Cost Containment in Emergency Medicine

Karas, Stephen

doi:10.1001/jama.1980.03300390040020

Cited by 29 publications

(2 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…2 With many health care cost-containment programs in progress and more being planned, clinical justification will be required for all laboratory tests.…”

Section: Procop Et Al 115mentioning

confidence: 99%

Laboratory Tests in Evaluation of Acute Febrile Illness in Pediatric Emergency Room Patients

1997

View full text Add to dashboard Cite

The rising costs of health care and the movement for health care reform have focused attention on methods of cost containment. Of routine laboratory and radiologic procedures, complete blood cell count (CBC) and determination of serum electrolyte values rank as high as 2nd and 9th in overall cost. We retrospectively studied use of the clinical laboratory to aid diagnosis of an acute infectious event in a pediatric emergency department population.For 5 months, we reviewed medical records of pediatric patients younger than 15 years brought to the emergency department because of a febrile episode. Of 155 cases reviewed, electrolyte concentrations were determined in 108 patients and CBC in 155. In all patients, either culture or rapid test for streptococcal organisms was performed. In addition, 838 pediatric patients with similar symptoms but who did not undergo laboratory testing were monitored for 100 days. Measures of effectiveness including sensitivity, specificity, positive and negative predictive values, and likelihood ratio were used to correlate specific laboratory findings with antibiotic therapy, serious bacterial disease, and culture positivity.Electrolyte abnormalities were found largely to be dismissed clinically, with the major clinical response consisting of parental education about hydration. The CBC profile was evaluated, with white blood cell count (WBC) indicator limits of >10,000, >10,000 but <15,000, and >15,000/mm 3 , and differentiated into absoluteThe rising costs of health care and calls for health care reform have focused attention on methods of cost containment. 1-8 Standards of care have been promulgated for specific clinical situations, in the hope of eliminating unnecessary laboratory testing and decreasing the use of tests with low yield, without compromise of patient care.9-11 Use and overuse of

show abstract

“…2 With many health care cost-containment programs in progress and more being planned, clinical justification will be required for all laboratory tests.…”

Section: Procop Et Al 115mentioning

confidence: 99%

Laboratory Tests in Evaluation of Acute Febrile Illness in Pediatric Emergency Room Patients

1997

View full text Add to dashboard Cite

show abstract

“…In addition, evidence of head injury was poorly recorded. The importance of interpretation of these findings has been well described.5 Up to 13.8% of attendances after a seizure have been shown to have sustained an injury with death occurring in an additional 1.2%. A policy paper from the American College of Emergency Physicians (ACEP) highlights the importance of appropriate interpretation of abnormal clinical findings in the examination of the epileptic patient.6 Minor seizure related head injury is relatively common, while severe head injury is rare.…”

Section: Introductionmentioning

confidence: 99%

Epilepsy in the accident and emergency department--developing a code of safe practice for adult patients. South East and South West Thames Accident and Emergency Specialty Sub-committees.

Ryan

Nash²,

Lyndon³

1998

Emergency Medicine Journal

View full text Add to dashboard Cite

Objectives-To benchmark current practice in the management of adult patients presenting with seizures to the accident and emergency (A&E) departments by performing a comparative interdepartmental audit. To assess the quality and degree of completeness of documentation in A&E records and to develop a proforma for the documentation of any case presenting with a seizure which would incorporate management guidelines for use by A&E doctors. Methods-This was a retrospective, criterion based audit carried out in 12 A&E departments in the South Thames region. It involved 1200 adult patients who presented to A&E departments after a seizure. The degree of completeness of A&E records was assessed using criteria identified by A&E consultants and neurologists. Guidelines for use in the management of patients with seizures have been produced. Results-Important aspects of the history and examination were frequently unrecorded in patients' notes. The recording of vital signs was particularly poor. A diversity of practice was shown between the departments that were audited and the number of investigations performed in each department varied considerably. Hospital admissions for patients with first seizures varied widely between departments, ranging from between 34.6% to 91.7% of cases. Documentation of advice given to patients about driving was evident in just 0.9% of cases. Conclusions-Wide interdepartmental variation exists in both the quality of information recorded in A&E records and in the management of patients. Deficiencies could be minimised and potential improvements in the quality of documentation might be achieved by the introduction of a structured proforma incorporating predefined management guidelines. (7Accid Emerg Med 1998;15:237-243)

show abstract

Program quality and program effectiveness:

Posavac

1995

Evaluation and Program Planning

View full text Add to dashboard Cite

Cost Containment in Emergency Medicine

Cited by 29 publications

References 5 publications

Laboratory Tests in Evaluation of Acute Febrile Illness in Pediatric Emergency Room Patients

Laboratory Tests in Evaluation of Acute Febrile Illness in Pediatric Emergency Room Patients

Epilepsy in the accident and emergency department--developing a code of safe practice for adult patients. South East and South West Thames Accident and Emergency Specialty Sub-committees.

Program quality and program effectiveness:

Contact Info

Product

Resources

About