ED management : the monthly update on emergency department management
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More than 20 hospitals in eight states are taking advantage of a service that enables patients with non-life-threatening conditions to set up appointments to be seen in the ED through an online resource. Critics of the practice are concerned that it will encourage patients to use the ED when they really should be seeing a primary care physician, but EDs that are using the service say patients are highly satisfied with the approach, and that it enables them to better control patient surges. ⋯ Experts say safeguards are essential to ensure that patients with life-threatening conditions come to the ED right away for care rather than waiting for an appointment. ED physicians contend the approach can be used to optimize resources.
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Baylor Medical Center in Garland,TX, has been able to drastically reduce ED wait times, as well as the LWBS rate by streamlining the triage process and implementing a staff-driven improvement effort aimed at identifying inefficiencies and replacing them with solutions that work. The result is 11 beds of added capacity just from changes in patient flow. ⋯ Solutions included letting low-acuity patients move themselves between care settings, freeing the charge nurse from patient care duties so that he or she could oversee patient flow, and empowering physician-nurse teams to see patients more quickly. ED managers say leadership is important, but letting staff drive the improvement process is key to their success.
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A visit to the ED represents a vital opportunity for victims of human trafficking to break free from their exploiters, but this opportunity is often lost, either because ED personnel don't recognize the subtle cues that a person may be a trafficking victim, or because they don't know how to handle the situation. However, resources and training are available to help ED managers raise awareness of the issue in their settings. ⋯ When you suspect that patients may be human-trafficking victims, it is important to speak with them alone so that they are free to explain their situation. However, unless they are a minor, it is their decision on whether to seek help.
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Patients who visit the ED frequently to obtain treatment for chronic pain can be frustrating and difficult to manage, but some EDs are making progress with this group by linking these patients to resources and establishing a firm policy on when narcotics will be prescribed. Experts say that while strict "no opioids" policies rarely work well, some patients can be helped when given access to more comprehensive treatment approaches. The ED at Methodist Hospital in Indianapolis has developed a multidisciplinary program that includes referrals to a primary care provider (PCP), as well as a chemical dependency specialist. ⋯ The hospital will help to link patients with a PCP and other resources in the region. The approach has curbed the incidence of drug-seeking behavior and helped to make the treatment of chronic pain uniform across all ED providers. Since the prevalence of pain is so high among patients in the ED, many emergency physicians are seeking added training in the treatment of pain.
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Under the final rules for Medicare's value-based purchasing program, one-third of the funding that is set aside to reward quality will be based on how patients rate their hospital experience. However, some EDs are already working to maximize patient satisfaction by implementing programs or policies whereby patients who have been discharged are routinely called to make sure their recovery is going well, as well as to intervene if there is an opportunity for service recovery. ⋯ To avoid pushback among staff, consider beginning a program of patient callbacks by asking clinicians to call back just two patients per shift worked, and to share their experiences with colleagues. For maximum value, experts recommend that patient callbacks be made within one to four days of discharge.