Journal ArticleDOI
Bringing value, balance and humanity to the emergency department: The Right Care Top 10 for emergency medicine
TLDR
The emergency department (ED) is a unique practice environment that functions simultaneously as a place for high-acuity care of life-threatening illness and injury and also as a safety net for patients with chronic untreated disease.Abstract:
The emergency department (ED) is a unique practice environment that functions simultaneously as a place for high-acuity care of life-threatening illness and injury and also as a safety net for patients with chronic untreated disease. Patient presentations reflect not only pathophysiological derangements in individuals but also the consequences of social dysfunction as well as of healthcare itself, the latter related to the contrasting harms of poor access (in many cases) and excessive intervention (in many others). As changes in the larger healthcare system lead to more frequent use of the ED, clinicians have less time to spend with increasingly sick patients, resulting in more testing and less listening,1 as well as burnout among providers and medical harm and financial cost for patients.1–3
In attempting to address overuse in medicine, the Choosing Wisely campaign asked medical specialty societies to develop lists of diagnostic and therapeutic interventions that are being undertaken too frequently, leading to waste and harm.4 While different individuals and groups might not agree on every item identified, the ‘top 5’ lists that emerged from this process reflected in part an attempt to avoid controversy and left some important items—indeed some critical ‘elephants in the room’—unmentioned. While specialty societies do undertake advocacy work to address the health needs of the public, they also have a fundamental duty to advocate for and protect the interests of their specialty. Furthermore, healthcare dollars that are ‘wasted’ are of course not actually thrown away but rather end up in someone’s pocket; thus, there is clearly a conflict of interest when specialty societies address the overuse of extremely lucrative medical procedures that provide substantial income to their members.
The Right Care Alliance (RCA) is a US-based collaborative effort of healthcare practitioners and patients to address systemic issues of both overuse and underuse …read more
Citations
More filters
Final report for HTA Project 07/37/05: Systematic review and validation of prediction rules for identifying children with serious infections in emergency departments and urgent-access primary care
Matthew Thompson,A Van den Bruel,Jan Y Verbakel,Monica Lakhanpaul,T Haj-Hassan,R Srevens,F Moll,Frank Buntinx,Marjolein Y. Berger,Bert Aertgeerts,Rianne Oostenbrink,David Mant +11 more
TL;DR: The most useful clinical features for ruling in serious infection was parental or clinician overall concern that the illness was different from previous illnesses or that something was wrong as mentioned in this paper, and the best performing clinical prediction rule was a five-stage decision tree rule, consisting of the physician's gut feeling, dyspnoea, temperature ≥ 40 °C, diarrhoea and age.
Journal ArticleDOI
Artificial Intelligence Technology-Based Medical Information Processing and Emergency First Aid Nursing Management
TL;DR: The research proved that the design of intelligent medical information processing and emergency first aid nursing management research model can effectively improve the triage efficiency of the wounded, assist the efficiency of emergency nursing of medical staff, and improve the survival rate of emergency patients, which is worthy of clinical promotion.
Journal Article
A Critical Appraisal of AHRQ's "Diagnostic Errors" Report.
TL;DR: The AHRQ report as mentioned in this paper identified reasonable target diseases for targeting diagnostic quality improvement efforts, as well as viable methods by which to measure any initiatives impact on diagnostic error, and highlighted innovative approaches to diagnostic science within emergency medicine.
OtherDOI
Shared Decision‐Making in Diagnostic Testing
TL;DR: Shared decision-making (SDM) is a conversational dynamic in which clinicians and patients discuss the best available evidence relevant to a medical decision as mentioned in this paper , which can improve the quality, safety, and outcomes of ED patients.
OtherDOI
Appropriate Testing in an Era of Limited Resources
TL;DR: In this paper , the role of diagnostic testing on healthcare costs, identifies practice changes that physicians can implement to help improve the appropriateness of testing, and discusses policy approaches to reduce the use of testing.
References
More filters
Journal ArticleDOI
From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider
TL;DR: It is recommended that the Triple Aim be expanded to a Quadruple Aim, adding the goal of improving the work life of health care providers, including clinicians and staff.
Journal ArticleDOI
Four Models of the Physician-Patient Relationship
TL;DR: Four models of the doctor-patient interaction are outlined, emphasizing the different understandings of the goals of the physicianpatient interaction, the physician's obligations, the role of patient values, and the conception of patient autonomy, which constitute Weberian ideal types.
Journal ArticleDOI
Shared decision making to improve care and reduce costs.
TL;DR: The first step is for the Centers for Medicare and Medicaid Services to begin certifying and implementing patient decision aids, which encourage use of shared decision making in health care.
Journal ArticleDOI
Time trends in pulmonary embolism in the United States: evidence of overdiagnosis.
TL;DR: The introduction of CTPA was associated with changes consistent with overdiagnosis: rising incidence, minimal change in mortality, and lower case fatality.
Journal ArticleDOI
Influence of reported study design characteristics on intervention effect estimates from randomised controlled trials: combined analysis of meta-epidemiological studies
Jelena Savović,Hayley E Jones,Douglas G. Altman,RJ Harris,P Jűni,Julie Pildal,Bodil Als-Nielsen,Ethan M Balk,Christian Gluud,Lise Lotte Gluud,Jpa Ioannidis,Kenneth F. Schulz,R Beynon,Nicky J Welton,Lesley Wood,David Moher,Jonathan J Deeks,Jac Sterne +17 more
TL;DR: Bias associated with specific reported study design characteristics leads to exaggeration of beneficial intervention effect estimates and increases in between-trial heterogeneity, and assessments of the risk of bias in RCTs should account for these findings.