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I recall rounding on the oncology ward as a medical student. The prognosis in those days was bad for nearly every patient. Children with acute lymphoblastic leukemia were expected to live less than one year. Adults with acute myeloblastic leukemia, less than three months. What a difference in the past three decades.
With longer survival, however, there are more patients presenting with life-threatening emergencies related to their treatment and tumor.
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Keeping costs under control is always an important consideration for ED managers, but in these challenging economic times, it has become critical.
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While a recent severe ice storm in Owensboro, KY, held most of the city in a standstill for several days, well-laid plans for just such a disaster helped keep ED staffing at adequate levels in the Owensboro Medical Health System.
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While the response rate (4.6%) was small, the message delivered in the results of a survey by the Emergency Nurses' Association (ENA) was huge: Significant barriers still remain to compliance with National Patient Safety Goals (NPSGs) in the ED.
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The ED at Catawba Valley Medical Center in Hickory, NC, has realized annual savings in excess of $1 million with the implementation of staffing strategies that involved the virtual elimination of contract staff and overtime for nurses.
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The hiring of physician scribes, known as "clinical information managers," has helped Saddleback Memorial Medical Center, a five-hospital system based in Laguna Hills, CA, to save a significant amount of money by avoiding the hiring of physician assistants (PAs) for its two EDs.
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The ED managers and administrators at Cuyahoga Falls (OH) General Hospital and the Greater Baltimore Medical Center agree that careful attention to design considerations in their new departments significantly improved patient flow and communications among staff members.
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A new initiative at Boston University Medical Center called the Re-Engineered Hospital Discharge Program (RED) has significantly reduced additional ED visits and readmissions.
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This second part concludes our discussion of acute appendicitis, focusing on three patient populations where the diagnosis can be challenging and imaging modalities are commonly used: the elderly, children, and pregnant women.
