PubMed Health⌕ Search

Biomedical subjects

W A Watson

Publications and source records attributed to W A Watson.

157 records · Page 9Linked to original sources
PubMedDate not supplied

Enhancing medical student consultation request skills in an academic emergency department.

The purpose of this study was to develop an educational protocol to enhance the communication skills of medical students when requesting specialty consultation. A protocol consisting of a worksheet and oral instructions was created to teach nine criteria of effective consultation requests, derived from the existing literature. Consultation requests made by senior medical students using the protocol were evaluated and compared to consultation requests made by Emergency Medicine residents who did not complete the educational protocol. Forty-two medical student consultation requests and 50 Emergency Medicine resident consultation requests were evaluated. The students included five of the nine criteria in their consultation requests significantly more often than the residents. The median number of criteria included by the students was eight, while the median number of criteria included by the residents was six. This study shows that senior medical students can be taught to communicate effectively with specialists when requesting consultations.

Communication↗
PubMedDate not supplied

System implications of the ambulance arrival-to-patient contact interval on response interval compliance.

BACKGROUND: In some emergency medical services (EMS) system designs, response time intervals are mandated with monetary penalties for noncompliance. These times are set with the goal of providing rapid, definitive patient care. The time interval of vehicle at scene-to-patient access (VSPA) has been measured, but its effect on response time interval compliance has not been determined. PURPOSE: To determine the effect of the VSPA interval on the mandated code 1 (< 9 min) and code 2 (< 13 min) response time interval compliance in an urban, public-utility model system. METHODS: A prospective, observational study used independent third-party riders to collect the VSPA interval for emergency life-threatening (code 1) and emergency nonlife-threatening (code 2) calls. The VSPA interval was added to the 9-1-1 call-to-dispatch and vehicle dispatch-to-scene intervals to determine the total time interval from call received until paramedic access to the patient (9-1-1 call-to-patient access). Compliance with the mandated response time intervals was determined using the traditional time intervals (9-1-1 call-to-scene) plus the VSPA time intervals (9-1-1 call-to-patient access). Chi-square was used to determine statistical significance. RESULTS: Of the 216 observed calls, 198 were matched to the traditional time intervals. Sixty-three were code 1, and 135 were code 2. Of the code 1 calls, 90.5% were compliant using 9-1-1 call-to-scene intervals dropping to 63.5% using 9-1-1 call-to-patient access intervals (p < 0.0005). Of the code 2 calls, 94.1% were compliant using 9-1-1 call-to-scene intervals. Compliance decreased to 83.7% using 9-1-1 call-to-patient access intervals (p = 0.012). CONCLUSION: The addition of the VSPA interval to the traditional time intervals impacts system response time compliance. Using 9-1-1 call-to-scene compliance as a basis for measuring system performance underestimates the time for the delivery of definitive care. This must be considered when response time interval compliances are defined.

Ambulances↗
PubMedDate not supplied

Using statistical process control to demonstrate the effect of operational interventions on quality indicators in the emergency department.

When our emergency department (ED) initiated a continuous quality improvement (CQI) program, we selected as a quality indicator the percentage of patients leaving without being seen (LWBS) by a physician. Because the primary reason for LWBS patients was determined to be dissatisfaction with waiting time, we devised four interventions in clinical operations to decrease delays in patient flow through the ED. Statistical process control (SPC) methodology was then used to assess the effect of these interventions. Because baseline data were available, we constructed control charts of the percentage of LWBS patients versus consecutive months beginning in January 1990 with the mean percentage of LWBS patients and upper and lower control limits. Postintervention data, plotted using control statistics from the baseline period, demonstrated sustained special-cause variation, indicating a fundamental change in the overall system. A new control chart was then constructed using postintervention data. A significantly lowered mean percentage LWBS and a narrowed control limit range were observed, leading to the conclusion that the interventions improved the quality of care as measured by a reduction in percentage LWBS.

Data Interpretation, Statistical↗
PubMedDate not supplied

Oleoresin capsicum (Cap-Stun) toxicity from aerosol exposure.

OBJECTIVE: To describe the clinical toxicity caused by oleoresin capsicum (OC) spray during law-enforcement action. DESIGN: A medical record review. SETTING: Emergency department (ED), Truman Medical Center, Kansas City, MO. PATIENTS: Consecutive patients who presented to the ED after OC-spray exposure from law-enforcement action between June 1991 and June 1994. MAIN OUTCOME MEASURES: Patient presentation and symptoms at presentation, evaluation, and treatment during ED stay. RESULTS: Eighty-one ED patients, approximately 10% of all individuals sprayed by police officers, presented after exposure to OC. Ocular burning and redness were the most common presenting symptoms. None of the patients required hospitalization due to OC toxicity. Corneal abrasions and respiratory symptoms occurred in 7 and 6 patients, respectively. CONCLUSIONS: The need for ED evaluation and treatment was infrequent after exposure to OC. A transient burning sensation, erythema, and localized irritation were the most common findings. While no patients had adverse outcomes attributed to OC exposure, practitioners assessing exposure should consider the potential for pulmonary and ocular toxicity.

Adult↗
PubMedDate not supplied

Chronic acetazolamide intoxication.

Severe acidosis associated with acetazolamide therapy is rare. We report the first case in which plasma and whole blood acetazolamide concentrations were measured. A 61 year-old patient receiving oral acetazolamide for treatment of glaucoma presented with a 7 day history of declining mental status. The patient was lethargic and oriented only to name. The respiratory rate was 36 per minute in a Kussmaul pattern with arterial blood gases revealing a pH of 7.23, pO2 68 mmHg, paCO2 14 mmHg and bicarbonate 6 mEq/L. Serum creatinine was 3.1 mg%, Cl 126 mEq/L, and anion gap 15. Urine pH was 6.0. Infection and other causes of acidosis and bicarbonate loss were excluded, and he was discharged with normal mental status and improving acid-base balance 18 days after admission. Acetazolamide concentrations four days after the last dose were 26.38 mcg/ml and 38.84 mcg/ml in serum and whole blood, respectively. The serum half-life was 34 hours, compared to a range of 1.5 to 6 hours in subjects with normal renal function. Monitoring acetazolamide concentrations may be useful in adjusting dosage and preventing toxicity in patients with decreased renal function.

Acetazolamide↗