11/10/2023 0 Comments Monica beamer md![]() Stanford Institute for Economic Policy Research (SIEPR).Institute for Stem Cell Biology and Regenerative Medicine.Institute for Human-Centered Artificial Intelligence (HAI).Institute for Computational and Mathematical Engineering (ICME).Freeman Spogli Institute for International Studies.Stanford Doerr School of Sustainability.Jakubowski, RN, and Sue Healy, RN, Yale-New Haven Hospital, New Haven, Connecticut. Denise Acampora, MPH, John Mellors, MD, Kathryn Trainor, MS, Rita M. Hedges, MD, and Beth Goldstein-Wayne, RN, University of Cincinnati Hospital, Cincinnati, Ohio Michael Kobernick, MD (site of director), and Daniel Jones, BA, William Beaumont Hospital, Royal Oak, Michigan and Donald A. Rouan, MD (site director), Robert Toltzis, MD, Jerris R. Mary’s Hospital, Waterbury, Connecticut Gregory W. Rosen, BA, Brigham and Women’s Hospital, Boston, Massachusetts George Terranova, MD (site director), Carol Stasiulewicz, PA, and David Copen, MD, Danbury Hospital, Danbury, Connecticut Alan Brandt, MD (site director), and Jay Walshon, MD, Milford Hospital, Milford Connecticut Louis Gottlieb, MD (site director), St. Weisberg, RN, BS, Karen Daley, BSN, and Barbara C. The Chest Pain Study Group includes Lee Goldman, MD (co-principal investigator). Kaiser Family Foundation Faculty Scholar in General Internal Medicine. Rouan is a Teaching and Research Scholar of the American College of Physicians. Lee is the recipient of a Public Health Service Clinical Investigator Award (HL01594-01) from the National Heart, Lung, and Blood Institute. Supported in part by a grant (83102-2H) from the John A. Boston, Massachusetts Yale-New Haven Hospital and Yale University School of Medicine, New Haven Connecticut and the University of Cincinnati Hospital and University of Cincinnati, Cincinnati, Ohio. Received from Brigham and Women’s Hospital and Harvard Medical School. The threat to sign out against medical advice. Ann Emerg Med (in press)Īlbert HD, Kornfeld DS. A chest pain clinic to improve the follow-up of patients released from an urban university teaching hospital emergency department. Rouan GW, Hedges JR, Toltzis R, Golstein-Wayne B, Brand DA, Goldman L. Diagnostic implications of the circadian variation of the onset of chest pain. Ann Intern Med 1987 106:181–6īeamer AD, Lee TH, Cook EF, et al. Sensitivity of routine clinical criteria for diagnosing myocardial infarction within 24 hours of hospitalization. Clinical characteristics and natural history of patients with acute myocardial infarction sent home from the emergency room. Evaluation of creatine kinase and creatine kinase-MB for diagnosing myocardial infarction. Lee TH, Weisberg MC, Cook EF, Daley K, Brand DA, Goldman L. Identification and examination of low-risk patients. Lee TH, Cook EF, Weisberg M, Sargent RK, Wilson C, Goldman L. ![]() A computer-derived protocol to aid in the diagnosis of emergency room patients with acute chest pain. Goldman L, Weinberg M, Weisberg M, et al. Men patients who leave a general hospital against medical advice mortality rate within six months. Leaving the hospital against medical advice. Diagnostic correlates of discharge against medical advice. The authors conclude that patients who left against medical advice had presentations and prognoses that were in between those of patients for whom admission was not recommended and those of patients who consented to be admitted. The only death within one month was that of a patient who died suddenly out-of-hospital later on the day of his emergency department visit. ![]() Fourteen patients (12%) were hospitalized within three days of their original emergency department visits, and three patients had documented acute myocardial infarctions. Survival data were obtained at 48–72 hours for 104 patients (97%) and at one month for 101 patients (94%). ![]() Specific follow-up plans were made at the time of evaluation for 45 patients (42%). In comparison with other emergency department patients with acute chest pain, patients who left against advice had findings that suggested they were at higher risk for myocardial infarction than patients for whom admission was not recommended but at lower risk than patients who consented to be admitted. The study group identified 107 patients who left against advice from the emergency departments of three university and four community hospitals after presenting for evaluation of acute chest pain.
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