ED management : the monthly update on emergency department management
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With the incidence of kidney stone disease on the rise, more of these patients are presenting to EDs for care. However, new data suggest that as many as one in nine of these patients will have to return for a second emergency visit. Researchers have linked a number of factors with these bounce-back visits, including issues impacting care access and quality. ⋯ Utilizing data from more than 128,000 visits to California EDs over a two-year period, researchers found that patients on Medicaid were at about a 50% higher risk of having a repeat ED visit than patients with commercial insurance. In areas where there were few urologists, patients were also more likely to return to the ED for care. Patients who had their blood counts checked during their initial ED visit were 12% less likely to require a return visit.
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A new study highlights how schedule changes among inpatient providers on the upper floors can impact crowding and boarding in the ED. Using Lean Six Sigma (LSS) management techniques, investigators at Penn State Hershey Children's Hospital in Hershey, PA, discovered that by adding an extra inpatient rounding team, discharge times could be accelerated, resulting in improved throughput without increasing length of stay or readmission rates. ⋯ To make the schedule changes, a core group of seven inpatient physicians needed to agree to work an extra two or three "on service" weeks per year. Investigators acknowledge that implementing this type of intervention requires culture change, which can be very difficult initially.