ED management : the monthly update on emergency department management
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A new study suggests that EDs across the country are experiencing difficulties because they don't have adequate on-call coverage by surgical specialty providers. The lead author indicates the root cause of this problem may have more to do with a lack of incentives for providers to accept on-call coverage responsibilities than an actual shortage of surgical specialists. ⋯ Respondents from the South reported the most difficulty, with 81% indicating they have problems with on-call coverage. The most serious problems reported with on-call coverage pertain to plastic surgery (81%), hand surgery (80%), and neurosurgery (75%).
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When a sudden increase in volume overwhelmed Ochsner Medical Center in New Orleans, LA, in the wake of hurricane Katrina, ED administrators created QTrack, a new ED protocol that effectively doubled the capacity of the ED by taking full advantage of waiting-room space while preserving beds for only the sickest patients. The approach requires firm policies and procedures and continual provider reinforcement, but the results are dramatic. ⋯ Average door-to-doc times have been slashed from hours to about 33 minutes. The LWBS rate is below 1% at facilities where QTrack has been implemented.