Louis G. Graff

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The findings are presented of a consensus committee created to address the measuring and improving of quality in emergency medicine. The objective of the committee was to critically evaluate how quality in emergency medicine can be measured and how quality improvement projects can positively affect the care of emergency patients. Medical quality is defined(More)
PURPOSE We assessed the performance of 3 validated prognostic rules in predicting 30-day mortality in community-acquired pneumonia: the 20 variable Pneumonia Severity Index and the easier to calculate CURB (confusion, urea nitrogen, respiratory rate, blood pressure) and CURB-65 severity scores. SUBJECTS AND METHODS We prospectively followed 3181 patients(More)
BACKGROUND Despite the development of evidence-based pneumonia guidelines, limited data exist on the most effective means to implement guideline recommendations into clinical practice. OBJECTIVE To compare the effectiveness and safety of 3 guideline implementation strategies. DESIGN Cluster-randomized, controlled trial. SETTING 32 emergency(More)
BACKGROUND Low-risk patients with community-acquired pneumonia are often hospitalized despite guideline recommendations for outpatient treatment. METHODS Using data from a randomized trial conducted in 32 emergency departments, we performed a propensity-adjusted analysis to compare 30-day mortality rates, time to the return to work and to usual(More)
The objective of this study was to survey the use of observation units (OUs) in the United States. A written survey was mailed to every third hospital (sequential by zip code) in the United States. There was a 32.9% response to the survey (522 of 1588 hospitals). A total of 18.8% of hospitals had an OU with another 11.6% planning to open an OU. Those(More)
Estimates of emergency physician needs traditionally have relied on calculations based on the number of patients seen by the emergency physician (volume formula). We have found this model has not predicted accurately manpower needs in our emergency department as the case mix of services has changed. The "LIVES" formula estimates the amount of time emergency(More)
OBJECTIVES To test the hypothesis that physician errors (failure to diagnose appendicitis at initial evaluation) correlate with adverse outcome. The authors also postulated that physician errors would correlate with delays in surgery, delays in surgery would correlate with adverse outcomes, and physician errors would occur on patients with atypical(More)
Community-acquired pneumonia causes more than 4 million episodes of illness each year and has high morbidity, mortality, and total cost of care. Nationwide, nearly 75% of community-acquired pneumonia patients are initially evaluated and treated in hospital-based emergency departments (EDs). Substantial variation exists in illness severity assessment,(More)
STUDY OBJECTIVE We quantify patient risk as related to the presence or absence of the Agency for Health Care Policy and Research (AHCPR) congestive heart failure (CHF) hospital admission criteria. METHODS This was a retrospective observational cohort study at 12 acute care hospitals examining consecutive patients with the final primary diagnosis of CHF.(More)
OBJECTIVES To report on the penetration of, and identified barriers to and facilitators of, efforts to incorporate evidence-based fall risk assessment and management into clinical practice throughout a defined geographic area. DESIGN Dissemination project. SETTING North central Connecticut. PARTICIPANTS Hospitals, home care agencies, primary care(More)