ED management : the monthly update on emergency department management
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The Clockwork ED Series on Eliminating Bottlenecks and Delays, developed by the Clinical Initiatives Center in Washington, DC, identified best practices for expediting admission and reducing wait times to see a physician and receive ancillary services. With bed control bypass, ED nurses fax or tube reports to inpatient nurses and send patients directly to inpatient beds. ⋯ Implementing a "zero tolerance" policy for empty ED beds increases satisfaction and reduces wait times. Your ED should have a place for patients other than the waiting room, such as an observation unit.
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The Joint Commission on Accreditation of Healthcare Organizations has issued a bulletin listing "high-alert" medications that have the highest risk of causing injury when misused. The five high-alert medications are insulin, opiates and narcotics, injectable potassium chloride (or phosphate) concentrate, intravenous anticoagulants (heparin), and sodium chloride solutions above 0.9%. The Joint Commission recommends strategies such as a system that confirms the correct drug, dosage, patient, time, and route.
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Timepieces are probably inaccurate in your ED, and that can have serious consequences during critical events such as major trauma and cardiac arrest resuscitation. During resuscitations, multiple timepieces are used, and many events occur in a short period of time. Inaccuracies make it impossible to reconstruct the order of events accurately, which increases liability risks in the event of a lawsuit. Staff can synchronize their timepieces by calling the local number that announces the atomic clock time every 10 seconds; ideally, however, all clocks should be set universally by a central server.