RESUMO
There have been a limited number of studies assessing the impact of attending physician supervision of residents in the emergency department (ED). The objective of this study is to describe the changes in patient care when attending emergency physicians (AEPs) supervise nonemergency medicine residents in a university hospital ED. This was a prospective study including 1,000 patients, 32 second- and third-year nonemergency medicine residents and eight AEPs. The AEPs classified changes in care for each case as major, minor, or none, according to a 40-item data sheet list. There were 153 major changes and 353 minor changes by the AEP. The most common major changes were ordering laboratory or x-ray tests that showed a clinically significant abnormality, and eliciting important physical exam findings. Potentially limb- or life-threatening errors were averted by the AEP in 17 patients. Supervision of nonemergency medicine residents in the ED resulted in frequent and clinically important changes in patient care.
Assuntos
Medicina de Emergência/educação , Serviço Hospitalar de Emergência/organização & administração , Internato e Residência/normas , Corpo Clínico Hospitalar/normas , Erros de Diagnóstico , Hospitais Universitários , Humanos , Corpo Clínico Hospitalar/educação , Pennsylvania , Estudos Prospectivos , Qualidade da Assistência à SaúdeRESUMO
The flow volume curve is useful for differentiating the various types of airway abnormalities. The conventional spirometric data have not been very useful in this regard, and therefore flow volume curves are now used as an adjunct measure in most laboratories in which pulmonary function is measured clinically. This article reviews the basic physiological concepts underlying the usefulness of the flow volume curve and describes the abnormalities which can be detected by this technique, with special reference to its role in clinical medicine.
