Journal Reviews

Baren JM, Shofer FS, Ivey B, et al. A randomized, controlled trial of a simple emergency department intervention to improve the rate of primary care follow-up for patients with acute asthma exacerbations. Ann Emerg Med 2001; 38:115-122.

A brief intervention for asthma patients in the ED resulted in increased follow-up with a primary care physicians, says this study from the Hospital of the University of Pennsylvania in Philadelphia.

A total of 178 ED adult asthma patients were studied, with 83 patients in the control group and 95 in the intervention group. The intervention consisted of three parts: giving patients a free five-day course of prednisone, providing patients with vouchers for transportation to and from the primary care physician, and making a follow-up telephone call within 48 hours to remind the patient to make the appointment.

44 obtained follow-up care

After a month, 44 patients (46.3%) of the intervention group had obtained follow-up care, as compared with 24 (28.9%) patients in the control group. For patients with no prior relationship with a primary care provider, five (17.2%) in the intervention group went for follow-up care, whereas no control group patients did.

The researchers estimate the total cost of the three-part intervention to be approximately $15 per patient. When patients receive follow-up care after their ED visits, it allows the provider to be a more active participant in overall disease management, argue the researchers.

"Adjustments in long-term control or maintenance medications can reduce exacerbation of symptoms and morbidity from asthma, reducing the need for episodic ED care and improving overall quality of life," they wrote.

Zachary MJ, Mulvihill MN, Burton WB, et al. Domestic abuse in the emergency department: Can a risk profile be defined? Acad Emerg Med 2001; 8:796-803.

Clinical presentations and demographic characteristics of female ED patients are not good indicators of domestic abuse, says this study from Bellevue Hospital Center and Montefiore Medical Center, both in New York City. The researchers surveyed 611 female patients in an urban ED. Recent domestic abuse (within the past year) was reported by 48 women (7.9%), and 232 (38%) of the women had been abused recently or in the past.

Victims of recent abuse were likely to include clinical presentations associated with trauma, obstetrical and gynecological syndromes, and psychiatric symptoms and substance abuse. However, these risk factors only predicted 27 (56.3%) of recently abused women. The researchers recommend the following steps:

  • Research the costs and effectiveness of interventions in medical settings.
  • Allocate resources to identify abused women who come to the ED.
  • Implement systems that support routine inquiry about domestic abuse.

"The ideal of routine inquiry about domestic abuse in women in the ED, with subsequent improved identification and intervention, remains a necessary priority," the researchers conclude.

Mahabee-Gittens EM, Grupp-Phelan J, Luria JW, et al. Is routine heparin lock placement beneficial in the evaluation and treatment of febrile children? J Emerg Nurs 2001; 27:335-339.

Although nurses often use intravenous heparin locks (HL) to evaluate fever without a source in children in order to avoid an intramuscular (IM) injection if antibiotics are ordered, this practice did not result in fewer injections, says this study from Children’s Hospital Medical Center in Cincinnati. A retrospective chart review was done for 439 pediatric patients who had laboratory studies for fever without a source, with 345 in the HL group. No significant differences were found in the two groups for the number of needlesticks.

The cost of nursing time to place an HL in a patient who receives antibiotics was $8.71, compared with $2.80 in a patient who receives IM antibiotics. "By extrapolating the numbers of patients who had laboratory evaluation for fever without a source in this study, these costs translate into total costs of $11,471 for patients in the HL group each year, and costs of $3,688 for patients in the non-HL group," they wrote.

This does not take into account patient/parent satisfaction, they add. "The results of this study can be used to help the ED nurse and physician decide if an HL should be placed in this patient population while they are undergoing laboratory evaluation," they conclude.