ED management : the monthly update on emergency department management
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Keeping an observation unit operating with current reimbursement might depend on successful implementation of cost-reduction strategies. A "hybrid" model with scheduled-procedure patients in addition to observation patients allows you to staff with fewer nurses per patient. Observe patients with only one specific acute problem who are likely to be discharged within 18 hours. By offering stress testing in close proximity to the observation unit, length of stay is reduced, and the hospital can provide stress testing to inpatients on weekends.
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ED personnel experience the majority of all hospital assaults, and these attacks can have long-term effects on morale and productivity. OSHA regulations require you to provide staff with a safe working environment. You should have a plan to address security personnel issues, responses to specific scenarios, restraint techniques, and violence prevention. Strategies include flagging violence-prone individuals, using patient liaisons in the waiting areas, and ensuring that ED security officers have been trained to work in hospitals.
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To improve patient care and avoid liability risks, you must ensure your staff are practicing according to new guidelines from the American Heart Association. To increase staff participation in inservicing, offer continuing education credit, provide refreshments, and hold several programs. Use e-mail to alert staff about the new guidelines and how to obtain copies. Hold mock codes for nurses, physicians, and respiratory therapists to manage patient scenarios.
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High diversion rates are a crisis nationwide, with many EDs reporting high diversion rates throughout the year that cause potentially unsafe conditions for patients. To avoid diversion, length of stay must be reduced not only in the ED, but hospitalwide. Patients will continue to come to the ED during diversion, so be prepared. Have an effective diversion policy and an expeditious process to implement it when needed.