Cardiology electrocardiogram overreads rarely influence patient care outcome.

OBJECTIVE: The value of electrocardiogram (ECG) overreads of emergency department (ED) tracings have been questioned in the literature. This review was designed to assess the validity of this criticism. METHODS: In this university teaching hospital ED, following the normal quality assurance protocol, each abnormal ECG is reviewed the following day against the corresponding chart; and if the official reading from cardiology is discordant from the initial clinical one, the patient and/or their physician is contacted. If necessary, the patient is instructed to return to the ED or to their private physician's office. This study is a retrospective review of those ECG overreads for a 21-month period, as well as a summary of those patients who required follow-up care. RESULTS: There were 38,490 patients seen with ECGs performed during the study interval. Of these, 16,011 were discharged and 22,479 were admitted from a total patient volume of 117,407. Of those 16,011 patients discharged, follow-up was deemed necessary in 22 patients whose official readings were discordant from the interpretation of the original clinician. Three patients were lost to follow-up (no phone, no address). Review of the tracings and patient/physician follow-up of the 19 remaining patients resulted in a significant change of therapy in 2 patients (admission). The remainder of the abnormal tracings were deemed, after patient or private physician follow-up, to be not significant or to mandate no change in management. CONCLUSION: Official cardiology overreads seldom affect the clinical outcome of patient care delivered in the ED setting.

Medical support for emergency relief workers after typhoon Sudal in Yap, Micronesia.

INTRODUCTION: On 09 April 2004, Typhoon Sudal struck the Island of Yap in the Federated States of Micronesia (FSM). Over 90% of homes, public utilities, and public property were damaged or destroyed. Nearly 10% of the population was displaced to shelters, and the majority of the population was without drinking water or power. United States disaster workers were deployed to Yap for three months to assist in the recovery and relief efforts. OBJECTIVE: The objective of this study was to evaluate the acute healthcare needs of the US disaster relief population serving in a remote setting with limited medical resources. METHODS: A retrospective chart review of all disaster relief workers presenting to an emergency clinic in Yap during the disaster relief effort from April 2004-July 2004 was performed. Investigators extracted demographic data, chief complaints, medical histories, medical management, disposition, and outcome data from the clinic charts. RESULTS: Together, the 60 disaster workers present on Yap during the relief effort made 163 patient contacts in the disaster emergency clinic. A total of 92% of patient contacts were for minor medical complaints or minor trauma, 13% were for upper-respiratory infections, 9% were for gastrointestinal illness, and 9% were for dermatological problems. Eight percent of visits were for serious medical problems or trauma. Life-threatening illnesses or injuries did not occur. CONCLUSIONS: Disaster relief workers on Yap frequently utilized the disaster relief clinic. In general, disaster workers remained healthy during the relief effort in Yap, and most injuries and illnesses were minor. On-site medical providers resulted in rapid care and stabilization, and after treatment, disaster workers were able to return to duty.

Circus disaster: Case report, response, and review of injuries.

Circus acts with human artists performing acrobatic feats are a popular spectator pastime in the United States and in international venues. There is little data in the literature regarding injuries sustained during circus acts. Some injuries are minor, but others can be serious, or even fatal. This article describes a recent circus disaster, a review of the relevant literature, and an analysis of the disaster response.

Peer review and feedback can modify pain treatment patterns for emergency department patients with fractures.

Consecutive fracture patients presenting to an adult (AED) or pediatric trauma center (PED) or a community teaching hospital (CED) were reviewed for treatment. Physicians received individual and group feedback. Data were dichotomized by age, gender, race and insurance status. Logistic regression analysis modeled variables approaching statistical significance. A total of 1454 patients participated in the study. The aggregate initial treatment rate was 54%, with no subgroup differences. Significant improvements were seen in all sites/subgroups; the final aggregate treatment rate was 84% (P < .001). PED and CED patients were less likely to receive treatment than AED patients (odds ratios = 0.49, 0.68). After feedback, whites were treated more often than were non-whites (84% vs 71%, P < .0001); CED alone did not show this pattern (odds ratios = AED 4.14, PED 2.67, CED1.28). Patients at all sites received improved pain treatment in association with directed feedback. Race and treatment site were significant factors.