ED management : the monthly update on emergency department management
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The ED at Carolinas Medical Center-Union, Monroe, NC, has implemented several processes and strategies in recent years that have earned it recognition for service excellence. Some of those strategies are: when beds are available,"pulling"patients straight to the back and performing triage in the room; introducing point of care devices for troponin, which cut 40 minutes off diagnostic time; creating a spreadsheet that tracked length of stay and patients leaving without being seen, broken down by shift.
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It's hard to believe that something as simple as a 15-30 minute consultation can have an impact on chronic pain patients using the ED as their venue of choice for medical care; however, that's just what happened in the ED at Providence Newberg Medical Center in Newberg, OR. The average number of visits per patient per year dropped from 6.8 to 2.3 in just three years. ⋯ A series of letters went to patients after discharge to reinforce follow-up recommendations. Local primary care providers were enlisted to treat patients who had no "medical home."
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Among those standards The Joint Commission reports offer the most difficult compliance challenges for hospitals, the three that have the greatest impact on EDs involve complete lab records, complete and accurate patient records, and egress. Install an electronic medical record, and verify that results have been reviewed. If you use a paper system, ensure that all final printed results are filed in the paper record. Involve clinicians who understand the standards in the selection of equipment.
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The ED leaders at St. Clair Hospital in Pittsburgh, PA, say that"managing by walking around"was one of the keys to their earning a ranking from Press Ganey as the no. 1 ED in patient satisfaction for EDs with more than 50,000 annual visits. ⋯ Staff members are asked specific questions based on the Press Ganey priority indices. If there are patient complaints about a staff member, confidential meetings are held to discuss ways to improve.