Demand for hospital emergency departments: a conceptual understanding

BACKGROUND: Emergency departments (EDs) are critical to the management of acute illness and injury, and the provision of health system access. However, EDs have become increasingly congested due to increased demand, increased complexity of care and blocked access to ongoing care (access block). Congestion has clinical and organisational implications. This paper aims to describe the factors that appear to infl uence demand for ED services, and their interrelationships as the basis for further research into the role of private hospital EDs. DATA SOURCES: Multiple databases (PubMed, ProQuest, Academic Search Elite and Science Direct) and relevant journals were searched using terms related to EDs and emergency health needs. Literature pertaining to emergency department utilisation worldwide was identified, and articles selected for further examination on the basis of their relevance and significance to ED demand. RESULTS: Factors influencing ED demand can be categorized into those describing the health needs of the patients, those predisposing a patient to seeking help, and those relating to policy factors such as provision of services and insurance status. This paper describes the factors influencing ED presentations, and proposes a novel conceptual map of their interrelationship. CONCLUSION: This review has explored the factors contributing to the growing demand for ED care, the influence these factors have on ED demand, and their interrelationships depicted in the conceptual model

Discovery of an extra hard spectral component in the high-energy afterglow emission of GRB 130427A

The extended high-energy gamma-ray (>100 MeV) emission occurred after the prompt gamma-ray bursts (GRBs) is usually characterized by a single power-law spectrum, which has been explained as the afterglow synchrotron radiation. The afterglow inverse-Compton emission has long been predicted to be able to produce a high-energy component as well, but previous observations have not revealed such a signature clearly, probably due to the small number of >10 GeV photons even for the brightest GRBs known so far. In this Letter, we report on the Fermi Large Area Telescope (LAT) observations of the >100 MeV emission from the very bright and nearby GRB 130427A. We characterize the time-resolved spectra of the GeV emission from the GRB onset to the afterglow phase. By performing time-resolved spectral fits of GRB 130427A, we found a strong evidence of an extra hard spectral component that exists in the extended high-energy emission of this GRB. We argue that this hard component may arise from the afterglow inverse Compton emission.Comment: 5 pages, 2 figures, 2 tables, ApJL, in pres