ED management : the monthly update on emergency department management
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To make a big dent in adverse drug events (ADE), Nationwide Children's Hospital devised medication huddles: a process that takes place after every reported ADE. A core huddle team meets with clinicians from the specific unit involved to discuss why the ADE occurred, and what can be done to prevent future events. In three years, the approach has reduced ADEs by 74%, and the rate of ADEs per 1,000 dispensed doses has decreased by 85%. * Administrators say a safety culture that encourages error reporting is key to making the process work. * To facilitate the huddle discussions, developers created a data collection tool that prompts huddle participants to describe the ADE, what factors were involved, and potential solutions. * While the medication huddles were first implemented in the hospital's critical care units, the process has since been expanded to include all areas of the hospital, including the ED.
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In a continuing effort to ease demand on busy EDs, some communities are coming up with new ways to leverage paramedics. Under a three-year pilot program in Raleigh, NC, a select group of paramedics with added training are being used to assess patients with mental health or addiction problems and transfer them to alternative facilities when appropriate. In Robbinsdale, MN, a community paramedicine program is filling in care gaps for patients with chronic diseases and other complaints who are at risk for repeat ED visits or inpatient hospitalizations. * Administrators of the Raleigh, NC, program say that in 2013, paramedics diverted more than 300 patients to alternative facilities. Of these, only 20% to 25% need further transport to the hospital. * Every time the NC paramedics divert a patient from the ED to an alternative facility, they return an estimated 14 bed-hours back to the ED. * In addition to responding to patients with non-urgent needs, the Robbinsdale, MN, community paramedicine program is a referral source for ED physicians who are concerned about follow-up care for patients who have presented to the ED with medical problems that require ongoing attention.
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A new study suggests that introducing palliative care consultations while patients are still in the ED, rather than waiting until after patients have been admitted, can significantly reduce inpatient length of stay. Experts say the approach may also improve quality of care while patients are in the hospital, and do a better job of meeting patient goals. *Researchers analyzed 1,435 palliative care consults, including 50 that took place in the ED over a four-year period. They found that consultation in the ED was associated with hospital stays that were 3.6 days shorter, on average, than the hospital stays of patients who received palliative care consults following admission to the hospital. * Palliative care typically includes an extensive goals-of-care discussion with patients and families, symptom management, and other services focused on meeting patient needs and improving quality of life. * Experts say the top four groups of patients who can benefit from goals-of-care discussions are patients with metastatic cancer, advanced congestive heart failure, advanced chronic obstructive pulmonary disease, and advanced dementia. *ED administrators interested in making improvements in their approach to palliative care should perform a needs assessment, forge partnerships with community resources, and identify a champion, according to palliative care experts.