5 research outputs found
Improved quality and efficiency after the introduction of physician-led team triage in an emergency department
Background: Overcrowding in the emergency department (ED) may negatively affect patient outcomes, so different triage models have been introduced to improve performance. Physician-led team triage obtains better results than other triage models. We compared efficiency and quality measures before and after reorganization of the triage model in the ED at our county hospital. Materials and methods: We retrospectively compared two study periods with different triage models: nurse triage in 2008 (baseline) and physician-led team triage in 2012 (follow-up). Physician-led team triage was in use during day-time and early evenings on weekdays. Data were collected from electronic medical charts and the National Mortality Register. Results: We included 20,073 attendances in 2008 and 23,765 in 2012. The time from registration to physician presentation decreased from 80 to 33 min (P <0.001), and the length of stay decreased from 219 to 185 min (P <0.001) from 2008 to 2012, respectively. All of the quality variables differed significantly between the two periods, with better results in 2012. The odds ratio for patients who left before being seen or before treatment was completed was 0.62 (95% confidence interval 0.54-0.72). The corresponding result for unscheduled returns was 0.36 (0.32-0.40), and for the mortality rates within 7 and 30 days 0.72 (0.59-0.88) and 0.84 (0.73-0.97), respectively. The admission rate was 37% at baseline and 32% at follow-up (P <0.001). Conclusion: Physician-led team triage improved the efficiency and quality in EDs.Peer reviewe
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Estimating dose鈥攔esponse relationships for vitamin D with coronary heart disease, stroke, and allcause mortality: observational and revised Mendelian randomization analyses
Background: Randomized trials of vitamin D supplementation for cardiovascular disease and all-cause mortality have generally reported null findings. However, generalizability of results to individuals with low vitamin D status is unclear. We characterized dose鈥攔esponse relationships between 25 hydroxyvitamin D [25(OH)D] concentrations and risk of coronary heart disease (CHD), stroke, and all-cause mortality in observational and Mendelian randomization frameworks.
Methods: Observational analyses were conducted in 33 prospective studies comprising 500,962 individuals with no known history of CHD or stroke at baseline. Mendelian randomization analyses were conducted in four population-based cohort studies comprising 386,406 middle-aged individuals of European ancestries, including 33,546 CHD cases, 18,166 stroke cases, and 27,885 deaths.
Findings: Observational analyses suggested threshold relationships for incident CHD, stroke, and mortality outcomes. In population-wide genetic analyses, there were no associations of genetically-predicted 25(OH)D with CHD (odds ratio [OR] per 10 nmol/L higher genetically-predicted 25(OH)D concentration 0路98, 95% confidence interval [CI] 0路95-1路01), stroke (OR 1路01, 95% CI 0路97-1路05), or all-cause mortality (OR 0路99, 95% CI 0路95-1路02). Null findings were also observed in genetic analyses for cause-specific mortality outcomes, and in stratified genetic analyses for all outcomes at all observed levels of 25(OH)D concentrations.
Interpretation: Stratified Mendelian randomization analyses suggest a lack of causal relationship for 25(OH)D concentrations with both cardiovascular and mortality outcomes for individuals at all levels of 25(OH)D. Our findings suggest that substantial reductions in mortality and cardiovascular morbidity due to long-term low-dose vitamin D supplementation are unlikely even if targeted at individuals with low vitamin D status