We analysed more than 7000 theatre lists from two similar UK hospitals, to assess whether start times and finish times were correlated. We also analysed gap times (the time between patients when no anaesthesia or surgery occurs), to see whether these affected theatre efficiency. Operating list start and finish times ...

OBJECTIVE: The Medicare and Premier Inc. Hospital Quality Incentive Demonstration (HQID), a hospital-based pay-for-performance program, changed its incentive design from one rewarding only high performance (Phase 1) to another rewarding high performance, moderate performance, and improvement (Phase 2). We tested whether this design change reduced the gap in incentive payments ...

Guidelines recommend the use of mild therapeutic hypothermia (MTH) and percutaneous coronary intervention (PCI) in the early post-resuscitation management of select out-of-hospital cardiac arrest (OHCA) cases. This study aims to assess the current use of MTH and PCI in Scottish Emergency Departments (ED) and Intensive Care Units (ICU). We conducted ...

Objective To introduce a new type of risk-adjusted (RA) exponentially weighted moving average (EWMA) chart and to compare it to a commonly used type of variable life adjusted display chart for analysis of patient outcomes. Data Routine inpatient data on mortality following admission for acute myocardial infarction, from all public ...

To ascertain the design and operational characteristics of acute Medical Assessment Units (MAU) located within Australasian hospitals, and to compare these with formal standards promulgated by the Internal Medicine Society of Australia and New Zealand (IMSANZ).   Descriptive study based on responses to questionnaires mailed to clinical and nursing leads ...

This study described the spectrum of emergency department (ED) physician performance correlating annual workload, experience and facility issues. Retrospective review reported physician hours worked comparing productivity measures--patients per hour (PPH) or relative value unit (RVU) per hour, as 'best fit' trend line and facility volume subgroups by analysis of variance. ...

The aim of this study was to determine the number of annual hospitalizations and overall episodes of care that involve a traumatic brain injury (TBI) by age and gender in the province of Ontario. To provide a more accurate assessment of the prevalence of TBI, episodes of care included visits ...

Oral corticosteroids (OCS) in the home management of asthma exacerbations have been recommended in the NIH/NHLBI guidelines since 1991. As a routine component of written action plans, OCS treatment at home is associated with reduced emergency department (ED) visits and hospitalizations as well as decreased mortality. A literature search of ...

Evidence-based clinical practice guidelines (CPGs) for managing febrile neutropenia (FN) are widely available; however, the integration of guidelines into routine practice is often incomplete. This study evaluated the uptake and clinical impact of implementing an electronic CPG on the management and outcomes of patients presenting with FN at 4 urban ...

Diabetes mellitus (DM) is a complex, chronic disease requiring active self-management and coordinated care. This study aimed to evaluate the relationship between schizophrenia and risk of preventable, acute DM complications. With the use of administrative data, a retrospective study assessed acute DM complications (emergency department [ED] visits or hospitalization for ...

BACKGROUND: Data on complications of gastrointestinal endoscopic procedures are limited. We evaluated prospectively the incidence and cost of hospital visits resulting from outpatient endoscopy. METHODS: We developed an electronic medical record-based system to record automatically admissions to the emergency department (ED) within 14 days after endoscopy. Physicians evaluated all reported ...

Hereditary angioedema (HAE) is a rare inherited disorder of complement factor C1 inhibitor. HAE is frequently confused with angioedema (AE), and little is known about emergency department (ED) or hospital utilization by patients with attacks in the United States. We examined hospitalizations and ED utilization for HAE and AE in ...

Studies of heart failure (HF) incidence and prevalence frequently rely on hospitalization to identify patients. Our objective was to describe the incidence, prevalence, or outcomes for HF patients diagnosed in the outpatient or emergency department (ED) setting. In a population-based study of 82,323 HF patients in a single-payer health-care system ...

Readmissions in patients with chronic obstructive pulmonary disease (COPD) are common and costly. We examined the effect of early follow-up visit with patient's primary care physician (PCP) or pulmonologist following acute hospitalization on the 30-day risk of an emergency department (ER) visit and readmission. We conducted a retrospective cohort study ...

Hospitals need to look more closely at an integration of community resources and mental health resources. Extend hospital/ED discharge planning to environmental assessments. One of the most common medication problems in therapeutic duplication.

This report describes ambulatory care visits to hospital outpatient departments (OPDs) in the United States. Statistics are presented on selected hospital, patient, and visit characteristics. Selected trends in OPD utilization from 1997 through 2007, as well as items new to the 2007 survey, are presented. The data presented in this ...

Although recent-onset atrial fibrillation and flutter are common arrhythmias managed in the emergency department (ED), there is insufficient evidence to help physicians choose between 2 competing treatment strategies, rate control and rhythm control. We seek to evaluate variation in ED management practices for recent-onset atrial fibrillation and flutter patients at ...

This study identified contributing factors in the occurrence of motor vehicle crashes (MVCs) and the severity of crashes according to work-related status in Utah. Analyses were based on probabilistically linked data involving police crash reports and hospital inpatient and emergency department (ED) records for the years 1999-2005. Of 643,647 drivers ...

Background Rapid sequence intubation (RSI) is an established core competency for emergency medicine trainees. The training and experience required to achieve competency is unclear. Aims To illustrate the RSI training and experience attained as a specialist registrar in a Scottish teaching hospital emergency department (ED) and establish whether it is ...

Background: Oral corticosteroids (OCS) in the home management of asthma exacerbations have been recommended in the NIH/NHLBI guidelines since 1991. As a routine component of written action plans, OCS treatment at home is associated with reduced emergency department (ED) visits and hospitalizations as well as decreased mortality. Methods: A literature ...

Sepsis is one of the leading causes of in-hospital mortality in Canada. Patient safety is an important component of sepsis prevention and control. The Canadian Institute for Health Information recently released a report that examines a national picture of sepsis hospitalizations and mortality. This article highlights and expands some of ...

Exposure to community violence (ECV) has been associated with asthma morbidity of children living in inner-city neighborhoods. To examine with prospective longitudinal data whether ECV is independently associated with asthma-related health outcomes in adults. Adults with moderate-severe asthma, recruited from clinics serving inner-city neighborhoods, completed questionnaires covering sociodemographics, asthma severity, ...

Road traffic injuries represent a relevant public-health problem. In the Lazio region of Italy, a surveillance system was activated. The aim of this work is to describe the surveillance system and report the health information in terms of temporal trends for the 5-year period 2001-2005. We identified all emergency department ...

Objectives To identify and characterise clusters of emergency department (ED) visits for fall injuries during the 2007-2008 winter season. Methods Hospital ED chief complaints and diagnoses from hospitals reporting to the Centers for Disease Control and Prevention BioSense system were analysed. The authors performed descriptive analyses, used time series charts ...

The objective of this study was to measure the relationship between emergency medicine (EM) specialty training and quality measures in the emergency department (ED). Data were gathered from the 2003-2004 National Hospital Ambulatory Medical Care Survey. The outcome was proportion of patients with acute myocardial infarction (AMI), pneumonia (PNA), and ...

To determine the characteristics of pediatric soft tissue abscesses that result in hospital admission. All visits for soft tissue abscesses to the study emergency department (ED) were examined during 2008. Detailed records were reviewed to determine ED disposition, abscess size, location, presence of fever, duration of symptoms, previous antibiotic therapy, ...

OBJECTIVE: This report presents data on U.S. emergency department (ED) visits in 2007, with statistics on hospital, patient, and visit characteristics. METHODS: Data are from the 2007 National Hospital Ambulatory Medical Care Survey, which uses a national probability sample of visits to emergency departments of nonfederal general and short-stay hospitals ...

Objectives To describe patterns of service use and to predict risk factors for re-presentation to a metropolitan emergency department (ED) among people who are homeless. Methods A retrospective cohort analysis was undertaken over a 24-month period from a principal referral hospital in Melbourne, Australia. All ED visits relating to people ...

Background Diagnostic and therapeutic approaches to trauma patients are, depending on experience, equipment and different therapeutic doctrines, subject to wide variations. The ability to compare trauma centres using a standardised trauma register helps to reveal unresolved systemic issues and simplifies the quality management in an Emergency Department (ED). Methods This ...

A new Joint Commission Sentinel Event Alert notes that EDs are the most vulnerable area of the hospital when it comes to violence and that access control is a key to preventing that violence. * Perform a risk assessment, so you know where your greatest threats lie. Examine physical control ...

Supervision of junior doctors in ED is vital but limited literature exists on how it is provided. To assess Australasian ED supervision and review regional legislature supervision requirements. Between December 2008 and June 2009 emails containing a link to a cross-sectional survey were sent to Directors of Emergency Medicine Training ...

Emerus Emergency Hospitals, a licensed emergency specialty hospital company in Texas, has taken the bold step of guaranteeing patients they will be seen by a physician within 15 minutes or their visit is free. In the first six weeks of the policy, the deadline was missed only four times. Patients ...

Emergency department (ED) crowding has been identified as a major public health problem in the United States by the Institute of Medicine. ED crowding not only is associated with poorer patient outcomes, but it also contributes to lost demand for ED services when patients leave without being seen and hospitals ...

BACKGROUND: We sought to determine the effect of emergency department length of stay (ED-LOS) on outcomes in stroke patients admitted to the Neurological Intensive Care Unit (NICU). METHODS: We collected data on all patients who presented to the ED at a single center from 1st February 2005 to 31st May ...

OBJECTIVE: In 2003, Oregon's Medicaid expansion program, the Oregon Health Plan (OHP), implemented premiums and copayments and eliminated outpatient behavioral health services. We ascertained whether these changes, including $50 copayments for emergency department (ED) visits, affected ED use. METHODS: This study used statewide administrative data on 414,009 adult OHP enrollees ...

The objective was to identify patient, provider, and hospital characteristics associated with the use of neuroimaging in the evaluation of head trauma in children. This was a cross-sectional study of children (< or =19 years of age) with head injuries from the National Hospital Ambulatory Medical Care Survey (NHAMCS) collected ...

Demand for the Emergency Department (ED) has increased, making the organization of work difficult. This quantitative, descriptive and documental study identifies and analyzes the characteristics of clinical care in the ED of a General Hospital in Ribeirão Preto, SP, in 2007, according to organizational variables. The study population included all ...

To quantify the determinants of the duration of time spent in an emergency department (ED) for patients who need admission to hospital. A retrospective analysis of a year of administrative data on all patients presenting to 38 public hospital EDs in Victoria, Australia in 2005/2006. Individual administrative data on patient ...

OBJECTIVES: Pentavalent rotavirus (RV) vaccine (RV5) was licensed in 2006 and recommended for routine childhood immunization. A significant decrease in the number of RV hospitalizations has been described. The objective of this study was to evaluate the effect of RV5 on acute gastroenteritis (AGE) seen in a primary practice. METHODS: ...

This study examined the relationship between electronic medical records (EMR) sophistication and the efficiency of U.S. hospital emergency departments (EDs). Using data from the 2006 National Hospital Ambulatory Medical Care Survey, survey-weighted ordinary least squares regressions were used to estimate the association of EMR sophistication with ED throughput and probability ...

Multiple sclerosis (MS) is a neurological disorder with a high burden on patient quality of life and medical rehabilitation services. Little is known about the acute hospitalization costs and characteristics. We examined the trends in MS hospitalizations from 1993 to 2006. The Nationwide Inpatient Sample of the Healthcare Cost and ...

A 43-year-old woman with a medical history significant only for hepatitis B carrier status presented to an emergency department with generalized weakness, dizziness, nausea, and diarrhea 36 h after eating an estimated 170 g of sautéed Lepiota subincarnata J.E. Lange (basionym Lepiota josserandii). Laboratory evaluation revealed profound metabolic acidosis with ...

This case study describes an incident of acute neck swelling in a patient presenting to the ED of a regional hospital after hours. Maintaining and securing her airway proved to be challenging, as did arriving at the correct cause of her airway obstruction and neck swelling.

Aim To investigate the impact, in terms of hospital admission and investigations, of individual care plans for patients who frequently attend the emergency department (ED). Method 32 patients who regularly attended the ED at St Thomas' Hospital were included in the study. After review of ED and hospital case records, ...

Syncope causes 1-3% of all emergency department (ED) visits, a high percentage of hospitalisations and prolonged hospital stay; nevertheless, many cases remain unexplained. This study analysed the incidence of syncope at the ED of the University Hospital of Parma in the first half of 2008; then a sample of 200 ...

OBJECTIVE: Emergency department (ED) visits continue to climb in the United States despite numerous primary care initiatives. A variety of staffing models including the utilization of nurse practitioners (NPs) and physician assistants (PAs) and the use of fast-track or express care are alternative methods of caring for the ED patients ...

The study describes and analyzes the hospitalizations due to eating disorders (EDs) among children and adolescents during 1998-2007 in Spain. We conducted a retrospective study of national hospitalization data using the Minimum Basic Data Set. Hospitalization rates were calculated for EDs among children and adolescents aged 10-18 years. Length of ...

Timely access to emergency patient care is an important quality and efficiency issue. Reduced discharges of inpatients at weekends are a reality to many hospitals and may reduce hospital efficiency and contribute to emergency department (ED) congestion. To evaluate the daily number of ED beds occupied by inpatients after evenly ...

Chest pain and chest discomfort are common problems in the acute care setting. Life-threatening causes of chest pain must be quickly differentiated from other less serious causes. There is a need to stratify risk rapidly in patients presenting to the emergency department (ED) with chest pain. This study evaluates the ...

BACKGROUND: In September 2005, Texas Children's Hospital initiated a protocol for all neonates presenting to the emergency department (ED) with hyperbilirubinemia based on the American Academy of Pediatrics guidelines. As part of the protocol, low-risk neonates with hyperbilirubinemia requiring phototherapy are treated in the ED observation unit (EDOU). OBJECTIVE: The ...