The sphere project: next steps in moving toward a rights-based approach to humanitarian assistance.

Since the Sphere Project was launched in 1997, it has sought to integrate principles of human rights norms with adherence to technical standards. While the Sphere Handbook has evolved as both a field tool and a resource for articulating human rights, it does not fully offer a rights-based approach to humanitarian assistance. In the handbook's current edition, its Humanitarian Charter asserts and affirms human rights principles, but the technical Minimum Standards Section that follows has yet to truly embody a rights-based approach; that is, it does not clarify how to operationalize human rights in the field, particularly with respect to the health sector. Using human rights documents, the Sphere documents, and existing, published literature in the field of humanitarian practice and human rights, this article provides critical commentary and suggests how strengthening the link between rights and standards, as well as rhetoric and action, can advance the Sphere Project beyond its current applicability as a handbook of technical standards in the field to operationalizing an effective rights-based approach to humanitarian aid.

Effects of implementing a rapid admission policy in the ED.

OBJECTIVE: The purpose of this study is to determine the impact of a new rapid admission policy (RAP) on emergency department (ED) length of stay (EDLOS) and time spent on ambulance diversion (AD). METHODS: The RAP, instituted in January 2005, allows attending emergency physicians to send stable patients, requiring admission to the general medicine service, directly to available inpatient beds. The RAP thereby eliminates 2 conventional preadmission practices: having admitting physicians evaluate the patient in the ED and requiring all diagnostic testing to be complete before admission. We compared patient characteristics, percentage of patients leaving without being seen, EDLOS for admitted patients, time on AD, and total adjusted facility charge for a 3-month period after the RAP implementation to the same period of the prior year. RESULTS: There was a 1.1% increase in census with no difference in patient demographics, acuity, or disposition categories for the 2 periods. The EDLOS decreased on average by 10.1 minutes (95% confidence interval [CI], 3.3-17.0 minutes), resulting in an average of 4.2 hours of extra bed availability per day. Weekly minutes of AD decreased 169 minutes (95% CI, 29-310 minutes). There was also a 3.2% increase (95% CI, 3.1%-3.3%) in adjusted facility charge between these periods in 2005 compared with 2004. CONCLUSIONS: The RAP resulted in a small decrease in the EDLOS, which likely decreased AD time. The resulting small increase in ED volume and higher acuity ambulance patients significantly improved ED revenue. Wider implementation of the policy and more uniform use among emergency physicians may further improve these measures.

Fever and the rational use of antimicrobials in the emergency department.

Any patient presenting to the emergency department (ED) with fever triggers consideration of the administration of an antimicrobial. Empiric antimicrobial therapy has become a cornerstone of treatment. Frequently, the decision to initiate empiric treatment needs to be made before the definitive diagnosis is known. In such cases, an organized approach is helpful. This article aims to provide a systems-based approach to prescribing antimicrobials to patients presenting to the ED with fever, while understanding the risk associated with overutilization. An understanding of the key considerations is needed to ensure that decisions are made well and appropriate treatment begins promptly.

A research agenda for acute care services delivery in low- and middle-income countries.

Delivery of acute care services at every level of the health system is essential to ensure appropriate evaluation and management of emergent illness and injury in low- and middle-income countries (LMICs). The health services breakout group at the 2013 Academic Emergency Medicine consensus conference developed recommendations for a research agenda along the following themes: infrastructure, implementation, and sustainable provision of acute care services. Based on these recommendations, a set of priorities was created to promote and guide future research on acute care services.

Diagnosis and evaluation of syncope in the emergency department.

With a careful history, physical examination, and directed investigation, physicians can determine the likely cause of syncope in more than 50% and perhaps up to 80% of patients. Understanding the cause of syncope allows clinicians to determine the disposition of high- and low-risk patients. Patients with a potential malignant cause, such as a cardiac or neurologic condition, should be treated and admitted. Those with benign causes can be safely discharged. This article reviews the diagnosis and ED work-up of syncope, the different classifications of syncope, and prognosis. The use of specific decision rules in risk stratification and syncope in the pediatric population are discussed in another article.