Quality in emergency departments: a study on 3,285,440 admissions

INTRODUCTION: A multi-centre study has been conducted, during 2005, by means of a questionnaire posted on the Italian Society of Emergency Medicine (SIMEU) web page. Our intention was to carry out an organisational and functional analysis of Italian Emergency Departments (ED) in order to pick out some macro-indicators of the activities performed. Participation was good, in that 69 ED (3,285,440 admissions to emergency services) responded to the questionnaire. METHODS: The study was based on 18 questions: 3 regarding the personnel of the ED, 2 regarding organisational and functional aspects, 5 on the activity of the ED, 7 on triage and 1 on the assessment of the quality perceived by the users of the ED. RESULTS AND CONCLUSION: The replies revealed that 91.30% of the ED were equipped with data-processing software, which, in 96.83% of cases, tracked the entire itinerary of the patient. About 48,000 patients/year used the ED: 76.72% were discharged and 18.31% were hospitalised. Observation Units were active in 81.16% of the ED examined. Triage programmes were in place in 92.75% of ED: in 75.81% of these, triage was performed throughout the entire itinerary of the patient; in 16.13% it was performed only symptom-based, and in 8.06% only on-call. Of the patients arriving at the ED, 24.19% were assigned a non-urgent triage code, 60.01% a urgent code, 14.30% a emergent code and 1.49% a life-threatening code. Waiting times were: 52.39 min for non-urgent patients, 40.26 min for urgent, 12.08 for emergent, and 1.19 for life-threatening patients.

State of Emergency Medicine in Switzerland: a national profile of emergency departments in 2006

BACKGROUND Emergency departments (EDs) are an essential component of any developed health care system. There is, however, no national description of EDs in Switzerland. Our objective was to establish the number and location of EDs, patient visits and flow, medical staff and organization, and capabilities in 2006, as a benchmark before emergency medicine became a subspecialty in Switzerland. METHODS In 2007, we started to create an inventory of all hospital-based EDs with a preliminary list from the Swiss Society of Emergency and Rescue Medicine that was improved with input from ED physicians nationwide. EDs were eligible if they offered acute care 24 h per day, 7 days per week. Our goal was to have 2006 data from at least 80% of all EDs. The survey was initiated in 2007 and the 80% threshold reached in 2012. RESULTS In 2006, Switzerland had a total of 138 hospital-based EDs. The number of ED visits was 1.475 million visits or 20 visits per 100 inhabitants. The median number of visits was 8,806 per year; 25% of EDs admitted 5,000 patients or less, 31% 5,001-10,000 patients, 26% 10,001-20,000 patients, and 17% >20,000 patients per year. Crowding was reported by 84% of EDs with >20,000 visits/year. Residents with limited experience provided care for 77% of visits. Imaging was not immediately available for all patients: standard X-ray within 15 min (70%), non-contrast head CT scan within 15 min (38%), and focused sonography for trauma (70%); 67% of EDs had an intensive care unit within the hospital, and 87% had an operating room always available. CONCLUSIONS Swiss EDs were significant providers of health care in 2006. Crowding, physicians with limited experience, and the heterogeneity of emergency care capabilities were likely threats to the ubiquitous and consistent delivery of quality emergency care, particularly for time-sensitive conditions. Our survey establishes a benchmark to better understand future improvements in Swiss emergency care.

Can geriatric approaches support the care of old patients in emergency departments? A review from a Swiss ED

In the coming decades, old patients will account for an increasing proportion of emergency department (ED) visits. During or after their stay in the ED, they more frequently suffer adverse outcomes than younger patients. There is evidence that specific age-centred approaches improve the outcomes. We therefore reviewed specific conditions needing particular attention in older ED patients, such as cognitive disorders and delirium, impaired mobility and falls, as well as problems related to the activities of daily living, disability, poly-pharmacy, adverse drug effects, co-morbidity and atypical presentation. We also propose steps to further improve the quality of care in older ED patients by using appropriate age-centred management.

Evaluation of Police Patrol Patterns

This paper describes an ArcView extension that allows police planners to design patrol districts and to evaluate them by displaying various performance measures. It uses a spatially distributed queuing system (the Larson Hypercube) to calculate expected travel times, workloads, preventive patrol frequencies, and other variables; and it allows planners to see the unavoidable tradeoffs among their objectives. Using this tool, planners can experiment with various patrol patterns to find those that best meet their Department.s goals. For example, those patrol patterns which are best in terms of average response time don.t do as well as others in terms of workload balance, or those that are best in terms of achieving a uniform response time across different parts of the city don't do as well as others in terms of minimizing inter-district dispatches. There is, of course, no perfect solution for this problem: the facts of the situation force us to balance competing goals. Described here is a way of explicitly weighting the alternative objectives.

Search, Seizure and (False?) Arrest: An Analysis of Fourth Amendment Remedies when Police can Plant Evidence

The Fourth Amendment prohibits unreasonable searches and seizures in criminal investigations. The Supreme Court has interpreted this to require that police obtain a warrant prior to search and that illegally seized evidence be excluded from trial. A consensus has developed in the law and economics literature that tort liability for police officers is a superior means of deterring unreasonable searches. We argue that this conclusion depends on the assumption of truth-seeking police, and develop a game-theoretic model to compare the two remedies when some police officers (the bad type) are willing to plant evidence in order to obtain convictions, even though other police (the good type) are not (where this type is private information). We characterize the perfect Bayesian equilibria of the asymmetric-information game between the police and a court that seeks to minimize error costs in deciding whether to convict or acquit suspects. In this framework, we show that the exclusionary rule with a warrant requirement leads to superior outcomes (relative to tort liability) in terms of truth-finding function of courts, because the warrant requirement can reduce the scope for bad types of police to plant evidence

Patient Safety Alert : A new way to share patient safety information among departments and units

Communication : If there is one topic that comes up over and over again as we discuss ways to make John Dempsey Hospital the safest hospital, it is “communication.” In fact, several of the 2006 and 2007 National Patient Safety Goals are centered around improving the effectiveness of communication among caregivers. There are many ways of doing this, and we have implemented several already. These include handoffs, medication reconciliation, “SBAR,” etc. On page two, we will talk in more detail about hand-offs and the use of “SBAR.”

Na 1 Nachlass Max Horkheimer, 687 - "Experimental Movie Project", "The Police and Minority Groups" u.a. (p. IX 150.1-17 - IX 152.1-2)

"Experimental Movie Project" (1945-46):; 1. "Below the Surface", Drehbuch des Testfilms, a) als Typoskript vervielfältigt, 46 Blatt, b) als Typoskript vervielfältigt, 26 Blatt, c) als Typoskript vervielfältigt, 26 Blatt, d) als Typoskript vervielfältigt, 26 Blatt "Experimental Movie Project" (1945-46): Memoranden zum Test; 2. 'Notes' 25.4.1946, Typoskript, 1 Blatt; 3. "Memorandum on Experimental Movie Project", 19.4.1946. Typoskript, 3 Blatt; 4. "Memorandum re: 'Below the Surface" (Juli 1945). Typoskript, 2 Blatt; 5. Dore Schary und Allen Rivkin: 'Memorandum, Subject: New Suggested Treatment for 'Below the Surface'", 13.7.1945. Typoskript, 2 Blatt; 6. Hans Richter: "Report about the film script 'Below the surface'", 7. u. 8.7.1945, a) Typoskript, 1 Blatt, b) Typoskript, 1 Blatt; 7. Hans Richter: Bestätigung der Vereinbarung mit dem American Jewish Committee, 3.7.1945. Typoskript, 1 Blatt; 8. "Notes and Suggestions re Experimental Motion Picture", Juni 1945. Typoskript, 2 Blatt; 9. Siegfried Kracauer; "Suggestions for the Dialogue" (4.4.1945). Typoskript, 3 Blatt; 10. "Motion Picture", März 1945. Typoskript, 5 Blatt; 11. "Project on a Test film", a) Typoskript, 4 Blatt, b) Typoskript, 5 Blatt; 12. "Memorandum re: 'Below the Surface'", a) Typoskript, 3 Blatt, b) Typoskript mit eigenhändigen Korrekturen von Theodor W. Adorno, 3 Blatt; "Experimental Movie Project" (1945-46): Korrespondenz zum Test-Film-Projekt:; 13. Friedrich Pollock: 1 Brief an Max Horkheimer, Santa Monica, California, 12.10.1945; 14. Theodor W. Adorno: 2 Briefe an Max Horkheimer, Los Angeles und Santa Monica, California, 1945; 15. Joseph M. Proskauer: 1 Brief von Max Horkheimer, o.O., 29.6.1945, 1 Brief mit Unterschrift an Max Horkheimer, o.O., o.D., 3 Blatt; 16. Alexander Hackenschmied, 1 Brief mit Unterschrift an Max Horkheimer, New York, 19.6.1945, 1 Blatt; 17. Gilbert Gabriel: 1 Brief von John Slawson, o.O., 22.3.1945, 2 Blatt; "The Police and Minority Groups" (1946):; 1. "The Police and Minority Groups". Typoskript, 2 Blatt; 2. Robert W. Kenny: "Police and Minority Groups - an Experiment". Als Typoskript vervielfältigt, 17 Blatt; 3. Davis McEntire, Robert B. Powers: "Police Training Bulletin. A Guide to Race Relations for Police Officers", State of California, 1946, 38 Seiten; Max Horkheimer: "Memorandum on a Study of Race Hatred in Post-War Germany" (1946):; 1. Memorandum, a) Typoskript, 8 Blatt, b) Typoskript mit eigenhändigen und handschriftlichen Korrekturen, 6 Blatt, c) Typoskript, 5 Blatt, d) Teilstück, Typoskript mit eigenhändigen Korrekturen, 1 Blatt e) Typoskript mit eigenhändigen Korrekturen, 5 Blatt, f) Teilstück, Typoskript mit handschriftlichen Korrekturen, 2 Blatt, g) Typoskript mit eigenhändigen Korrekturen, 7 Blatt, h) Teilstück, Typoskript mit eigenhändigen Korrekturen und Ergänzungen, 1 Blatt, i) Typoskript, 2 Blatt; 2. Theodor W. Adorno: "Ad Memorandum Neumann", Manuskript, 3 Blatt;

A model for use by local public health departments to evaluate pandemic influenza plans

The events of the 1990's and early 2000's demonstrated the need for effective planning and response to natural and man-made disasters. One of those potential natural disasters is pandemic flu. Once defined, the CDC stated that program, or plan, effectiveness is improved through the process of program evaluation. (Centers for Disease Control and Prevention, 1999) Program evaluation should be accomplished not only periodically, but in the course of routine administration of the program. (Centers for Disease Control and Prevention, 1999) Accomplishing this task for a "rare, but significant event" is challenging. (Herbold, John R., PhD., 2008) To address this challenge, the RAND Corporation (under contract to the CDC) developed the "Facilitated Look-Backs" approach that was tested and validated at the state level. (Aledort et al., 2006).^ Nevertheless, no comprehensive and generally applicable pandemic influenza program evaluation tool or model is readily found for use at the local public health department level. This project developed such a model based on the "Facilitated Look-Backs" approach developed by RAND Corporation. (Aledort et al., 2006) Modifications to the RAND model included stakeholder additions, inclusion of all six CDC program evaluation steps, and suggestions for incorporating pandemic flu response plans in seasonal flu management implementation. Feedback on the model was then obtained from three LPHD's—one rural, one suburban, and one urban. These recommendations were incorporated into the final model. Feedback from the sites also supported the assumption that this model promotes the effective and efficient evaluation of both pandemic flu and seasonal flu response by reducing redundant evaluations of pandemic flu plans, seasonal flu plans, and funding requirement accountability. Site feedback also demonstrated that the model is comprehensive and flexible, so it can be adapted and applied to different LPHD needs and settings. It also stimulates evaluation of the major issues associated with pandemic flu planning. ^ The next phase in evaluating this model should be to apply it in a program evaluation of one or more LPHD's seasonal flu response that incorporates pandemic flu response plans.^

Houston police officer attitudes towards the mentally ill: CIT trained and non-CIT trained

The purpose of this study was to develop a better understanding of police officer attitudes towards the mentally ill and what impact that might have on their behavior. Focused on the effects of Crisis Intervention Team (CIT) training on Houston police officers, this research wanted to determine if CIT training decreases attitudes of authoritarianism and increases attitudes of self-efficacy in dealing with the mentally ill—other factors assessed were age, years of service, ethnicity, and gender. Results confirmed that CIT training had an effect on an officer's attitudes with CIT officers being less authoritarian and having more self-efficacy with respect to dealing with the mentally ill as compared to non-CIT officers. Because of these results, this study could offer support in tailoring training programs to have successful officer-mentally ill person interactions. ^

America's state health departments and the enhancement of health communication through podcasting

Perhaps it was foreshadowing the influence emerging technologies would have on health when the term "podcast" beat out "bird flu" for the 2005 word of the year, an honor given by The New Oxford American Dictionary. From medical school courses to medical journal summaries, podcasting has found a niche in the health field and with studies showing a high proportion of people using the Internet to seek health information, it is imperative that the online information be accurate and easily accessible. With the responsibility of health departments to reach out to their respective communities with effective health communication strategies, this study assessed the proportion of 50 states' and the District of Columbia's health departments utilizing podcasting as a tool for health communication. Additionally, to assess any trends, the prevalence of podcasting was compared to select state demographic characteristics (age, sex, and median income), the organization of the health department (freestanding or super-agency), and the respective United Health Foundation 2007 health ranking. ^ Prevalence data were collected from each state health department's website to find evidence of podcasting to any extent. If a podcast was present, characteristics including creator, release frequency, and transcript were further assessed. The study found that 51% (26/51) of all health departments were utilizing podcasts in some capacity and almost 20% (5/26) of these had created their own podcasts. The most common use of podcasting was to link to outside podcast resources, most notably, the Centers for Disease Control's podcast series. No significant associations were found between the state-specific variables and the podcasting outcomes; however, higher percentages of young adults in some states suggest potential podcasting opportunities for targeting these known podcast users with age-specific health messages. Another recommendation is a future assessment of local health departments' use of podcasting as their smaller, more defined target audiences may be a more efficient use of podcasting as a health communication tool. Additionally, there is a need for evaluations of podcasts' overall effectiveness as a health communication tool to (1) reach a target audience; and (2) convey a specific health message. In conclusion, the findings from this project illuminate the extent of podcast influence in states' and the District of Columbia's health departments as a health communication tool; however evaluations of effectiveness are imperative for future studies.^

The public health applications of law enforcement medical direction: A practical experience with the Dallas Police Department

In 2008, 132 law enforcement officers were killed in the line of duty in The United States. Additionally, some have explored both the public health implications of interactions with law enforcement as well as the potential benefits of the use of law enforcement officers as public health and emergency healthcare providers. By virtue of these novel analyses and techniques, professional medical direction of the emerging specialty of law enforcement medicine is needed. This paper, an analysis of law enforcement medical direction through a look at the Dallas Police Medical Direction Program, seeks to examine origins of law enforcement medicine through a comprehensive literature review, as well as begin to define to core competencies of law enforcement medical direction. ^ The unique intersection of public health, medicine and law enforcement, and the subsequent specialty that is developing to manage this interface, is in its relative infancy. An analysis of this nature is in order to begin to lay down the foundations necessary for future study and improvements in the field. ^