ED management : the monthly update on emergency department management
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According to researchers who completed a five-year study at the Olive View-University of California at Los Angeles Medical Center in Sylmar, CA, time studies are the most effective way to identify delays and improve efficiency in the ED. Time studies may reveal that your assumptions about delays are incorrect. ⋯ Constructing a time study allows you to understand all the steps in patient care. Identify who is responsible for each increment of time, including the registration clerk, bed control staff person, nurses, X-ray personnel, lab staff, and physicians.
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Because pediatric patients are at high risk for inadequate pain management, ED staff should be vigilant about identifying painful conditions, treating them quickly with adequate analgesics, and ensuring adequacy of outpatient pain management. Studies have shown that analgesia was given to pediatric patients less frequently than adults in the ED. ⋯ Often, parents feel that their child's pain management is inadequate. Staff education, including regular lectures or informal inservicing, can lead to better management of pain.
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Demand respect when consultants second-guess your clinical decisions or behave rudely. Address consultants' specific complaints and don't respond to generalizations about the ED. Establish credibility by having radiologists confirm your X-ray readings in front of consultants. If consultants are rude, don't hesitate to confront them.
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ED reimbursement experts say the new documentation guidelines proposed by the Health Care Financing Administration will be easier to comply with. For a comprehensive history, only five organ systems are required to be reviewed, not 10. Instead of organ systems, the number of physical exam elements now includes individual components of those systems. It will be easier to identify the level of history if the patient is unable to give an adequate history.