EMRP had 24-ho.urcoverageor not, was not related to academic criteria for long term {aculty employment, faculty's salary dependenceon patient billing, the number o{ faculty, academicdepartmental status or departmentalaffiliation. Residentsfrom programs with 24-hour coveragereported that their faculty were physically present in the ED from 7 AM to midnight a greater percentageof the shift than residents{rom programswithout 24hour coveragereportedabout their faculty (comparisonof distrrbutions, P < .0001).Residentsfrom all programs would have preferredthat their faculty were physically present in the ED a greaterpercentageof all shifts than they were (comparisonof distributions, P < .0001),but wanted them to be physically present less during the midnight to 7 AM shift than the 7 AM to midnight shift (comparisonof distributions, P < .0001).Residents from programs without 24-hov coveragewould have ideally liked their {aculty to be physically present {rom midnight to 7 AM a smaller percentageof the shift than residentsfrom programs with 24-hour coveragewould have preferredof their faculty {comparisonof distributions, P < .0001).Residentsfrom programs with 24-hour coveragereported that their faculty spent a greaterpercentageof their shift doing primary patient care than residents from programs without 24-hov coveragereported about their faculty (35% versus I7%, respectively,P < .0001),as well as, a smaller percentageo{ their shilt educating residents P <.0001).Residentsfrom ail pro{21%versus30%, respectively, gramswould have preferredthat their faculty spent a greaterpercentageof their shi{t educating residents than they were 142% vercus24ok,respectively,P < .0001),as well as,a smaller percentageof their shift doing research/administrationll4o/" versus23o/", respectively,P < .0001).Residentsfrom programs with 24-hour coveragewould have preferredthat their faculty spent a smaller percentageof their shift doing primary patient care than they werc l23ohversus35%, respectively,P < .0001).Ninety-five percent of faculty andTI% of residents{P < .0001)thought that the quality of patient care was better or significantly better when faculty were physically presentin the ED. Sixty percent of residents and6l% of iaculty did not think that 24-hov attending coverage in academicemergencymedicine should be mandated;4O% and 39%, respectivelythought that it should be. This survey suggests that the majority of residentsand faculty in emergencymedicine in the United States would prefer that Z{-hour coveragenot be mandated by the ResidencyReview.Committee for Emergency Medicine. Further study is needed,howeveqto determine the effect of faculty presenceon the quality of patient care in an academic emergencydepartment. *iI propereducation;and 35 136.5%lwere due to patient non-compliance. Of the related visits, 192 147.2%)returned within 24 hours; 134 132.9%lbetween24 and 48 hours; and 8l {19.9%}between 48 and 72 hours. Of the avoidable visrts, 85% returned within 48 hours, as did 92'/" of those with medical management deficiencies.The data suggeststhat monitoring 48-hour revisits, rather than 72, is a useful and efficient tool for detectingmedical managementdeficienciesand other quality assuranceproblems, including proper patient education and appropriateness of follow up. The majority of the avoidablereturn visits representederrors or omissions of the medical staff which could be corrected by case review and education. a a, | 3 Repeat ED Visits: Red Flag or Red Herring? Hospital, EA Michelson,SM Schneider,R Clare/ Montefiore University o{ Pittsburgh Patientsreturning for unscheduledED visits have beenreferred to as "red'flags",posinga high medicolegalrisk. These encounters are often approacheddifferently than initial patient visits. We reviewedour recordsto assessif return visits really are "redflags" (RFs)or "red herrings"(RHs).Recordsof all patientspresenting to our adult med/surghospital ED during a six-month period were retrospectivelyreviewed to identify patients also seen in the precedingthirty days. Patient demographicswere recordcdfor thc initial and subsequentvisits along with a coded rcasonfor thc rcturn. Patientswith new unrelatedproblems,with schcdulcdvisits and thosc called back due to discoverederrors wcre then cxcluded.RFs were defined as patients who requireda significantchangein therapy(such as admission)on the return visit. In comparison,RHs' return visit resultedin no changein therapyor new intervention.Among 9,588patient-visitsduring the study period, there were 84(r repeatvisits by 661 patients. Thc study group of 475 visits includcda largcnumbcr 142.5'l'lof RFs,75'2,of whom rcquircdadmission.Thc RFswcrc oldcr,mcan agcof 57.7 + 1.4yrs vs 4(r.8 * 1.3yrs for RHs {1,< 0.0001).Thc intcrval bctwccn visits was similar for thc RF and RH groupsat t1.85* 0.(rand ll.5 + 0.5 days,rcspcctivcly. Lookingat thc cause of the return visit, 37.8Yuinvolved patient or physician failure (PF)and 62.20/"were unforseeable failures to improve (UF),including worsening of condition and recurrenceof symptoms. PFs wereyoungerthan UFs; mean agc44.8 + I.6 vs 55.5 + 1.3yrs (P < . 0 0 0 1 l a n dr e t u r n e ds o o n e r5 . 6 * 0 . 5 d a y sv s 1 0 . 4+ 0 . 5 ( P < 0.0001).Return visrts invoiving physicianfailurc occurredat a m e a n o f 3 . 2 + 0 . 4 d a y s , 7 4 7 oo f p a t i e n t s w c r e R F s . P a t t e n t failures returned latcr at 6.9 + O.7 days and only a 7.6"L were RFs.Thcrefore, a high percentageof ED return patient visrts are "red-flags"and descrvcheightenedscrutiny.Older patientsare at particularlyincreasedrisk. Physicianerror is likely to precipitate who the earlicstreturn visit. Thesepatientsareindccd"red-flags" posea high medicolegalrisk. Emergency Department Revisits K Kenh,J Bocka,M Kobernick,R Krome,M Ross/ Department of EmergencyMedicine,WilliamBeaumontHospital,RoyalOak, Michigan The charts of patients returning within 72 hours to our Emergency Department were reviewed to determine if monitoring revisits is a use{ul quality assuranceindicator. Patrentvisits for the months of fune and December,1987,werc selectedto eliminate a potential seasonaldi{ference.Of the I3,26I visits during these two months, 455 /3.4%) were revisits within 72 hours. Charts were availableon 444 patients, of which 407 19I.7%)represented casesin which the return visit and the initial visit were clearly related. Charts were reviewed for deficiencies in the foliowing areas:(1) medical managementi (2) appropriateprescribedfollow up; {3} patient education; and/or (4) patient compliance.Suspected medical management problems were discussedby the 3 senior authors and a consensusdecision was made. Return visits were consideredavoidable if a deficiency was noted in at least one of the areaslisted above.There were 4O7relatedreturn visits, 96 123.6%lof which were avoidable.O{ these avoidablevisits, 38 had medical management deficiencies; 14 114.6%)had 139.6'/.1 inappropriateprescribedfollow up; 20 ,20.8%)had not beengiven 13 Prediction of Downtime During Ventricular Fibrillation CG Brown, F Dzwonczyk, H Werman, R Hamlin / Division ot E m e r g e n c y M e d i c i n e a n d D e p a r t m e n t o f A n e s t h e s i o l o g y ,O h i o S t a t e U n i v e r s i t yC o l e g e o f M e d r c r n e , D e p a r t m e n t o i V e t e r i n a r y P h y s i o l o g y a n d P h a r m a c o l o g y , O h i o S t a t e U n i v e r s i t yC o l l e g e o f V e t e r i n a r yM e d i c i n e , C o l u m b u s , O h i o As the duration of time between the onset of ventricular f i b r i l l a t i o n ( V F ) a n d t h e a p p l i c a t i o n o f d e f l b r i l l a t i o n i n c r e a s e s ,t h e rate of successful defibrillation {SDl decreases.In one animal study, SD was accomplished in 70% of the animals defibrillated within one minute of the onset of VF. The rate of SD decreased to less than lO% by l0 minutes of VF We recently have shown that the rate of SD could be increased to greater than 6O% after l0 minutes of VF when pharmacologicai therapy rs instituted prior to defibrillation. Thus an accurate prediction o{ the duration of l5

SAEM (UAEM) 1988 Annual Meeting Program