ABSTRACT
STUDY OBJECTIVE: We sought to determine whether sharing an observation unit with scheduled procedure patients would maintain a more consistent unit census and patient/nurse ratio. A secondary objective was to determine the effect of this model on patient length of stay and discharge rates. METHODS: This retrospective, descriptive study was conducted in a high-volume suburban teaching hospital, using a "before-and-after" study design. A "pure" postprocedure unit became a "hybrid" observation postprocedure unit by displacing specific postprocedure patients to inpatient locations. Subsequently, the displaced patients were returned to the unit. On weekends, the unit operated as a pure observation unit. Hourly unit occupancy and census data were prospectively collected, and hourly patient/nurse ratios were calculated. Patient length of stay and discharge data were collected and compared in different settings. RESULTS: The 2 services showed a complementary census pattern that allowed the hybrid unit to maintain an average hourly patient/nurse ratio of 3.7 compared with the ratio of 2.5 for a pure observation unit. There was no difference in observation patient length of stay (14.8 hours versus 14.7 hours) or discharge rate (20.4% versus 18.1%) between weekdays and weekends. However, scheduled procedure patients experienced significantly shorter lengths of stay in the hybrid unit setting (4.3 hours) than in alternative inpatient locations (9.4 hours). CONCLUSION: The hybrid model showed better hourly census and nurse resource use rates, with no adverse effect on observation patients. However, scheduled procedure patient length of stay was shorter in this setting.
Subject(s)
Emergency Service, Hospital/organization & administration , Observation , Bed Occupancy/economics , Cost Savings , Efficiency , Emergency Service, Hospital/economics , Hospitals, Teaching , Humans , Length of Stay/economics , Patient Care Team/economics , Patient Care Team/organization & administration , Patient Discharge/economics , Prospective Studies , Retrospective StudiesABSTRACT
We evaluated the accuracy of a hand-held breath alcohol analyzer in the rapid determination of blood alcohol levels in the emergency patient with suspected ethanol intoxication. The Alco -Sensor III breath alcohol analyzer was used to measure alcohol levels in orally and nasally obtained end-expiratory breath samples in 55 patients. These levels were compared to directly measured blood alcohol levels. The patients were categorized into cooperative and uncooperative groups. The mean oral breath alcohol level obtained was 0.187 +/- 0.100 g/dL (range, 0.000 to 0.419) while the mean serum level was 0.217 +/- 0.113 g/dL (range, 0.00 to 400). The overall correlation between these two methods of measuring blood alcohol level was strong (r = .879, P less than .001). In cooperative patients the correlation was even stronger (r = .963, P less than .001), while in uncooperative patients the correlation was less but still significant (r = .723, P = .001). Nasally obtained samples correlated well with blood levels in cooperative patients (r = .874, P less than .001), but the correlation was less strong in uncooperative persons (r = .694, P = .003). Our study indicates that the Alco -Sensor III breath alcohol analyzer is sufficiently accurate to be of use in rapidly assessing blood alcohol levels, even when a patient is unable to cooperate fully.
Subject(s)
Alcoholic Intoxication/diagnosis , Breath Tests/standards , Ethanol/blood , Alcoholic Intoxication/blood , Breath Tests/instrumentation , HumansABSTRACT
The epidemiologic, microbiologic, radiographic, and clinical presentations of pneumonias caused by the most common pathogens are discussed in detail, and current recommendations for hospitalization are reviewed. Also considered are the clinical characteristics, diagnosis, and treatment of primary and secondary lung abscess.
Subject(s)
Lung Abscess/diagnosis , Pneumonia/diagnosis , Diagnosis, Differential , Emergencies , Haemophilus Infections/diagnosis , Haemophilus Infections/therapy , Hospitalization , Humans , Klebsiella Infections/diagnosis , Klebsiella Infections/therapy , Klebsiella pneumoniae , Legionnaires' Disease/diagnosis , Legionnaires' Disease/therapy , Lung Abscess/therapy , Pneumonia/therapy , Pneumonia, Mycoplasma/diagnosis , Pneumonia, Mycoplasma/therapy , Pneumonia, Pneumococcal/diagnosis , Pneumonia, Pneumococcal/therapy , Pneumonia, Pneumocystis/diagnosis , Pneumonia, Pneumocystis/therapy , Pneumonia, Staphylococcal/diagnosis , Pneumonia, Staphylococcal/therapy , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Streptococcal Infections/diagnosis , Streptococcal Infections/therapyABSTRACT
The pathogenesis, clinical presentation, radiographic signs, and treatment of atelectasis are reviewed.
