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1.
West J Emerg Med ; 25(2): 268-274, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38596929

RESUMEN

Introduction: Numerous studies have demonstrated the accuracy of point-of-care ultrasound (POCUS). Portable, handheld devices have expanded the clinical scope of POCUS at a fraction of the cost of traditional, cart-based models. There is a paucity of data assessing the diagnostic accuracy of portable devices. Our objective in this study was to compare the diagnostic accuracy of a portable device with a cart-based model. Methods: This was an institutional review board-approved, observational, prospective, randomized clinical trial (NCT05196776) of a convenience sample of adult patients who presented to a university-based health system. Patients who required a cardiac, lung, renal, aorta, or biliary POCUS were randomized to a portable device or to a cart-based model. We hypothesized that the cart-based model would have a 90% diagnostic accuracy vs 70% for the handheld device. To detect a 20% difference, the sample size was calculated to be 98, with 49 patients randomized to each arm. We used standard 2x2 tables to calculate test characteristics with 95% confidence intervals (CI). Results: A total of 110 patients were enrolled, with 56 patients randomized to the cart-based model and 54 to the handheld device. The sensitivity, specificity, and diagnostic accuracy of the cart-based vs handheld were 77.8% (40-97.2) vs 92.9% (66.1-99.8), 91.5% (79.6-97.6) vs 92.3% (79.1-98.4%), and 89.3% (78.1-96) vs 92.5% (81.8-97.9), respectively. Conclusion: The diagnostic accuracy of a portable, handheld device is similar to that of a cart-based model.


Asunto(s)
Pruebas en el Punto de Atención , Proyectos de Investigación , Adulto , Humanos , Estudios Prospectivos , Ultrasonografía
3.
Am J Emerg Med ; 38(11): 2387-2390, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33041118

RESUMEN

OBJECTIVES: Return visits to the emergency department (ED) and subsequent readmissions are common for patients who are unable to fill their prescriptions. We sought to determine if dispensing medications to patients in an ED was a cost-effective way to decrease return ED visits and hospital admissions for skin and soft tissue infections (SSTIs). METHODS: A retrospective review of ED visits for SSTIs, during the 24 weeks before and after the implementation of a medication dispensing program, was conducted. Charts were analyzed for both ED return visits and hospital admissions within 7 days and 30 days of the initial ED visit. Return visits were further reviewed to determine if the clinical conditions on subsequent visits were related to the initial ED presentation. A cost analysis comparing the cost of treatment to cost savings for return visits was also performed. RESULTS: Before the implementation of the medication dispensing program, the return rate in 7 days for the same condition was 9.1% and the rate of admission was 2.8%. The return rate for the same condition in 8-30 days was 2.1% and the rate of admission was 1.0%. After the implementation of the medication dispensing program, the return rate for the same condition in 7 days was 8.0%, and the admission rate was 1.7%. The return rate for the same condition in 8-30 days was 0.8%, and the admission rate was 0%. The total cost of dispensed medications was $4050, while total cost savings were estimated to be $95,477. CONCLUSION: A medication dispensing program in the ED led to a reduction in return visits and admissions for SSTIs at both 7 days and 30 days. For a cost of only $4050, an estimated total of $95,477 was saved. A medication dispensing program is a cost-effective way to reduce return visits to the ED and subsequent admissions for certain conditions.


Asunto(s)
Antibacterianos/uso terapéutico , Atención a la Salud/métodos , Servicio de Urgencia en Hospital , Hospitalización/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Servicios Farmacéuticos , Enfermedades Cutáneas Infecciosas/tratamiento farmacológico , Infecciones de los Tejidos Blandos/tratamiento farmacológico , Absceso/tratamiento farmacológico , Celulitis (Flemón)/tratamiento farmacológico , Cefalexina/uso terapéutico , Clindamicina/uso terapéutico , Ahorro de Costo , Análisis Costo-Beneficio , Costos y Análisis de Costo , Doxiciclina/uso terapéutico , Costos de los Medicamentos , Gastos en Salud , Accesibilidad a los Servicios de Salud , Hospitalización/economía , Humanos , Sistemas de Medicación en Hospital , Readmisión del Paciente/economía , Proyectos Piloto , Transportes , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico
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