ED management : the monthly update on emergency department management
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To cut down on diversion time, Denver Health Medical Center in Denver, CO, decided to locate a hospital medicine team in its ED (HMED). The HMED team focuses on streamlining patient flow as well as caring for patients boarded in the ED. The approach has proven successful, slashing diversion by 27% while also increasing discharges from the ED by 61%, according to a pre and post study of the intervention. ⋯ Emergency department physicians say having immediate access to an admitting team streamlines the admitting process and helps to ensure that patients are sent to the most appropriate floors for care. A successful HMED intervention requires commitment to the approach from hospitalists, and a willingness among ED staff to have a hospitalist team located in the department, according to hospital sources. A productive relationship between ED physicians and hospitalists is key.
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A new study suggests that proven strategies for eliminating boarding and crowding in the ED are being left on the table in many hospitals because leadership has not stepped forward to eliminate pockets of resistance. Further, there is new evidence that changes in practice intensity in the ED are contributing to crowding even though some of these changes were designed to do the opposite. ⋯ Experts say such strategies are difficult to implement because they are hospital-level rather than ED-level problems. A new emphasis on physician satisfaction surveys is driving ED practice intensity along with changes in billing practices and technological innovations.