hospital mortality and the quality and timeliness of care received in Emergency Departments. Furthermore, the purpose of this is to determine ways in which better care can be provided to patients needing emergency services in order to minimize the mortality rate. This is a valid objective, as the document states that little literature is available in the field. As a result, little evidence is available of what is needed to help patients receive the best of medical care. It is therefore clear that intensive study is necessary in this field, making this a groundbreaking study in a very necessary field. Where human lives are at stake, any attempt to reduce mortality is a worthwhile endeavor. In terms of research criteria, the objective is valid, as the field of study lends itself to much deeper investigation.
The author states that literature focusing on mortality rates of patients directly admitted to the ICU is limited. The Reference List is therefore not extensive, consisting of only thirteen sources. Nevertheless, the author does focus on sources that provide the most targeted information for the study concerned. Sources such as reports on ED trends and a comparative mortality study are mentioned and referenced by footnotes. The author might perhaps have mentioned the specific reports and studies by name in the document itself. Still, the available literature seems to have been thoroughly considered in terms of the objective of the study. The literature study therefore adheres to good research criteria.
Being a study of mortality rates, the population sample will have to focus on patients admitted to the ICU and making use of ED services. For this study specifically, the population sample was drawn from an inner-city teaching hospital level I trauma center. Being quantitative and retrospective in nature, the study did not require a specific population sample, but rather focused on collecting data from historical patient records. The patients were not contacted for consent, as no personal identifiers were collected from these records. The records used were from the period between August 2001 and July 2003. Two years of data were therefore scrutinized in order to determine mortality rates.
In terms of research criteria, I feel the data are somewhat limited in terms of population, especially as few studies have been conducted in the field. Firstly, greater validity might be obtained from a wider area of study. More than one hospital could for example be used. Furthermore, medical records could be supplemented by an actual population sample of patients, who could supply valuable data by interviews or questionnaires. Such additions would increase the validity of the study by widening its scope, even if the focus remains quantitative and retrospective.
Measurement occurred via a number of stud variables, including ED initial complaints, admission diagnosis, primary discharge diagnoses, weekend admissions, weekday admissions, gender, race, age, and other variables. These are supplemented by ICU variables such as wait time until the results of tests, admission and discharge. Hospital mortality was also used as a measurement factor. The measurements appear to be consistent with the objective of the study, to relate specific elements of ED care with mortality rates.
Data Collection and Analysis
Data included targeted information such as arrival in emergency department, registration time, medication, intervention results, as well as specific patient data. Data were analyzed by a variety of methods, including descriptive statistics and logistic regression analysis. Statistical methods include scatter plots, box plots, cross tabs, and regression. These methods of collection and analysis are thorough and consistent with the study objective. A larger population base may have resulted in greater analysis validity. The collection and analysis methods themselves are however consistent with research criteria.
The conclusions are drawn according to the measurement criteria. While the results show that race was not a significant factor in mortality rates, weekend and weekday admissions were. According to the study results, weekend admissions entailed significantly higher mortality rates than weekday admissions. Other factors included age, with which the likelihood of mortality increased. This likelihood decreased for walk-in patients as opposed to those arriving by ambulance. Mortality also increased for patients for whom more time elapsed after an ICU admission order and for those with mainly respiratory problems. Another problem related to care is hospital staffing differences between weekends and weekdays. Weekend staff for example tends to be less experienced and numerous than those on weekdays. This is a significant factor in the higher mortality rates over weekends.
The study mostly adheres to research criteria. The data interpretation methods are thorough and statistically valid, while the results compare well with the initial study objective. The results show that a problem does exist to prove the hypothesis that several factors influence the mortality rate of ED and ICU patients. The only significant limitation is the population size and variety. However, the study does provide a valuable basis for future investigations of this kind. Quality emergency service is one of the most important issues today, and would benefit greatly from more in-depth study into the field.
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