This study examines how emergency department (ED) performance measures at an academic tertiary care center in the Midwest were affected by a regionally-adopted zero diversion policy.Two six-month periods before and after the policy was enacted were selected to measure differences in key performance measures, including left without treatment (LWOT), left without being seen (LWBS), left against medical advice (AMA), mortality, length of stay and hospital admission rate.Total ED census during the two periods was similar. While the zero diversion policy was in effect, LWOT and LWBS rates were 19.4% and 18.2% lower, respectively, than the prior period, p < .002; discharged patients had faster treatment times (228 + 8.0 minutes vs. 242 + 9.0 minutes), p = .015. No differences were observed in AMA or mortality rates. This study revealed no worsening of ED performance measures after adoption of a zero diversion policy.
Increased screening for HIV is required to reduce mortality and transmission. Patients with risk factors for HIV may lack access to routine care and emergency departments are an important site for screening and linkage to care. We implemented an electronic health record algorithm to identify patients meeting criteria for HIV screening. Compared to unstructured clinical judgement, the EHR alert increased the number of patients screened and case identification.
Purpose: Treatment and prevention strategies regarding people who jump from medium height bridges over water could be optimized by an improved understanding of patient demographics and injury spectra. Currently, little is known about this EMS patient population. We sought to describe the demographics and injuries sustained by those who jumped or fell from medium height bridges.Methods: We searched the River Rescue and EMS reports of a medium size city for the ten year period 1986–1995 to identify cases involving a person who jumped/fell from a bridge into water. Additional cases were identified by searching coroner and trauma center registries. For each case, we reviewed applicable EMS, hospital, and coroner records to determine patient demographics, treatment provided, and injuries sustained.Results: We identified 76 cases of individuals who jumped/fell from bridges into water. Eighteen of the region's 24 bridges (40 to 100 feet high) were involved. Average patient age was 34.8 years, 87% were male, and 29% jumped during July. These jumps/falls resulted in 25 (33%) deaths and 22 (29%) uninjured persons. Of those who died, 18 (72%) drowned, sustaining no other detectable injuries. Hospitalized survivors and injured coroner cases suffered predominantly extremity and rib fractures, pneumo/hemothoraces, and closed head injuries. No neck injuries were identified. No patient whose advanced level EMS treatment exceeded basic monitoring and IV access survived.
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