U.S. Health System

    ACADEMIC EMERGENCY MEDICINE, Issue 12 2006
    Scott T. Wilber MD
    Abstract Three recently published Institute of Medicine reports, Hospital-Based Emergency Care: At the Breaking Point, Emergency Medical Services: At the Crossroads, and Emergency Care for Children: Growing Pains, examined the current state of emergency care in the United States. They concluded that the emergency medicine system as a whole is overburdened, underfunded, and highly fragmented. These reports did not specifically discuss the effect the aging population has on emergency care now and in the future and did not discuss special needs of older patients. This report focuses on the emergency care of older patients, with the intent to provide information that will help shape discussions on this issue. [source]


    The Art and Science of Surge: Experience from Israel and the U.S. Military

    ACADEMIC EMERGENCY MEDICINE, Issue 11 2006
    Boaz Tadmor MD
    In a disaster or mass casualty incident, health care resources may be exceeded and systems may be challenged by unusual requirements. These resources may include pharmaceuticals, supplies, and equipment as well as certain types of academic and administrative expertise. New agencies and decision makers may need to work together in an unfamiliar environment. Furthermore, large numbers of casualties needing treatment, newer therapies required to care for these casualties, and increased workforce and space available for these casualties all contribute to what is often referred to as "surge." Surge capacity in emergency care can be described in technical, scientific terms that are measured by numbers and benchmarks (e.g., beds, patients, and medications) or can take on a more conceptual and abstract form (e.g., decisions, authority, and responsibility). The former may be referred to as the "science" of surge, whereas the latter, an equal if not more important component of surge systems that is more conceptual and abstract, can be considered the "art" of surge. The experiences from Israel and the U.S. military may serve to educate colleagues who may be required to respond or react to an event that taxes the current health care system. This report presents concrete examples of surge capacity strategies used by both Israel and the U.S. military and provides solutions that may be applied to other health care systems when faced with similar situations. [source]


    Has the education of professional caregivers and lay people in dental trauma care failed?

    DENTAL TRAUMATOLOGY, Issue 1 2009
    Ulf Glendor
    This situation could seriously affect the outcome of TDIs, especially a complicated TDI. The overall aim of this study was to present a review of dental trauma care with focus on treatment and dentists and lay persons' lack of knowledge on how to manage a TDI. A further aim is to introduce the actors involved and the outcome of their education. Material and method:, The databases Medline, Cochrane, SSCI, SCI and CINAHL from the year 1995 to the present were used. Focus was on treatment need, inadequate care, lack of knowledge and poor organization of emergency care. Result:, Studies from different countries demonstrated that treatment needs were not properly met despite the fact that not all untreated teeth needed treatment. Treatment in emergency dental care was often inadequate or inappropriate. With the exception of lay people, teachers, medical personnel and even dentists performed inadequate care. Furthermore, information to the public was insufficient. Despite a low level of knowledge, lay people expressed a strong interest in helping someone with a TDI. Conclusion:, The conclusion from this review is that consideration must be given the problematic results from different studies on education or information about dental trauma care. Despite that the studies reviewed were from different countries and groups of people, the results seem to be consistent, i.e. that a large part of the educational process of professional caregivers and lay people has failed. Too much hope seems to be put on lay people to handle difficult cases such as tooth avulsion. Education of caregivers and lay people is a field where much remains to be explored. [source]


    Limited Opportunities for Paramedic Student Endotracheal Intubation Training in the Operating Room

    ACADEMIC EMERGENCY MEDICINE, Issue 10 2006
    Bradford D. Johnston MD
    Abstract Background Paramedics, who often are the first to provide emergency care to critically ill patients, must be proficient in endotracheal intubation (ETI). Training in the controlled operating room (OR) setting is a common method for learning basic ETI technique. Objectives To determine the quantity and nature of OR ETI training currently provided to paramedic students. Methods The authors surveyed directors of paramedic training programs accredited by the Commission on Accreditation of Allied Health Education Programs. An anonymous 12-question, structured, closed-response survey instrument was used that requested information regarding the duration and nature of OR training provided to paramedic students. The results were analyzed by using descriptive statistics. Results From 192 programs, 161 completed surveys were received (response rate, 85%). OR training was used at 156 programs (97%) but generally was limited (median, 17,32 hours per student). Half of the programs provided fewer than 16 OR hours per student. Students attempted a limited number of OR ETI (median, 6,10 ETI). Most respondents (61%) reported competition from other health care students for OR ETI. Other identified hindering factors included the increasing OR use of laryngeal mask airways and physicians' medicolegal concerns. Respondents from 52 (33%) programs reported a recent reduction in OR access, and 56 (36%) programs expected future OR opportunities to decrease. Conclusions Despite its key role in airway management education, the quantity and nature of OR ETI training that is available to paramedic students is limited in comparison to that available to other ETI providers. [source]


    Do California Counties With Lower Socioeconomic Levels Have Less Access to Emergency Department Care?

    ACADEMIC EMERGENCY MEDICINE, Issue 5 2010
    Deepa Ravikumar
    Abstract Objectives:, The study objective was to examine the relationship between number of emergency departments (EDs) per capita in California counties and measures of socioeconomic status, to determine whether individuals living in areas with lower socioeconomic levels have decreased access to emergency care. Methods:, The authors linked 2005 data from the American Hospital Association (AHA) Annual Survey of Hospitals with the Area Resource Files from the United States Department of Health and Human Services and performed Poisson regression analyses of the association between EDs per capita in individual California counties using the Federal Information Processing Standard (FIPS) county codes and three measures of socioeconomic status: median household income, percentage uninsured, and years of education for individuals over 25 years of age. Multivariate analyses using Poisson regression were also performed to determine if any of these measures of socioeconomic status were independently associated with access to EDs. Results:, Median household income is inversely related to the number of EDs per capita (rate ratio = 0.83; 95% confidence interval [CI] = 0.71 to 0.96). Controlling for income in the multivariate analysis demonstrates that there are more EDs per 100,000 population in FIPS codes with more insured residents when compared with areas having less insured residents with the same levels of household income. Similarly, FIPS codes whose residents have more education have more EDs per 100,000 compared with areas with the same income level whose residents have less education. Conclusions:, Counties whose residents are poorer have more EDs per 100,000 residents than those with higher median household incomes. However, for the same income level, counties with more insured and more highly educated residents have a greater number of EDs per capita than those with less insured and less educated residents. These findings warrant in-depth studies on disparities in access to care as they relate to socioeconomic status. ACADEMIC EMERGENCY MEDICINE 2010; 17:508,513 2010 by the Society for Academic Emergency Medicine [source]


    The effect of nightshift on emergency registrars' clinical skills

    EMERGENCY MEDICINE AUSTRALASIA, Issue 3 2010
    Leonie Marcus
    Abstract Objective: The effect of nightshift on ED staff performance is of clinical and risk-management significance. Previous studies have demonstrated deterioration in psychomotor skills but the present study specifically assessed the impact of nightshift on clinical performance. Methods: The ED registrars in a tertiary hospital were enrolled in a prospective observational study and served as their own controls. During nightshift, subjects were presented simulated scenarios and tested with eight clinical questions developed to Fellowship examination standard. Matched scenarios and questions for the same subjects during dayshift served as controls. Two investigators, blinded to subject identity and the setting in which questions were attempted, independently collated answers. Results: Of 22 eligible subjects, all were recruited; four were excluded owing to incomplete data. A correlation of 0.99 was observed between the independent scoring investigators. Of a possible score of 17, the median result for nightshift was 9.5 (interquartile range: 8,11); corresponding value for dayshift was 12 (interquartile range: 10,13); P= 0.047. Conclusion: Nightshift effect on clinical performance is anecdotally well known. The present study quantifies such effects, specifically for the ED setting, and paves the way for focused research. The implications for clinical governance strategies are significant, as the fraternity embraces the mandate to maintain quality emergency care 24 h per day. [source]


    Emergency medicine in India: Why are we unable to ,walk the talk'?

    EMERGENCY MEDICINE AUSTRALASIA, Issue 4 2007
    Suresh S David
    Abstract The largest democracy on earth, the second most populous country and one of the most progressive countries in the globe, India, has advanced tremendously in most conventional fields of Medicine. However, emergency medicine (EM) is a nascent specialty and is yet to receive an identity. Today, it is mostly practised by inadequately trained clinicians in poorly equipped emergency departments (EDs), with no networking. Multiple factors such as the size of the population, variation in standards of medical education, lack of pre-hospital medical systems and non-availability of health insurance schemes are some of the salient causes for this tardy response. The Indian medical system is governed by a central, regulatory body which is responsible for the introduction and monitoring of all specialties , the Medical Council of India (MCI). This organisation has not recognized EM as a distinct specialty, despite a decade of dogged attempts. Bright young clinicians who once demonstrated a keen interest in EM have eventually migrated to other conventional branches of medicine, due to the lack of MCI recognition and the lack of specialty status. The Government of India has launched a nationwide network of transport vehicles and first aid stations along the national highways to expedite the transfer of patients from a crash site. However, this system cannot be expected to decrease morbidity and mortality, unless there is a concurrent development of EDs. The present article intends to highlight factors that continue to challenge the handful of dedicated, full time emergency physicians who have tenaciously pursued the cause for the past decade. A three-pronged synchronous development strategy is recommended: (i) recognise the specialty of EM as a distinct and independent basic specialty; (ii) initiate postgraduate training in EM, thus enabling EDs in all hospitals to be staffed by trained Emergency physicians; and (iii) ensure that EMs are staffed by trained ambulance officers. The time is ripe for a paradigm shift, since the country is aware that emergency care is the felt need of the hour and it is the right of the citizen. [source]


    Emergency management of the morbidly obese

    EMERGENCY MEDICINE AUSTRALASIA, Issue 4 2004
    Peter Grant
    Abstract Objectives: To identify the difficulties encountered with the emergency management of morbidly obese patients and formulate recommendations to streamline care. Methods: An English language literature search was undertaken using Medline (1966,2003) with key words ,morbid obesity',anaesthesia',imaging',obesity',emergency',transportation',retrieval',critical illness' and ,monitoring'. Potential articles were selected for content applicable to emergency medicine based on title and abstract and reviewed in detail. Reference lists were manually searched for further relevant articles. In view of the very limited systematic study in this area, all information deemed by the authors' to be of assistance to the emergency physician was included regardless of evidence level. Additional information was sought from standard critical care textbooks and their bibliographies and through personal communication with local ambulance and retrieval services. The authors' unpublished personal experience in providing emergency care to the morbidly obese was included for aspects of management not documented in medical literature. Results: Obesity levels and associated health problems are rapidly rising in Australia. Few studies were identified dealing with critical illness in the morbidly obese and none specifically addressing ED management. Problems identified included size related logistical issues, and limitations of physical assessment, monitoring and routine investigations. Invasive procedures, intubation and ventilation can be particularly problematic, and modified techniques may be required. Limited data indicates a poorer outcome from critical illness most marked in the case of blunt traumatic injury. Conclusion: Very obese patients present a variety of logistical and medical challenges for EDs. A series of recommendations are made based on available data. Further studies in this area would be desirable to more specifically address ED issues. [source]


    Emergency Department Information System Adoption in the United States

    ACADEMIC EMERGENCY MEDICINE, Issue 5 2010
    Adam B. Landman MD
    Abstract Objectives:, The American Recovery and Reinvestment Act of 2009 incentivizes adoption of health care information technology (HIT) based on support for specific standards, policies, and features. Limited data have been published on national emergency department information systems (EDIS) adoption, and to our knowledge, no prior studies have considered functionality measures. This study determined current national estimates of EDIS adoption using both single-response rates of EDIS adoption and a novel feature-based definition and also identified emergency department (ED) characteristics associated with EDIS use. Methods:, The 2006 National Hospital Ambulatory Medical Care Survey, a nationally representative sample of ED visits that also surveyed participating EDs on EDIS, was used to estimate EDIS adoption. EDIS adoption rates were calculated using two definitions: 1) single-response,response to a single survey question as to whether the EDIS was complete, partial, or none; and 2) feature-based,based on the reported features supported by the EDIS, systems were categorized as fully functional, basic, other, or none. The relationship of EDIS adoption to specific ED characteristics such as facility type and location was also examined. Results:, Using the single-response classification, 16.1% of EDs had a complete EDIS, while 30.4% had a partial EDIS, and 53.5% had none. In contrast, using a feature-based categorization, 1.7% EDs had a fully functional EDIS, 12.3% had basic, 32.1% had other, and 53.9% had none. In multivariable analysis, urban EDs were significantly more likely to have a fully functional or basic EDIS than were rural EDs. Pediatric EDs were significantly more likely than general EDs to have other EDIS. Conclusions:, Despite more optimistic single-response estimates, fewer than 2% of our nation's EDs have a fully functional EDIS. EDs in urban areas and those specializing in the care of pediatric patients are more likely to support EDIS. Accurate and consistent EDIS adoption estimates are dependent on whether there are standardized EDIS definitions and classifications of features. To realize the potential value of EDIS for improved emergency care, we need to better understand the extent and correlates of the diffusion of this technology and increase emergency medicine engagement in national HIT policy-making. Academic Emergency Medicine 2010; 17:536,544 2010 by the Society for Academic Emergency Medicine [source]


    A cost-effective simulation curriculum for preclinical endodontics

    EUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 1 2004
    Roberta Pileggi
    A challenge in contemporary dental education is to achieve a smooth transition from preclinical teaching environments to patient-care clinics in a cost-effective manner. The preclinical endodontic courses at The University of Texas, Dental Branch at Houston provide a unique learning environment that enables the student to perform endodontic treatment on extracted teeth in a typodont, and be involved in diagnosis and treatment-planning discussions. The specially designed stone typodont used has built-in radiographic capability, and is mounted at each chair in the clinic. During each preclinical session, students are assigned clinical cubicles and proper aseptic protocol is followed. Students are required to wear gloves, masks and eyewear, and place a rubber dam during treatment. Written self-assessment evaluations based upon prescribed criteria are utilised; feedback is given by faculty composed of both full-time endodontists and graduate students who periodically rotate and are calibrated on a regular basis. In the lecture phase, clinical case scenarios are presented to reinforce concepts of diagnosis and emergency care and to help integrate endodontics with other disciplines; a Socratic-like teaching style is established by the faculty facilitator to create an environment for developing critical-thinking and problem-solving skills. The overall feedback from graduating students has been very positive. Advantages of this format are an easier transition to patient management, a more keen interest in specialsation and a perceived increase in levels of confidence. [source]


    Advance Directives in Skilled Nursing Facility Residents Transferred to Emergency Departments

    ACADEMIC EMERGENCY MEDICINE, Issue 12 2001
    Michael Lahn MD
    Abstract Objective: Ten years have passed since Congress enacted the Patient Self-Determination Act to promote the use of advance directives (ADs). This study was performed to determine the frequency, type, demographic distribution, and utility of ADs that accompany residents of skilled nursing facilities (SNFs) transferred to emergency departments (EDs). Methods: This was an observational, cross-sectional cohort of SNF residents, transferred to two urban, academic EDs. Chart review and physician interviews were conducted on consecutive patients arriving during 12-hour data collection shifts. Results: Among 715 patients entered, 315 [44%, 95% confidence interval (95% CI) = 40% to 48%] had an AD. Advance directives were significantly more prevalent among white (50%) than African American (34%) or Hispanic (39%) patients (p < 0.001), and varied from 0% to 94% among SNFs. Of the 315 patients with ADs, do-not-resuscitate (DNR) orders were the most prevalent (65%, 95% CI = 58% to 69%). Although 75% (95% CI = 69% to 81%) of the DNR orders addressed cardiopulmonary resuscitation (CPR), only 12% (95% CI = 8% to 16%) addressed intubation. Among 39 patients who required intubation or CPR, 44% had ADs, 82% (95% CI = 57% to 96%) of which were deemed useful. Conclusions: Despite a decade of legislation promoting their use, ADs are lacking in most SNF residents transferred to EDs for evaluation and in most settings in which a clinical indication exists for intubation or CPR. Variation in their prevalence appears to be associated with both ethnicity and SNF origin. Although about three-fourths of DNR ADs addressed CPR, only about one in ten offered guidance regarding intubation. When available, ADs are used in most instances to guide emergency care. [source]


    The Emergency Medical Treatment and Labor Act as a Federal Health Care Safety Net Program

    ACADEMIC EMERGENCY MEDICINE, Issue 11 2001
    W. Wesley Fields MD
    Abstract Despite the greatest economic expansion in history during the 1990s, the number of uninsured U.S. residents surpassed 44 million in 1998. Although this number declined for the first time in recent years in 1999, to 42.6 million, the current economic slow-down threatens once again to increase the ranks of the uninsured. Many uninsured patients use hospital emergency departments as a vital portal of entry into an access-improverished health care system. In 1986, Congress mandated access to emergency care when it passed the Emergency Medical Treatment and Labor Act (EMTALA). The EMTALA statute has prevented the unethical denial of emergency care based on inability to pay; however, the financial implications of EMTALA have not yet been adequately appreciated or addressed by Congress or the American public. Cuts in payments from public and private payers, as well as increasing demands from a larger uninsured population, have placed unprecedented financial strains on safety net providers. This paper reviews the financial implications of EMTALA, illustrating how the statute has evolved into a federal health care safety net program. Future actions are proposed, including the pressing need for greater public safety net funding and additional actions to preserve health care access for vulnerable populations. [source]


    Incident Monitoring in Emergency Departments An Australian Model

    ACADEMIC EMERGENCY MEDICINE, Issue 11 2000
    FIFEM, John Vinen FACEM
    Abstract. The specialty-based study of incidents, adverse events, and errors in medicine has largely occurred in anesthesia and to a lesser extent in intensive care and psychiatry. Few studies have specifically addressed the problem in emergency medicine (EM). Because of the significant risks, the resulting adverse outcome, and the high degree of preventability of errors occurring in the emergency department (ED), it is essential that an incident monitoring system be part of the ED's risk management program. The combination of time pressure, uncertainty, complexity, and workload means the ED is a high-risk environment. The delivery of high-quality emergency care is dependent on having an effective patient processing system in place and, because EM is a "systems-dependent" specialty, the environment lends itself to improvements to the system (re-engineering) to improve the safety of the environment given that the majority of errors in the ED are probably the result of failures of the system. This paper describes an existing incident monitoring system that has recently been adopted by six EDs in Australia. It was developed as a result of a similar successful program in anesthesia, and funded by the Federal Department of Health of Australia. Incorporating incident monitoring and analysis to identify causative factors of incidents and the subsequent implementation of corrective strategies as part of the ED risk management program may result in improvement in the quality of care through a reduction in the frequency of incidents. [source]


    The Robert Wood Johnson Foundation Clinical Scholars Program and Emergency Medicine

    ACADEMIC EMERGENCY MEDICINE, Issue 4 2010
    Adam Landman MD
    ACADEMIC EMERGENCY MEDICINE 2010; 17:1,6 2010 by the Society for Academic Emergency Medicine Abstract Specialized research training for emergency physicians (EPs) may strengthen overall patient care through the development and improvement of clinical evidence in emergency care. One way an increasing number of emergency physicians have acquired these skills is through the Robert Wood Johnson Foundation Clinical Scholars Program (CSP), a 2-year fellowship that trains physicians to be leaders in improving health care. In addition to providing training in health policy and health services research, the CSP emphasizes the translation of research into action through leadership training, program development, and community-based participatory research. This article provides an in-depth look at the CSP and its impact on emergency medicine (EM). To date, 41 EPs have trained through the program, with increasing numbers in recent years. Graduates have gone on to become leaders in academia, public health, private industry, and foundations. Past and present EM-trained Clinical Scholars are working to find creative solutions for the challenges posed by the U.S. health care system and improve the delivery of emergency care. Emergency physicians who wish to conduct research or work with communities, organizations, practitioners, and policy-makers to address issues essential to the health and well-being of all Americans should consider the Robert Wood Johnson Foundation CSP. [source]


    A study into dentists' knowledge of the treatment of traumatic injuries to young permanent incisors

    INTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 1 2005
    M. N. KOSTOPOULOU
    Summary. Objective., The aims of this study were to evaluate dentists' knowledge of the emergency treatment of traumatic injuries to young permanent incisors, and to investigate barriers to treatment. Design., A closed-ended questionnaire was sent to 1023 general dental practitioners (GDPs) and community dental officers (CDOs) in West/North Yorkshire and Humberside, UK. Methods., The questionnaire comprised 17 questions. Six questions asked for general information about the participants (i.e. profession, age, gender, year of graduation, training or education on dental trauma, and willingness to provide emergency care), 10 were relevant to the emergency treatment of crown fractures, root fractures, luxation and avulsion injuries, and the last question queried any perceived barriers to treatment. Results., Seven hundred and twenty-four questionnaires were returned, a response rate of 71%, and these indicated that dentists' knowledge of the emergency treatment of dentoalveolar trauma in children was inadequate. The CDOs were significantly more knowledgeable than the GDPs, as were younger and more recently graduated dentists compared with older ones. The GDPs regarded the difficulty of treating children and the inadequate fees of the UK National Health Service as important barriers to treatment. Dentists who attended continuing dental education courses on dental traumatology had a more thorough knowledge than those who did not. Conclusion., Overall, the dentists' knowledge of the emergency treatment of dentoalveolar trauma in children was inadequate. Greater emphasis on undergraduate and postgraduate education in this area is indicated. [source]


    Developing an advanced nurse practitioner service in emergency care: attitudes of nurses and doctors

    JOURNAL OF ADVANCED NURSING, Issue 3 2006
    Miriam Griffin MSc RGN PGCSNP
    Aim., This paper reports a study to determine the attitudes of nurses, doctors and general medical practitioners towards the development of an advanced nurse practitioner service within an emergency department. Background., The role of advanced nurse practitioner in emergency care has emerged in a number of countries, and has brought with it confusion about titles, role boundaries, clinical accountability and educational requirements. Initially, the role resulted from a need for healthcare professionals to provide a service to the increased numbers of patients presenting to hospital with less urgent problems. Since then, the service has evolved to one where nurse practitioners provide high-quality and cost-effective care to persons who seek help for non-urgent, urgent or emergent conditions in a variety of emergency care settings. However, little research could be identified on the attitudes of relevant nursing and medical staff towards the development of this role. Methods., A questionnaire survey was carried out, and a 29-item Likert rating scale was developed to measure attitudes. Along with some demographic variables, two open-ended questions were added to allow respondents to elaborate on what they perceived as benefits and difficulties associated with an advanced nurse practitioner service. All general practitioners, emergency nurses and emergency doctors in one health board in the Republic of Ireland were targeted, and 25 emergency nurses, 13 emergency doctors and 69 general practitioners were approached to take part. Data were collected in February 2004. Findings., An overall response rate of 748% was achieved. All respondents were positive towards the development of an advanced nurse practitioner service, with general practitioners being less positive. The principal differences appeared between general practitioners and hospital emergency care staff. Conclusion., There is a need for a multidisciplinary approach to the planning of advanced nurse practitioner services. To achieve multiprofessional acceptance, an accredited and standardized education programme is required, and this must address existing role boundaries. [source]