ED management : the monthly update on emergency department management
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To address identified patient safety risks in the handoff process, a group of emergency providers developed Safer Sign Out, a paper-based template that prompts clinicians to jointly review issues of concern on patients who are being passed from one clinician to another at the end of a shift. Already in practice at 12 hospitals in the Mid-Atlantic region, the approach is now being disseminated nationwide with the help of the non-profit Emergency Medicine Patient Safety Foundation. ⋯ Safer Sign Out seeks to prevent communications failures by putting structure into the handoff process. In addition to prompting incoming and outgoing physicians to discuss each patient being handed off, the approach involves having both physicians round at the bedside of these patients so that patients fully understand when their care is being transitioned to a new provider.
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In a study dubbed Emergency Department Telemedicine Initiative to Rapidly Accommodate in Times of Emergency (EDTITRATE), investigators at the University of California San Diego Health System are gauging whether remote physicians can be quickly and cost-effectively mobilized to evaluate patients when the ED is busy. While there have been administrative hurdles involved with implementing the approach, investigators say the strategy could offer big savings in terms of time and efficiency. ⋯ While both patients and providers give the telemedicine encounters high marks, managing the workflow is challenging. Investigators say the approach could produce significant gains in efficiency, including the possibility that a single on-call physician could remotely treat patients from multiple ED sites.
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To reduce mortality and improve the care of patients with sepsis, Wake Forest Baptist Medical Center in Winston-Salem, NC, created a new rapid-response protocol aimed at facilitating earlier diagnosis and treatment. In this approach, clinicians who suspect a patient may have sepsis can call a Code Sepsis, which will fast-track the series of tests and evaluations that are needed to confirm the diagnosis and get appropriate patients on IV antibiotics quickly. Administrators say the approach fits in with the culture of the ED, and it has quickly slashed time-to-treatment in this environment. ⋯ In the ED, where a modified version of the approach has been in place since April 1 of this year, the percentage of patients with sepsis receiving antibiotics within one hour of diagnosis has increased from 25% to 85%. Key to the success of the approach are specially trained rapid-response nurses who are called in on a case whenever a diagnosis of sepsis is suspected and a series of policy changes designed to facilitate needed diagnostic tests to confirm a diagnosis. A mandated online education module helped to bring all clinicians and staff up to speed on the new process quickly.