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To compare efficiency and cost-effectiveness of an observation unit (OU) when managed as a closed unit vs an open unit.This observational, retrospective study of a 30-bed OU compared three time periods: Nov 2007 to Aug 2008 (period 1), Nov 2008 to Aug 2009 (period 2) and Nov 2010 to Aug 2011 (period 3). The OU was managed and staffed by non-emergency department physicians as an open unit during period 1, and a closed unit by emergency department physicians during periods 2 and 3.OU volume was greatest in period 3 (1 vs 3, 95% CI -235.8 to -127.9; 2 vs 3, 95% CI -191.9 to -84.095%). Periods 2 and 3 had shorter lengths of stay for discharged (1 vs 2, 95% CI -6.6 to 1.7; 1 vs 3, 95% CI -8.1 to -3.1) and admitted (1 vs 2, 95% CI -11.4 to -8.6; 1 vs 3, 95% CI -11.8 to -9.0) patients, less admission rates (P.001), and less 30-day all cause admission rates after discharge (P.0001). Cost was less during periods 2 and 3 for direct (1 vs 2, 95% CI -392.5 to -305.9; 1 vs 3, 95% CI -471.4 to -388.4), indirect (1 vs 2, 95% CI -249.5 to - 199.8; 1 vs 3, 95% CI -187 to-139.4) and total cost (1 vs 2, 95% CI -640.7 to -507; 1 vs 3, 95% CI -657.2 to -529).The same OU was more efficient and cost-effective when managed as a closed unit vs an open unit.

When an infectious pandemic occurs in the United States,emergency care providers (ECPs) will be on the frontlines caring for infected,potentially infected,and non-infected patients.Logistically,the current emergency care system is not ready for a pandemic,but are the providers ethically ready? Some of the most difficult and challenging issues that will be raised during a pandemic will be ethical in nature.An ECP likely will be confronted with ethical values and value conflicts underlying restriction of liberty,duty to care,and resource allocation. This report summarizes the ethical concerns and challenges that ECPs face during an infectious pandemic,and raises ethical questions that may arise related to the role of an ECP as a healthcare provider and stakeholder. Pena ME;Irvin CB;Takla RB:Ethical considerations for emergency care providers during pandemic influenza—Ready or not…Prehospital Disast Med 2009;24(2):115‐119.

When an infectious pandemic occurs in the United States, emergency care providers (ECPs) will be on the frontlines caring for infected, potentially infected, and non-infected patients. Logistically, the current emergency care system is not ready for a pandemic, but are the providers ethically ready? Some of the most difficult and challenging issues that will be raised during a pandemic will be ethical in nature. An ECP likely will be confronted with ethical values and value conflicts underlying restriction of liberty, duty to care, and resource allocation. This report summarizes the ethical concerns and challenges that ECPs face during an infectious pandemic, and raises ethical questions that may arise related to the role of an ECP as a healthcare provider and stakeholder.

An inverse correlation has been reported between motor vehicle crash mortality rate (MVCMR) and population density. The reasons for this are unknown, but variations in prehospital and hospital resources are a possible explanation.Hypothesis:Densities of prehospital and hospital resources correlate inversely with motor vehicle crash mortality rates.Methods:Data regarding population, area, number of motor vehicle deaths, and number and types of hospital and prehospital care resources for 1987, were obtained from the Michigan State Department of Public Health and transformed to create measures of resource per square mile by county. Correlation coefficients were computed between motor vehicle death rate and medical resource densities.Results:Small negative correlations were seen for all variables. Correlation coefficients ranged from -0.224 (EMTs per sq mi) to -0.167 (beds per sq mi). Only the coefficient for EMTs per square mile was statistically significant (p=0.043).Conclusion:Small negative correlations exist in Michigan counties between MVCMR and medical resources. We conclude that only a small proportion of MVCMR variation can be accounted for by the density of medical resources.