Local EDs Research Articles

Structure and Properties of the Xerogels Based on Potassium Silicate Liquid Glass and Urea.

The xerogels based on the aqueous solutions of urea in potassium silicate liquid glass (PSLG) were produced by CO2 bubbling and investigated. The structure and chemical composition of the obtained materials were analyzed. Using the SEM, XRD, IR-FT, DSC, and low energy local EDS analysis, it was recognized that the dried gels (xerogels) contained three forms of urea: oval crystals of regular shape appeared onto the surface of xerogel particles; fibrous crystals were located in the silicate matrix; and molecules/ions were incorporated into the silicate matrix. It was shown that an increase in [(NH2)2CO] in the gel-forming system promoted increased contents in crystalline forms of urea as well as the diameter of the fiber-shaped urea crystals. A rate of the urea release in water from the granulated xerogels containing 5.8, 12.6, and 17.9 wt.% of urea was determined by the photometric method. It was determined that the obtained urea-containing xerogels were characterized with a slow release of urea, which continued up to 120 days, and could be used as controlled release fertilizers containing useful nutrients (N, K).

A Study on Evaluation Methods of Conserving Painted Sculpture

A lot of individual research on materials and methods suitable for the color of the paint layer has been conducted in the conservation of existing painted sculptures. However, there was no guidance standard for conservation treatment and repainting of painted sculptures, and an evaluation method for objective conservation management was required as deterioration continued in the outdoors. Therefore, in this study, the conservation treatment effect was confirmed by comparing and evaluating the physical properties of the original paint and the replacement paint by citing two cases. Based on the survey items : SEM observation (a cross-section and surface defect) and local EDS analysis, comparison of chromaticity and color difference, evaluation of adhesion and adhesive bond strength, and a salt spray test, a condition status table was prepared and applied to the specimen. Based on the results of applying the completed condition status table in the future, it is judged that it can be an objective data onto conservation treatment of outdoor painted sculptures and public artworks.

Effect of Filler Wire Feed Rate on the Formation of Porosity in Laser Welded Joints of Magnesium Alloy AZ31B–H24

In this work, the effect of a filler wire feed rate was studied with special attention to the proportion of porosity volume in the weld metal, microstructure, and mechanical properties. Butt laser weld joints were created using the Nd:YAG laser. Weld joints were produced with the AZ31 filler wire with a diameter of 1.2 mm. Decreasing the filler wire feed rate of the filler wire led to an increase in the porosity of the weld metal. Therefore, porosity is more likely to occur in laser welding without the use of a filler wire. Clear segregation of aluminium, manganese, and zinc was observed in the EDS maps and the local EDS line profile measurements. The precipitates formed were rich in Al and Mn or Al and Zn, compared to the matrix. They also show a large decrease in Mg content to minimum values ranging from 10 to 60 wt.% in the precipitates. To investigate pores in the weld metal of the weld joint, computed tomography was used. The highest volume of porosity was measured in weld joint no. 3. (0.63 mm3). On the contrary, the lowest porosity volume was detected in weld joint no. 1. (0.06 mm3). The largest width of the weld metal (2.25 mm) was measured if the filler wire feed rate was 130 cm/min. The highest average microhardness (82.5 HV0.1) was recorded in the weld metal of weld joint no. 1. In weld joint no. 3, a fracture occurred in the weld metal and the measured tensile strength was only 154 MPa.

62 Network Analysis To Understand Regional Patient Flow

Consolidation of health care systems in the United States has created integrated enterprises with large geographical reach and complex interacting components. Specialty services vary among sites, and patients often need to travel between facilities for different aspects of care. Network science is an established method employed to investigate these complex systems, and can be used to identify bottlenecks, opportunities to increase value and patient-centeredness in health care. The COVID-19 pandemic changed care demand patterns unexpectedly. We wanted to investigate if network analysis would allow us to better understand these changes and challenges - where our patients receive hospital-based care, what services they used and how far they travelled. We focused this analysis on a multispecialty, tertiary care academic center emergency department (“AC_ED”), with 70,000 patient visits annually. We extracted patient location information from electronic health records, including originating location and level of care, to create a network representation of all care pathways that passed through our ED. The volume of transfers between nodes and the distance travelled were encoded as weighted/colored edge attributes, with edges between nodes in closer proximity being darker. Nodes include: communities within our service area, EDs, and academic center units, and an outcome of mortality. They are sized/colored by betweenness centrality, reflecting the importance of the node in the integrity of the network. The figure shows the overall network structure was similar for pre- and post-pandemic onset with some changes in details. AC_ED receives patients from many home locations and referring hospitals. A large proportion of visits come from the local area reflected by M16 and M12. There are many patients who travel far to access emergency care at AC_ED, bypassing local EDs though the average distance travelled to access care reduced from 114 to 85 miles. During the pandemic there was more traffic to the AC_ED from the local area (M16), fewer connections to surrounding hospitals and disproportionately reduced visits from distant areas (O and OT). Low ED volumes and restricted outpatient clinic availability during the pandemic time frame likely affected this. Inter-hospital transfer volumes declined overall, several sites transferred very few patients to AC_ED post-pandemic start, and other sites increased their transfer rate (eg, CAH13). Looking at hospital systems through the lens of network science can reveal changes in patterns of referrals, allows for identification of unexpected results by presenting data visually and can assist identifying crucial components of a health care system. Application of this methodology to other variables has the potential to identify new areas of improvement to increase value, outcomes and services to improve patient-oriented care.

Longitudinal description and evaluation of an emergency department avoidance strategy for a youth mass gathering (Schoolies) in Australia.

ED avoidance strategies including In-Event Health Service (IEHS) processes during mass gathering events (MGEs), such as 'Schoolies week', may be important for EDs, ambulance services, the local population, and attendees. The aim of the present study was to provide a longitudinal description of emergency care requirements for young adults (16-18 years old); focussing on the impact of the Schoolies MGEs. This retrospective observational study included youth (16-18 years) presentations made (i) to local public EDs during Schoolies week in 2008-2014 and (ii) to local EDs over a 3-week period (pre, during, post-Schoolies week) and the IEHS in 2015 and 2016. Descriptive and inferential statistics were undertaken. Youth presentations (n = 4256) were included. Presentation rates/1000 fluctuated over time (range 6.2-21.2). The IEHS provided care for 167 and 288 youth during 2015 and 2016 Schoolies week, respectively. Demographic factors (gender, age, region domiciled) and episode of care factors (time of presentation, mode of arrival, urgency, time to triage, time to be seen by a clinician and length of stay) between 2008 and 2016 varied by year. Toxicology (alcohol and other drugs), trauma, and mental health concerns were the most common diagnoses. The IEHS, operational during Schoolies, appeared to reduce pressures on local EDs by offering rapid, targeted care for potentially vulnerable youth; decrease requirements for hospital transport and minimise impacts on care provision for the local community. Given increases in ED crowding and pressures on ambulance services, such care models may be worth considering for other types of MGEs and in other locations.

What do adolescents want from their ED? An evaluation on the preferences and opinions of adolescents attending local EDs

IntroductionThe adolescent population comprises a significant proportion of attendances to the ED. Despite adolescent patients reporting lower levels of healthcare satisfaction compared with other age groups, their opinions are under-represented...

Abstract WP50: Potential Impact of Triage Using Non-Contrast Head CT and Stroke Severity on a Regional Stroke System of Care: A Population-Based Study

Background and Purpose: Acute ischemic stroke (AIS) patients may benefit from endovascular therapy (EVT) up to 24 hours since last known normal (LKN). Advanced imaging, including CT or MR angiography and perfusion studies, is required for patient selection. Large non-thrombectomy centers may be able to obtain and interpret these images quickly, but smaller hospitals may not have sufficient real-time CT technician and radiology support. We estimated transfer rates using non-contrast head CT and stroke severity to select patients to be transferred to larger centers for evaluation. Methods: We identified all AIS among residents of the Greater Cincinnati/Northern Kentucky Stroke Study region in 2010 comprising approximately 1.3 million people. Study nurses abstracted relevant information from the medical record, including times of symptom onset, LKN, and ED arrival, and all cases were verified by study physicians. Only cases age ≥18 with baseline mRS 0-2 that presented to an ED were included. Among cases that presented between 6 and 24 hours from LKN, those without evidence of acute infarct on head CT and with initial NIHSS ≥6 or ≥10 were identified. Results: Of 1359 AIS cases at local EDs, 448 (33.0%) presented between 6 and 24 hours, of which s383 (85.5%) showed no evidence of acute infarct on CT. Of cases with no acute infarct on CT, 89/383 (23.2%) had NIHSS ≥6, of which 66 (74.2%) initially presented to a hospital without thrombectomy capabilities; and 51/383 (13.3%) had NIHSS ≥10, of which 40 (78.4%) presented to a non-thrombectomy hospital. Conclusions: From 6 to 24 hours after stroke onset within our population, 40-66 AIS patients annually (0.8-1.3/week, or 3-5 patients per 100,000 persons per year) may present to non-thrombectomy hospitals and need to be transferred using non-contrast CT and stroke severity as screening tools. Such an approach may sufficiently mitigate the impact of delays in treatment on outcomes, without overburdening the referring nor accepting hospitals.

The effect on the patient flow in local health care services after closing a suburban primary care emergency department: a controlled longitudinal follow-up study

BackgroundIt has not been studied what happens to patient flow to EDs and other parts of local health care system if distances to ED services are manipulated as a part of health policy in urban areas.MethodsThe present work was an observational and quasi-experimental study with a control and it was based on before-after comparisons. The impact of terminating a geographically distant suburban primary care ED on patient flow to doctors in local public primary care EDs, office-hour primary care, secondary care EDs and in private primary care was studied. The effect of this intervention was compared with a primary care system where no similar intervention was performed. The number of monthly visits to doctors in different departments of health care was scored as the main measure of the study in each department studied (e.g. in primary care EDs, secondary care ED, office-hour public primary care and private primary care). Monthly mortality rates were also recorded.ResultsIncreasing the distance to ED services by terminating a peripheral ED did not cause an increase in the use of local office-hour services in those areas whose local ED was terminated, although use of ED services decreased by 25% in these areas (P < 0.001). The total use of primary care doctor services rather decreased - if anything - after this intervention while use of doctor services in secondary care ED remained unaffected. Doctor visits to the complementary private primary care increased but this was probably not associated with the intervention because a simultaneous increase in this parameter was observed in the control. There was no increased mortality in any age groups.ConclusionManipulating distances to ED services can be used to direct patient flows to different parts of the health care system. The correlation between distance to ED and the tendency to use ED by inhabitants is negative. If secondary care ED was available there were no life-threatening side-effects at the level of general public health when a minor ED was closed in a primary care ED system.

Formation of sol-gel based Cu2ZnSnS4 thin films using ppm-level hydrogen sulfide

This study reports the preparation of copper zinc tin sulfide (Cu2ZnSnS4 or CZTS) thin films using parts-per-million (ppm) level of hydrogen sulfide (H2S) gas as opposed to high percentage level of H2S (e.g., ≥5%) in many other studies. Sol-gel technique was adopted for the preparation of metal oxide films from precursor solutions with different ratios of Cu, Zn, and Sn metal ions. Sulfurization process was carried out in tube furnace using 100ppm H2S balanced by hydrogen at different temperatures. Generally, it was observed that the sulfur content of the thin films obtained showed strong dependence on the sulfurization temperature. Samples sulfurized at higher temperatures (e.g., ~450 and 550°C) in ppm-level H2S experienced significant sulfur loss as confirmed by EDS, which was accompanied by the formation of metal alloys such as Cu3Sn as identified by XRD. On the other hand, samples sulfurized at lower temperatures of ~350°C and even 125°C revealed the formation of CZTS phase as confirmed by XRD, Raman micro-spectroscopy, and sheet resistance measurement. Moreover, local EDS analysis indicates that CZTS films prepared at those low temperatures have near-stoichiometric composition and are sometimes accompanied by the formation of Cu2−xS phase(s). In addition, stoichiometric and Cu-rich precursor solutions tend to yield CZTS samples with better crystallinity and superior optical properties compared with the Cu-deficient solution. These results are discussed from thermodynamics perspective and the directions for future research for safer and more economical processing of CZTS solar cells are pointed out.

Obstacle course runs: review of acquired injuries and illnesses at a series of Canadian events (RACE)

BackgroundThe growing popularity of obstacle course runs (OCRs) has led to significant concerns regarding their safety. The influx of injuries and illnesses in rural areas where OCRs are often held...

Co@CoSb Core–Shell Nanorods: From Chemical Coating at the Nanoscale to Macroscopic Consolidation

Core–shell magnetic anisotropic particles were prepared by reduction of Sb acetate at the surface of cobalt nanorods dispersed in a solution consisting of 1,2 tetradecanediol in oleylamine. X-ray diffraction and local EDS analyses revealed a thin β-CoSb shell with a controlled thickness ranging from 5 to 15 nm that depended on the Sb/Co molar ratio and the reduction temperature. The shell completely coats the rod surface but does not alter the shape anisotropy or the hcp structure of the cobalt cores, and the hard magnetic properties are preserved after coating with a coercivity higher than 3 kOe. Consolidated nanostructured materials that exhibit properties of permanent magnets were prepared by compaction of the core–shell Co@CoSb nanorods. The thin CoSb shell was very efficient for preventing the cobalt anisotropic core from sintering at high temperatures (up to 300 °C) and high pressures (up to 1.5 GPa). These results indicate that the bottom-up approach is very promising for preparation of nanostructu...

Emergency department triage performance timing. A regional multicenter descriptive study in Italy

ObjectivesWe explored the time employed by nurses to perform the ED triage process in the clinical setting. Moreover, we assessed the influences on triage timing performance exerted by variables related to nurses, local EDs' features, and by interruptions. MethodsThis is a multicenter prospective descriptive-explorative study performed in 11 EDs of the Tuscany region (Italy), using a 5 tier triage system. The sample was made up of 1/3 of nurses working in each ED. Sampling was performed by a stratified proportional randomization (length of service classes: <5 years; 5–10 years; >10 years). Triage nurses were observed during their triage work-shift. ResultsIn 2014, 120 nurses were observed, during 1114 triage processes. The timings of triage phases were: waiting time to triage, median 2.55 min (IQR 1.28–5.03 min; range 0.1–56.25 min); triage duration, median 2.58 min (IQR 1.36–4.35 min; range 0.07–50 min). 400 interruptions were recorded (35.9%). In 9.9% there were 2 interruptions at least. There were significant differences in the medians of triage duration among the years of nurses' triage experience (P < 0.001). The presence of interruption was significantly associated with the increasing of the time intervals in all the triage phases (P < 0.0001). Finally, we recorded significant differences in all the triage time phases between the EDs. ConclusionWe found that the nurses triage time performances are similar to other triage systems in the world.

Providing Rural Care, Remotely: Avera’s eCare Initiative

Providing Rural Care, Remotely: Avera’s eCare Initiative

Shorter Ischaemic Time and Improved Survival with Pre-hospital STEMI Diagnosis and Direct Transfer for Primary PCI

We sought to determine if our regional program for pre-hospital STEMI diagnosis and direct transfer for primary PCI (PPCI) was associated with shorter ischaemic times and improved survival compared with ED diagnosis. STEMI diagnosis was made at the scene by pre-hospital ECG or in local EDs depending on patient presentation. Ambulance ECGs were transmitted to our ED for cath lab activation. Patient variables and outcomes at 12 months were recorded. We treated 782 consecutive patients with PPCI during January 2008-June 2013. Cath lab activation was initiated prior to hospital arrival (pre-hospital) in 24% of cases and by ED in 76% of cases. Median total ischaemic time was 154 min for pre-hospital and 211 minutes for ED patients (p<0.0001). Mortality at 12 months was 7.9% in the ED group compared with 3.7% in the pre-hospital group (p=0.036). On multivariate Cox regression analysis including baseline and procedural variables, pre-hospital activation remained an independent predictor of mortality (HR 0.45, 95% CI 0.20-1.0, p=0.03). Pre-hospital diagnosis of STEMI and direct transfer to the cath lab reduced total ischaemic time by 57 minutes and mortality by >50% following PPCI. Further efforts are needed to increase the proportion of STEMI patients treated using this strategy.

Indium Zinc Oxide Pyramids with Pinholes and Nanopipes

Micropyramids of zinc-doped indium oxide have been grown by thermal treatments of compacted InN and ZnO powders at temperatures between 700:and 900 degrees C Under argon flow. X-ray diffraction (XRD) measurements and energy-dispersive X-ray (EDS) mappings as well as local EDS spectra enable the identification of rough surfaces of the pyramids with the nucleation of a shell of nanocrystallites with high Zn/In ratio because of the formation of Zn(k)In(2)O(k+3). Some of the pyramids have a truncated tip with pinholes with regular crystalline facets. The apexes of these pinhole's present a hollow core or nanopipe The possible relation of the nanopipes with a dislocation driven growth is discussed. A growth model is proposed from the morphology evolution of the pyramids during the formation of the In(2)O(3)-ZnO (IZO) compound X-ray photoelectron spectroscopy and microscopy (XPS-ESCA) Measurements are used to discuss the Zn incorporation as a dopant and the formation of Zn(k)In(2)O(k+3) ternaries. Cathodoluminescence (CL) in the scanning electron microscopy (SEM) shows a dependence of the luminescence of the microstructures on the Zn concentration and the growth temperature.

Spectroscopic and Topographic Investigations of Nanoparticle Abrasive retention in Polyurethane CMP Pads for Cu CMP

ABSTRACTA spectroscopic and topographic investigation of abrasive nanoparticle retention in polyurethane chemical mechanical planarization (CMP) pads has been carried out as a function of ex situ pad conditioning parameters for Cu CMP. X-ray photoelectron spectroscopy (XPS) and scanning electron microscope energy dispersive spectroscopy (SEM-EDS) were utilized to quantitatively characterize the presence of alumina nanoabrasive in the pad following Cu CMP. As expected, conditioning did not modify the overall pad morphology but did increase local asperity roughness with increasing conditioner downforce. As expected, the magnitude of the conditioner downforce reduced the overall average alumina nanoabrasive retention, albeit weakly, as determined via XPS. However, local EDS analysis revealed that increased downforce does significantly reduce nanoabrasive retention at pad asperities. In contrast, increased downforce increased the amount of nanoabrasive present in the polyurethane pad surface pores. Moreover, overall conditioning time was shown to be a more dominant parameter compared to conditioner downforce regarding removal of abrasive particles from both pad asperities and pores.

Emergency medical services for children: A general pediatrician's perspective

The EMSC movement is still in its infancy, and there is much that remains to be done. The primary care pediatrician plays a major role in the EMSC system and should continue to advocate for efficient, high-quality pediatric emergency care. In summary, there are several ways that the office-based pediatrician can and should become involved with EMSC: 1. Pediatricians should emphasize safe and injury prevention at each health maintenance visit throughout a child's life. 2. Pediatricians should encourage all parents to become certified in BLS/CPR. Ideally, training in CPR should be provided during prenatal and childbirth classes. 3. Pediatricians should advocate for injury prevention and safety campaigns in their communities. They can also become involved with efforts to develop legislation dealing with issues in injury prevention and safety. 4. Pediatricians should ensure that all children receive the appropriate immunizations. 5. Pediatricians need to maintain office emergency preparedness. All office personnel should maintain certification in BLS as a minimum and ideally, PALS. Equipment used for pediatric resuscitation should be available and functional. Monthly mock codes should be scheduled to ensure that all personnel clearly know their roles and responsibilities in the event of an emergency. 6. Pediatricians should maintain their skills in emergency pediatrics. In addition, they should maintain certification in PALS. Continuing medical education (CME) workshops and conferences in emergency pediatrics are available throughout the year. Also, pediatricians can maintain their airway management skills by practicing endotracheal intubation in the operating room setting. 7. Pediatricians must become familiar with the prehospital care providers, EDs, and transport services in their communities. Association with a pediatric intensive care unit at a tertiary care center would also be beneficial. 8. Pediatricians must be available for consultation to local EDs. They must realize that, in many instances, they may represent the physician who is most experienced with caring for the critically ill or injured child. 9. Pediatricians can serve as medical advisors to the EMS systems in their communities. 10. Pediatricians should stay well informed on issues pertaining to EMSC.

Prospective Identification and Triage of Nonemergency Patients Out of an Emergency Department: A 5-Year Study

Study objective: To determine whether nonemergency patients can be prospectively identified by triage nurses and safely triaged out of the emergency department without treatment. Methods: All adult patients (16 years or older) who presented to a university ED were provided an evaluation by a triage nurse. For a patient's case to be defined as nonemergency, four criteria were required: vital signs within a specific range, presence of 1 of 50 potentially nonemergent chief complaints, absence of key indicators found on screening examination, and absence of chest pain, abdominal pain, any severe pain, and inability to walk. Between July 1988 and July 1993, patients who satisfied these criteria were defined as nonemergency, refused care in the ED, and triaged out of the ED. Patients were referred to off-site clinics. The clinics had agreed to see patients in advance of the study, and the referral lists were frequently updated. Outcome data were obtained by telephone surveys to both triaged individuals and other health care providers. Results: In this 5-year study, 176,074 adults presented to the ambulatory triage area in the ED, and 31,165 (18%) were defined as nonemergency, were not treated, and were referred elsewhere. Letters and telephone calls to all referral clinics, eight local EDs, and the coroner's office identified no instances of gross mistriage and only a small number of insignificant adverse outcomes. Telephone follow-up to individuals triaged away was successful in 34% of calls and showed that 39% of persons received care elsewhere on the same day, 35% received care within 3 days, and 26% decided not to seek medical care. A group of 1.0% sought care at other hospital EDs for minor complaints. Conclusion: A subset of patients with nonemergency problems can be prospectively identified and triaged out of the ED without significant adverse outcomes provided there is community support for follow-up care. [Derlet RW, Kinser D, Ray L, Hamilton B, McKenzie J: Prospective identification and triage of nonemergency patients out of an emergency department: A 5-year study. Ann Emerg Med February 1995;25:215-223.]

The HIV-1 seroprevalence rate of injured patients admitted through California emergency departments

<h3>Study objectives:</h3> To measure the HIV seroprevalence of injured emergency department patients in a number of California hospitals and to examine the relationship between ED seroprevalence and local AIDS incidence. <h3>Design:</h3> Prospective blinded testing for HIV-1 antibody was performed on routinely collected blood samples. <h3>Setting:</h3> Ten California hospitals; group 1 included three hospitals from counties of high AIDS incidence (more than 40 cases per 100,000 population), group 2 included three hospitals from counties of intermediate AIDS incidence (20 to 40 cases per 100,000 population); and group 3 included four hospitals from counties of low AIDS incidence (less than 20 cases per 100,000 population). <h3>Type of participants:</h3> Eligible patients were all adult trauma victims admitted to a participating hospital through the ED during a consecutive three-month period occurring between June and November 1989. <h3>Measurements:</h3> HIV-1 antibody testing was done using enzyme immunoassay confirmed by immunofluorescence assay. Equivocal results were confirmed by Western blot. Mann-Whitney <i>U</i> test, <i>χ</i>² test, and multiple logistic regression were used where appropriate. <h3>Results:</h3> There were 2,264 patients with adequate blood samples for serologic testing. The seroprevalence rates for hospitals in groups 1, 2, and 3 were significantly different (<i>χ</i>² = 8.44, <i>P</i> = .02): Group 1, 2.5% (19 of 756; 95% confidence interval [CI], 1.5% to 3.9%); group 2, 0.9% (10 of 1,078; CI, 0.5% to 1.7%); and group 3, 0.5% (two of 430; CI, 0.06% to 1.7%). <h3>Conclusion:</h3> This study suggests that local AIDS incidence rates do not necessarily predict the seroprevalence rates of injured patients who are admitted through local EDs.

Multiple expanded roles for nurses in urban emergency rooms

Study objective: To determine whether nonemergency patients can be prospectively identified by triage nurses and safely triaged out of the emergency department without treatment.Methods: All adult patients (16 years or older) who presented to a university ED were provided an evaluation by a triage nurse. For a patient's case to be defined as nonemergency, four criteria were required: vital signs within a specific range, presence of 1 of 50 potentially nonemergent chief complaints, absence of key indicators found on screening examination, and absence of chest pain, abdominal pain, any severe pain, and inability to walk. Between July 1988 and July 1993, patients who satisfied these criteria were defined as nonemergency, refused care in the ED, and triaged out of the ED. Patients were referred to off-site clinics. The clinics had agreed to see patients in advance of the study, and the referral lists were frequently updated. Outcome data were obtained by telephone surveys to both triaged individuals and other health care providers. Results: In this 5-year study, 176,074 adults presented to the ambulatory triage area in the ED, and 31,165 (18%) were defined as nonemergency, were not treated, and were referred elsewhere. Letters and telephone calls to all referral clinics, eight local EDs, and the coroner's office identified no instances of gross mistriage and only a small number of insignificant adverse outcomes. Telephone follow-up to individuals triaged away was successful in 34% of calls and showed that 39% of persons received care elsewhere on the same day, 35% received care within 3 days, and 26% decided not to seek medical care. A group of 1.0% sought care at other hospital EDs for minor complaints. Conclusion: A subset of patients with nonemergency problems can be prospectively identified and triaged out of the ED without significant adverse outcomes provided there is community support for follow-up care. [Derlet RW, Kinser D, Ray L, Hamilton B, McKenzie J: Prospective identification and triage of nonemergency patients out of an emergency department: A 5-year study. Ann Emerg Med February 1995;25:215-223.]