ED management : the monthly update on emergency department management
-
The University of Michigan Health System (UMHS) in Ann Arbor has opened a new unit within its ED to focus on caring for the most critically ill patients Who present to the ED. Dubbed the Massey Emergency Critical Care Center, or EC3, the model is the first of its kind in the country, with its own ICU and a lower nurse-patient ratio than the main ED to facilitate closer monitoring. ⋯ Staffing of the EC3 includes emergency nurses and physicians who have had extra training in critical care. The EC3 will serve as a new research center for emergency critical care patients, and a training ground for physicians and nurses looking to enhance their skills in critical care.
-
Through the use of a sophisticated modeling technique, investigators at the University of Cincinnati have found that the creation of a so-called "flex track" that includes beds that can be assigned to either high-acuity or Iow-acuity- patients has the potential to lower mean wait times for patients when it is i added to the traditional fast-track and high-acuity areas of a 50-bed ED that sees 85,000 patients per year. Investigators used discrete-event simulation to model the patient flow and characteristics of the ED at the University of Cincinnati Medical Center, and to test out various operational scenarios without disrupting real-world operations. ⋯ Investigators suggest the modeling technique could be useful to other EDs interested in optimizing their operational plans. Further, they suggest that ED administrators consider ways to introduce flexibility into departments that are now more rigidly divided between high- and low-acuity areas.
-
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.
-
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.
-
To reduce the risk of dangerous tubing misconnections, the ISO is rolling out new tubing connector standards that will eventually make it nearly impossible for tubing associated with one delivery system to be connected to a delivery system that serves a different purpose. Experts welcome the change, noting that tubing misconnections that cause injury and even death have been happening for years. However, TJC has issued a Sentinel Event Alert, warning that health care organizations need to be vigilant in managing the risk posed by these misconnections during the phased-in transition to the new connectors. ⋯ It will not connect to IV tubing, making that type of misconnection unlikely. The new connector should be available early next year. Since hospitals will continue to use older tubing until their supplies are exhausted, manufacturers will temporarily provide adapters capable of making new administration sets compatible with older tubing.