Using a Computer-assisted Prescription to Decrease Inappropriate Use of Plain Abdominal Radiography in Emergency Department

Author(s):  
2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
C. Wek ◽  
T. P. Fox ◽  
G. H. Muir

We report on the case of a frustrated 90-year-old gentleman who was seen in the Accident and Emergency department for the third time in four days with failure of his long-term urethral catheter. He reported that the catheter simply “fell out” with the balloon deflated. On each occasion previously, the catheter had been reinserted in A&E and the patient discharged home. These repeated visits to A&E were understandably a source of much frustration for the patient and his family. On the third presentation, plain abdominal radiography demonstrated a large spiculated bladder calculus.


2020 ◽  
Author(s):  
Andrea Negro ◽  
Valerio Spuntarelli ◽  
Paolo Sciattella ◽  
Paolo Martelletti

Abstract Background Headache is one of the most common reason for medical consultation to emergency department (ED). Inappropriate use of ED for non-urgent conditions is a problem in terms of crowding emergency facilities, unnecessary testing and treatment, increased medical bills, burden on medical service providers and weaker patient-primary care provider relationships. The aim of this study was to analyzed the different steps of the ED management of patients with headache to detect those deficiencies that can be overcome by a prompt referral to a headache clinic.Methods The study is a retrospective analysis of the electronic medical records (EMRs) of patients discharged from an academic ED between 1 January 2015 and 31 December 2018 and referred to the tertiary level headache centre of the same hospital. We analyzed all the aspects related to the permanence in ED and we also assessed if there was a concordance between ED diagnosis and ours.Results Among our sample of 244 patients, 76.2% were admitted as green tag, 75% underwent a head computed tomography, 19.3% received neurological consultation, 43% did not receive any pharmacological treatment and 62.7% still had headache at discharge. Length in ED stay was associated with the complaint of the first aura ever (p = 0.014) and if patients received consultations (p < 0.001). Concordance analysis shown a significant moderate agreement only for the diagnosis of migraine and only between triage and headache centre.Conclusions The majority of patients who went to the ED complaining of headache received the same therapy regardless of their diagnosis and in many cases the headache had not yet resolved at the time of discharge. Given the several shortcomings of ED management of headaches, a rapid referral to the headache centre is of primary importance to help the patient obtain a definite diagnosis and adequate treatment.


2020 ◽  
pp. 211-218
Author(s):  
Pat Croskerry

In this case, a middle-aged male presents to the emergency department (ED) of a general hospital with dizziness and weakness and a history of falling the previous day associated with seizures. There is also a possibility of head injury. He is well known to the department and has been seen previously by the head of the department regarding inappropriate use of the ED. Some difficulty ensues in terms of whether he has been having seizures or not, which, combined with a medication error and a laboratory error, results in him being overdosed with a significantly toxic drug. The case is an example of groupthink as well as fundamental attribution error.


CJEM ◽  
2007 ◽  
Vol 9 (05) ◽  
pp. 347-351 ◽  
Author(s):  
Valérie Homier ◽  
Colette Bellavance ◽  
Marianne Xhignesse

ABSTRACT Objective: Pneumonia is a well-known cause of acute abdominal pain in children. However, the utility of chest radiography in this setting is controversial. We sought to determine the prevalence of pneumonia in children under 12 years of age who had abdominal pain and underwent abdominal radiography when visiting an emergency department (ED). We also aimed to describe the signs and symptoms of children diagnosed with pneumonia in this context. Methods: We conducted a retrospective analysis of electronic data from ED visits to a tertiary care centre by children 12 years of age and under who were seen between June 1, 2001, and June 30, 2003, and who underwent both an abdominal and a chest radiograph during the same visit, or an abdominal x-ray at a first visit as well as a chest x-ray in the 10 days following the initial visit. Results: Of 1584 visits studied, 30 cases of pneumonia were identified, for a prevalence of 1.89% (95% confidence interval 1.22%–1.56%). If chest radiography had been limited to children who presented with fever, cough and symptoms of an upper respiratory tract infection (URTI), the diagnosis of pneumonia would have been missed in only 2/1584 visits (0.13%). Conclusion: Children aged 12 years and under presenting to the ED with acute abdominal pain and in whom an abdominal radiograph is requested need only undergo a chest radiograph in the presence of cough, fever or other symptoms of a URTI.


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