ED management : the monthly update on emergency department management
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The leaders of the ED at Tri-City Medical Center have come up with an initiative that has saved them $600,000, generated a billing increase of 10% per provider per hour, and won over physicians: using physician scribes in concert with their electronic medical record (EMR). It eliminates the concern that EMRs will slow them down. ⋯ The physicians can focus on the bedside and look at the patient at the same time the scribe enters information into the electronic chart. Scribes prepare the discharge forms, including medication reconciliation, so they are ready for the doctor to sign.
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Hypothermia is proving to be an effective therapy for cardiac arrest patients at Providence (CA) Tarzana Medical Center, where the first three patients treated with this modality showed remarkable neurologic recovery. Here are some reasons why the program has been successful: A multidisciplined team developed the protocol, to help ensure chain of survival. ICU staff were trained along with ED staff, to ensure that the protocols for cooling down and rewarming patients were followed closely. Preprinted order sheets, order sets, inclusion and exclusion criteria are hanging off every one of the cooling units, along with the cooling wraps.
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Even if you're fortunate enough to have a new state-of-the-art ED, that doesn't guarantee optimal results in smoother patient flow. As the team at Forsyth Medical Center in Winston-Salem, NC, found out, it also requires processes that make the most of the space you have. ⋯ Creation of a "pivot nurse" position, staffed 24/7 by RNs trained in advanced cardiac life support, trauma nursing, and emergency pediatrics. Establishment of a three-bed intake area using a team approach of a doctor, two RNs, and a CEN.
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Providing adequate surge capacity during a disaster is one of the greatest challenges of emergency response. Now, researchers have proposed a new process called "reverse triage" to help create surge capacity that otherwise would not exist. ⋯ ED staff can provide a daily initial reverse triage score for patients being admitted, even if a disaster is not imminent. While general guidelines can have great value, take the interests of the patient and their family into account when making discharge decisions.
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You can improve the efficiency of operations in your ED with careful attention to design, say ED managers. As a bonus, they say, you will improve communication among your staff members and boost patient safety. ⋯ If you have several units within your ED, design flexibility into the patient rooms so that rooms in units that are not full can be "borrowed" by units that are. Create as many computer stations as possible so your staff can readily access information about patients and department flow.