ED management : the monthly update on emergency department management
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A new approach to hospital handoffs has shown it can significantly reduce medical errors as well as preventable adverse events. The approach, dubbed the I-PASS bundle, uses a mnemonic to alert providers to all the issues that need to be covered during a handoff, but also includes a written handoff tool, communication training, a sustainability campaign, and a process for feedback. In a study of the I-PASS bundle conducted at nine pediatric hospitals, investigators found that the approach reduced medical errors by 23%, and the rate of preventable adverse events by 30%. ⋯ On average, handoffs in the study took 2.5 minutes per patient. Several medical centers are now implementing the approach hospital-wide, and additional studies into the approach are planned. Developers advise hospitals interested in the approach to first gather data and survey providers to make a case for the intervention.
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As new approaches to the care of psychiatric emergencies emerge, one solution is gaining particular traction. Under the Alameda model, which has been put into practice in Alameda County, CA, patients who are brought to regional EDs with emergency psychiatric issues are quickly transferred to a designated emergency psychiatric facility as soon as they are medically stabilized. This alleviates boarding problems in area EDs while also quickly connecting patients with specialized care. ⋯ The model is funded by through a billing code established by California's Medicaid program for crisis stabilization services. Currently, only 22% of the patients brought to the emergency psychiatric facility ultimately need to be hospitalized; the other 78% are able to go home or to an alternative situation. In a 30-day study of the model, involving five community hospitals in Alameda County, CA, researchers found that ED boarding times were as much as 80% lower than comparable ED averages, and that patients were stabilized at least 75% of the time, significantly reducing the need for inpatient hospitalization.