ED management : the monthly update on emergency department management
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With bottlenecks boosting ED wait times as well as the LWBS rate, Methodist Hospital of Sacramento decided to boost its triage capacity by taking over six beds that were being used for fast-track patients, and by taking advantage of waiting-room space for patients who don't need to be placed in beds. Within a month of implementing the new approach, the LWBS rate dropped to less than 2%, and door-to-doc time was slashed by 20 minutes. Under the POD system, providers have 15 minutes to determine whether patients should be discharged, sent back to the waiting room while tests are conducted, or placed in an ED bed where they can be monitored. To implement the approach, no alterations in physician staffing were needed, but the hospital added a triage nurse and a task nurse to manage patient flow of the triage POD.
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Methodist Le Bonheur Healthcare in Memphis, TN, is investigating whether posting ED wait times via the internet can positively impact patient flow in the six EDs the health system operates in the Memphis region. The health system began posting wait times in August 2010, resulting in increases in ED volume ranging from 6% to 10%. ⋯ One marketing challenge is that a competitor is posting ED wait times as well, but it is posting the time it takes for a patient to be placed in a bed as opposed to the door-to-provider time that Methodist Le Bonheur is posting. The approach has the most impact on lower-acuity patients, but experts worry that in the future, payers may not be reimbursed for ED care for these patients.
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New data strongly suggest that the routine practice of administering i.v. fluids in trauma patients before transport to the hospital may do more harm than good. The study's lead author suggests that ED leaders have a strong role to play in changing a decades-old protocol that was implemented without sufficient scientific evidence. ⋯ Administration of i.v. fluids delays time to treatment and may exacerbate bleeding by raising blood pressures. There might be specific types of patients who would benefit from pre-hospital i.v. fluids, but the issue requires further study.
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EDs find physical therapists are an underused asset for musculoskeletal injuries, patient education.
Some EDs are finding that the unique skill sets offered by physical therapists (PT) can be an asset to emergency care while also improving the patient experience. Experts say PTs are particularly valuable in the management of musculoskeletal pain and injuries, but they are also being used for wound care, gait training, and balance assessment. ⋯ PTs need to be comfortable with proactively marketing their skills to other ED clinicians who may not be used to having access to this resource. Experts say PT services in the ED can be reimbursed at a level that is consistent with reimbursement in other inpatient and outpatient settings.