RESUMEN
PURPOSE: To determine the effect on time to diagnosis of making MRI imaging for hip fractures available directly in the emergency department (ED). METHODS: We conducted a retrospective observational study of patients with MRI imaging of the hip for suspected occult fracture, comparing time to diagnosis and time to disposition of populations imaged in the year preceding and the year following installation of an MRI scanner in the ED. RESULTS: Time to diagnosis of hip fractures was 709 min before installation of a dedicated ED MRI scanner and 280 min after, a 60% reduction. Including the MRI in the diagnostic workup did not increase ED throughput time, and we were able to save 48% of the patients who had an ED-based MRI from an admission to the hospital. CONCLUSION: Implementation of an MRI scanner for dedicated emergency department use enables faster hip fracture diagnosis and surgical consultation, or definitive disposition without increasing ED throughput time.
Asunto(s)
Servicio de Urgencia en Hospital , Fracturas de Cadera/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Anciano , Diagnóstico Diferencial , Fracturas de Cadera/cirugía , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosAsunto(s)
Accidentes por Caídas , Heridas no Penetrantes/etiología , Adulto , Consumo de Bebidas Alcohólicas/efectos adversos , Consumo de Bebidas Alcohólicas/psicología , Tubos Torácicos , Servicio de Urgencia en Hospital/organización & administración , Examen Ginecologíco/métodos , Hemorragia/complicaciones , Hemorragia/etiología , Humanos , Masculino , Obesidad/psicología , Pelvis/lesiones , Pelvis/fisiopatología , Neumotórax/diagnóstico , Neumotórax/cirugía , Radiografía/métodosRESUMEN
[Full article available at http://rimed.org/rimedicaljournal-2017-10.asp].
Asunto(s)
Dolor de Espalda/terapia , Competencia Cultural/ética , Fracturas por Compresión/terapia , Indígenas Norteamericanos/psicología , Mieloma Múltiple/terapia , Atención Dirigida al Paciente/ética , Negativa del Paciente al Tratamiento/etnología , Anciano , Dolor de Espalda/etiología , Dolor de Espalda/psicología , Femenino , Fracturas por Compresión/diagnóstico , Fracturas por Compresión/etiología , Fracturas por Compresión/psicología , Humanos , Consentimiento Informado/ética , Consentimiento Informado/psicología , Competencia Mental , Mieloma Múltiple/complicaciones , Mieloma Múltiple/diagnóstico , Mieloma Múltiple/psicología , Negativa del Paciente al Tratamiento/ética , Negativa del Paciente al Tratamiento/psicologíaRESUMEN
An overview of access to and use of general infertility and assisted reproductive technology (ART) services in the United States (U.S.) shows a declining trend for the ever-use of infertility services. Moreover, the use of ART services lags relative to other member nations of the Organization for Economic Co-operation and Development (OECD). Access to and use of general infertility and ART services is primarily undermined by a severely constrained underwriting universe dominated by self-insured employers and by a finite number of state infertility insurance mandates. The contribution of traditional public and private payers to the underwriting of ART is limited. As compared with OECD member nations wherein the access to and underwriting of general infertility and ART services is universal, the current status quo in the U.S. can only be characterized as dismal. Further, the current state of affairs is socially unjust in that the right to build a family in the face of infertility appears to have become a function of economic prowess. Given the dominance of the self-insured employers as underwriters of general infertility and ART services, advocacy directed at this interest group is likely to prove most productive. Improving the state of underwriting of general infertility and ART services in the U.S. must be embraced as a central moral imperative and as an unwavering strategic goal of the professional societies entrusted with the reproductive health of women and men.