Schull MJ, Mamdani MM, Fang J. Community influenza outbreaks and emergency department ambulance diversion. Ann Emerg Med 2004; 44:61-67.

Influenza outbreaks are linked with increased ED ambulance diversion, says this study from University of Toronto.

Researchers did a retrospective study in Toronto from 1996 to 1999 to see if influenza outbreaks resulted in more hours on diversion. For every 100 cases of influenza in the community, ED ambulance diversion increased by 2.5 hours per week. Throughout the four influenza seasons during the study, the average ED experienced 83 hours of additional diversion, which comprises 24% of the diversion that actually occurred during that period.

"Our study suggests that influenza in the community leads to brief, but substantial, worsening of ED ambulance diversion," the researchers write.

To reduce diversion hours during influenza outbreaks, they suggest the following:

  • promote influenza vaccinations throughout the community;
  • provide alternatives to the ED for medical care of patients with influenza complications;
  • improve access to inpatient beds to free up the ED.

Kline JA, Webb WB, Jones AE, et al. Impact of a rapid rule-out protocol for pulmonary embolism on rate of screening, missed cases, and pulmonary vascular imaging in an urban U.S. emergency department. Ann Emerg Med 2004; 44:490-502.

A rapid rule-out protocol doubled the number of ED patients evaluated for pulmonary embolism and increased positive scans from 8% to 11%, says this study from Carolinas Medical Center in Charlotte, NC.

The researchers compared results on all patients with suspected pulmonary embolism before and after the screening tool was implemented and found that length of stay decreased from 297 minutes from 385 minutes, and the number of missed diagnoses did not increase. Missed or delayed diagnosis of pulmonary embolism is a common cause of malpractice claims, and delay in diagnosis contributes to death and disability, note the researchers. They estimate the cost of materials needed at less than $3,500, with a cost per patient tested of under $20, as long as an arterial blood gas-analyzing machine is available in the ED.

"The present data show that a point-of-care clinical protocol doubled the number of patients evaluated for pulmonary embolism without increasing radiologic testing or ED length of stay," the researchers conclude.