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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Thursday, September 1, 2016

Admission variability in the ED

emDocs - August b31, 2016 - Authors: Rodos A and Meehann T
Edited by: Koyfman A and Alerhand S

..."The more experienced the ED physician, the more likely the patients they cared for were to be admitted to the hospital. This remained statistically significant even when controlling for acuity, patients seen, etc. Does this suggest that our more “seasoned” colleagues know something more about this debate? They have seen the low-risk chest pain return in cardiogenic shock and the well-appearing pyelonephritis patient re-present in septic shock.
Calder et al. used focus groups to create a model of the emergency department discharge decision using key stakeholders including physicians and residents, nurses, social workers, and administrators. Key determinants of disposition decision across all focus groups included triage location and location of patient assessment, the so called “geography is destiny” maxim. Other themes that emerged included social/patient factors, risk stratification, and clinical gestalt. As evidenced by this consensus focus group map, the disposition decision is not exactly straightforward. Though we often think of the disposition decision lying solely within the realm of the emergency physician, there appears to be more team input and influence than one might have expected...
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We take our responsibility for the safe disposition of patients very seriously, yet as much as we debate the best initial fluid for sepsis resuscitation, the most effective way to ventilate after percutaneous cricothyrotomy, or the optimal technique for reduction of the dislocated shoulder, we talk far less about how to disposition our patients. This falls into the gray area of EM – an unwritten curriculum in residency, learned “in the pit” with little to no formal dedicated time. As the patient disposition process is among most important aspects of every patient encounter, more resources ought to be devoted to its study."