Journal of emergency nursing : JEN : official publication of the Emergency Department Nurses Association
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Struggling to keep up with The Centers for Medicare and Medicaid Services out-patient throughput metrics, an adult emergency department serving Burlington and Camden Counties, New Jersey, sought to redefine its care delivery model by adopting the patient segmentation initiatives of the split-flow process of patient care. ⋯ Working collaboratively with all stakeholders to define the right patient care delivery model, combined with an understanding of the right resource assignments to optimally support that care delivery model, an emergency department can institute cost-effective changes to realize and sustain significant patient throughput improvements.
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Lethal weaponry and tactics used by enemy forces in Operations Enduring Freedom and Iraqi Freedom have resulted in complex multisystem injury patterns among US allied military personnel engaged in combat operations. Military medical personnel deployed in support of these campaigns have had to maintain a high degree of clinical skill to effectively render care to wounded combatants, a necessity that has been challenged by a lack of training opportunities within the military health care system. Medical components across the military have formed partnerships with civilian institutions to form programs such as the Saint Louis Center for Sustainment of Trauma and Readiness Skills, in which medical personnel from active and reserve components are able to obtain and build skills needed to respond to contingencies that may arise both abroad and within the homeland.
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Ongoing education, an ever-present challenge in a hectic clinical environment, can be addressed by utilizing peer-to-peer education. Enhancing nurses' comfort level with specialty topics can reduce anxiety while enhancing core knowledge and skill proficiency for the provision of safe care. Increased self-confidence in a nurse's ability to detect a new or developing concern can lead to fewer delays in care. Critical problems identified and addressed promptly support better outcomes.
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For emergency departments experiencing crowding and a high percentage of patients leaving without being seen, a telephone triage service can provide other care options for low-acuity patients. ⋯ A telephone triage service may help decrease ED crowding by communicating other care options to patients with low-acuity health problems.
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Nontargeted human immunodeficiency virus (HIV) screening and targeted hepatitis C virus (HCV) screening for selected high-risk patients (those born between 1945 and 1965 and those who report injection drug use) was integrated into our ED triage process and carried out by nurses. Determining whether emergency nurses accurately perceive what patients experience is important to know because staff misperceptions may pose a barrier to program adherence and sustainability. ⋯ Emergency nurses not only frequently misperceive how patients experience ED-based HIV/HCV screening, but these misperceptions are skewed toward the negative, representing a type of staff bias. Further research is recommended to determine if such misperceptions adversely affect implementation of screening.