Context Previous surveillance studies have documented increasing rates of antimicrobial resistance in US intensive care units (ICUs) in the early 1990s. Objectives To assess national rates of antimicrobial resistance among gramnegative aerobic isolates recovered from ICU patients and to compare these rates to antimicrobial use. Design and Setting Participating institutions, representing a total of 43 US states plus the District of Columbia, provided antibiotic susceptibility results for 35790 nonduplicate gram-negative aerobic isolates recovered from ICU patients between 1994 and 2000. Main Outcome Measures Each institution tested approximately 100 consecutive gram-negative aerobic isolates recovered from ICU patients. Organisms were identified to the species level. Susceptibility tests were performed, and national fluoroquinolone consumption data were obtained. Results The activity of most antimicrobial agents against gram-negative aerobic isolates showed an absolute decrease of 6% or less over the study period. The overall susceptibility to ciprofloxacin decreased steadily from 86% in 1994 to 76% in 2000 and was significantly associated with increased national use of fluoroquinolones. Conclusions This study documents the increasing incidence of ciprofloxacin resistance among gram-negative bacilli that has occurred coincident with increased use of fluoroquinolones. More judicious use of fluoroquinolones will be necessary to limit this downward trend.

The majority of cost in providing hospital service is related to buildings, equipment, salaried labor, and overhead, which are fixed over the short term. The high fixed costs emphasize the importance of adjusting fixed costs to patient consumption to maintain efficiency.

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Rapid HIV testing was acceptable and feasible in this STD clinic and facilitated entry of newly identified HIV-infected patients into health care.

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Abstract. Objective: To compare levels of patient satisfaction between the diagnostic and treatment protocols in an ED-based asthma observation unit (AOU) and those with standard inpatient hospitalization. Methods: This was a prospective, randomized, controlled trial with a sample of 163 patients presenting to the ED with acute asthma exacerbations over a 30-month period. Eligible patients were those who could not resolve their symptoms after three hours of standard ED therapy. Patients were then randomly assigned to an ED-based AOU (experimental group) or to customary inpatient care (control group). Patient satisfaction and problems with care processes were assessed by standardized instrumentation at discharge in both groups. Results: The AOU patients scored higher than those randomized to the inpatient hospitalization protocol on four summary ratings of patient satisfaction measures: received service wanted, recommendation of the service to others, satisfaction with the service, and overall satisfaction. The AOU patients reported fewer total number of problems with care received, and fewer specific problems with communication, emotional support, physical comfort, and special needs, than did the inpatient group. However, the AOU patients reported more problems regarding their knowledge of financial costs and liabilities for their service than did the inpatients. Conclusion: Patients were more satisfied and had fewer problems with rapid diagnosis and treatment in the AOU than they did with routine inpatient hospitalization. Since AOUs represent a new ambulatory service modality, patients would benefit from greater awareness of the costs and coverage for AOUs as compared with hospital inpatient care. These findings have important implications for the future short-and long-term success and feasibility of ED-based AOUs. Key words: patient satisfaction; observation units; asthma; asthma randomized trial. ACADEMIC EMERGENCY MEDICINE 1999; 6:178 -183 A STHMA is a chronic condition with acute episodes necessitating continuous and coordinated care to prevent exacerbations, control symptoms, monitor treatment, and reduce chronic airway inflammation. Inconsistent or inadequate self-management of asthma, combined with a lack of or nonstandardized community-based primary care, often results in episodic treatment of chronic conditions in hospital EDs.

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