Journal Reviews
Journal Reviews
Gulla J, Singer AJ. Use of alternative therapies among emergency department patients. Ann Emerg Med 2000; 25:226-228.
This study from the State University of New York at Stony Brook says most ED patients sampled had tried alternative therapies, but most did not inform their physicians, says. Here are the study’s key findings:
• Of 139 patients surveyed, 56% had tried alternative therapies.
• The most frequently tried alternative therapies were massage therapy (31%), chiropractic (30%), herbs (24%), medication (19%), and acupuncture (15%).
• Most patients (70%) who tried alternative therapies did not inform their physicians.
The numbers are slightly higher than others reported by previous studies, note the researchers. This change might reflect the continually increasing use of alternative therapies, or the fact that symptomatic patients in the ED are more likely to use alternative therapies than asymptomatic individuals surveyed by telephone, they suggest.
ED patients should be routinely questioned about the use of alternative therapies, particularly herbal preparations, which may cause adverse effects, the researchers advise. "Most important to emergency practice is herbal use because of the propensity for adverse effects that may be relevant to the patient’s presenting condition," they say. For example, severe bleeding has been reported in patients using extracts of gingko biloba in combination with anticoagulants: "In our ED, we are adding use of alternative therapies to our structured histories."
Watson WT, Marshall ES, Fosbinder D. Elderly patients’ perceptions of care in the emergency department. J Emerg Nurs 1999; 25:88-92.
A need for more information about their care was expressed by elderly patients visiting the ED at Utah Valley Regional Medical Center in Provo, UT, says this study. Elderly patients visit the ED more than the general population, so pay attention to their perceptions and satisfaction, the researchers advise. Twelve elderly patients were interviewed about their experience in the ED, and five themes became apparent, including the following two concerns:
• Need for information. Patients expressed a need to understand specific care and treatment processes, what they could expect, and whether their condition was serious or might worsen.
• Personal tolerance. Elderly patients were understanding about the needs of patients in the ED.
The researchers recommend the following practice changes to improve care of the elderly in the ED:
— A comprehensive geriatric triage program by geriatric nurses, where triage includes both assignment for acute treatment and discharge planning with home care agencies and other community services.
— A geriatric consultation team in the ED that assesses needs of elderly patients regarding hospital admission, community services, or both.
— Improvement of training of nurses and physicians in the care of geriatric patients in the ED. t
Hsieh M, Gutman M, Haliscak, D. Clinical clearance of cervical spinal injuries by emergency nurses. Acad Emerg Med 2000; 7:342-347.
Nurses unsafely clinically cleared 5% of cervical spinal injuries, according to this study from the University of Connecticut in Farmington, Bristol (CT) Hospital, and St. Francis Hospital in Hartford, CT.
"These data suggest that the potential of an increased number of missed injuries using nursing clearance without physician supervision would have offset the potential benefits of more prompt removal of cervical spinal precaution in a third of the study patients," they say.
A large number of asymptomatic patients are subjected to the cost and discomfort of cervical spinal immobilization and radiography because physicians are afraid of missing occult cervical injuries, say the researchers. This is the first study that has looked at ED nurses’ ability to clinically clear cervical spinal injuries. Patients may be immobilized for a long time before physician evaluation, and waits could be decreased if ED nurses could clear these injuries, say the researchers.
Blunt trauma patients arriving with cervical spine precautions were included in the study. Each member of a ED physician-nurse pair completed a questionnaire about five criteria for clinically clearing the cervical spine for each patient. Physicians and nurses agreed on the presence or absence of the combined criteria in 175 of 211 patients (82.9%). If the nurses assessed the patients before physicians, they would have cleared 35% of the patients before the physicians. These patients could have had their cervical spinal immobilization removed prior to physician evaluation, since they lacked all of the risk criteria as judged by both the nurse and physician, say the researchers.
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