Predicting patient patterns in veterans administration emergency departments.

Veteran's Affairs (VA) hospitals represent a unique patient population within the healthcare system; for example, they have few female and pediatric patients, typically do not see many trauma cases and often do not accept ambulance runs. As such, veteran-specific studies are required to understand the particular needs and stumbling blocks of VA emergency department (ED) care. The purpose of this paper is to analyze the demographics of patients served at VA EDs and compare them to the national ED population at large. Our analysis reveals that the VA population exhibits a similar set of common chief complaints to the national ED population (and in similar proportions) and yet differs from the general population in many ways. For example, the VA treats an older, predominantly male population, and encounters a much lower incidence of trauma. Perhaps most significantly, the incidence of psychiatric disease at the VA is more than double that of the general population (10% vs. 4%) and accounts for a significant proportion of admissions (23%). Furthermore, the overall admission percentage at the VA hospital is nearly three times that of the ED population at large (36% versus 13%). This paper provides valuable insight into the make-up of a veteran's population and can guide staffing and resource allocation accordingly.

Ultrasound training for medical students and internal medicine residents--a needs assessment.

PURPOSE: While sonography has been a mainstay of certain medical specialties, such as obstetrics and gynecology, internal medicine has been slower to integrate this technology into practice. No standardized training in sonography exists for either medical students or internal medicine residents, and little is known about the current competency and utilization of ultrasound among these groups. The goal of this article is to examine the present state of ultrasound education among internal medicine residents and medical students at a major university hospital. METHODS: Third-year medical students from the University of Illinois at Chicago and senior medicine residents from University of Illinois at Chicago and Northwestern University were invited to complete a Likert-type survey regarding their attitudes, competence, and interest in ultrasound, the nature of previous training, and areas where incorporation of ultrasound would be useful. RESULTS: One hundred sixty-three students and 40 residents participated (81.8% response rate). Students and residents generally felt incompetent in the use of ultrasound; objective competency in the resident group, as evaluated by an emergency physician certified by the American College of Emergency Physicians, was equally low. However, interest in additional training was high. Nearly 50% of the respondents had no prior sonography training; however, those with previous training rated it highly. Areas in which sonography was most sought-after include central line placement, paracentesis, and thoracentesis. CONCLUSIONS: There is a clear desire for training in sonography among the medical students and internal medicine residents surveyed. As ultrasound is further integrated into clinical practice, students and residents would strongly benefit from formal didactic and hands-on training in the modality.