PubMed · 10168973
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J Cook. 1997. Implementing access management strategies.. https://pubmed.ncbi.nlm.nih.gov/10168973/
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The purpose of this study was to use population-based sources to estimate the frequency and characteristics of first inpatient hospital admission through an emergency department (ED) among 11,023 patients with diagnosed colorectal cancer between 1992 and 1996. Patients were identified from the population-based Connecticut Tumor Registry. Linkage with a statewide hospital discharge database (inpatient only) disclosed that 20% had a first hospital inpatient admission through an ED. Inpatient admission through an ED was statistically significantly associated with older age and race and was a statistically significant risk factor for distant stage at diagnosis. Studies are needed of the roles of patient delay and lack of screening in influencing ED presentation, especially in the elderly.
The author's experience with portable CT has been positive. Nurses and clinical physicians have been pleased with this new imaging capability also, and have written testimonial letters endorsing its value. Recently, the STC extended availability of the mobile CT to the University of Maryland Hospital, an adjoining 600-bed center with numerous medical and surgical patients in ICU. They are particularly interested in assessing use of portable CT in the neonatal ICU, where patient transport outside the unit is particularly difficult and dangerous. Technical improvements for portable CT are in development. Soon, helical volume scanning will be available, allowing faster image acquisition and better two- and three-dimensional image reformations (Fig. 12). A new, more powerful x-ray tube is in development that will permit more slices to be acquired without tube cooling interruptions. Gantry translate capability coupled with a radiolucent backboard extender has the potential to permit scanning of the head, neck, spine, face, and upper torso without the patient being moved from the ICU bed. For applications in head, face, and neck surgery, a radiolucent cranial fixation device also has been developed. Other potential improvements include extended battery power for more scanning between charges, a larger tube heat unit storage for extended scanning situations, decreased system weight for easier transport, and more detector efficiency for improved image quality while maintaining significant dose reduction over conventional scanning. The capability of portable CT scanning for emergency, intensive care, and intraoperative studies exists now. The commercially marketed cost for this system is between $400,000 and $500,000. Further studies are anticipated to clarify the economic and clinical benefits of this technology.
The outcome of all resuscitations in a 20-bed observation unit of a large teaching hospital over a 25-month period was reviewed. Resuscitation was defined as a patient receiving one or more of the following: external chest compressions; defibrillation, assisted ventilation (e.g. intubation); and/or advanced cardiac life support drug therapy such as atropine or lidocaine for life threatening dysrhythmias including ventricular tachycardia, ventricular fibrillation, or asystole. There were nine patients out of 10,245 patients admitted to the observation unit (9/10,245 = 0.088% or approximately 0.09%) over the 26-month period from May 1994 to July 1996 who needed resuscitation. Each patient was initially successfully resuscitated. There was only one death (1/10,245 = 0.0098% or approximately 0.01%) in the observation unit. This patient was resuscitated with return of a spontaneous pulse and blood pressure only to expire while awaiting transfer to the Intensive Care Unit (ICU). Eight of the nine patients were admitted to the ICU, four of whom later died, making a total of five deaths (5/10,245 = 0.049% or approximately 0.05%). The other four patients were discharged neurologically intact and at 1 year follow-up were alive and doing well. Compared with resuscitation rates for the prehospital setting, the emergency department, the hospital medical/surgical floors, or the intensive care units, there is a higher successful resuscitation rate for the observation unit.