ED management : the monthly update on emergency department management
-
New data suggest there is a huge opportunity for EDs to identify patients with the hepatitis C virus (HCV) and link them into care before downstream complications lead to higher medical costs and adverse outcomes. Early results from a pilot study at the University of Alabama Medical Center in Birmingham show that at least 12% of the targeted baby boomer population being screened for HCV in the ED is testing positive for HCV, with confirmatory tests showing that about 9% of the screened population is infected with the disease. Both the Centers for Disease Control in Atlanta and the US Preventive Services Task Force recommend one-time HCV screening for patients who were born between 1945 and 1965. ⋯ Researchers at UAB report that so many patients are testing positive for HCV that demand for care can quickly overwhelm the health system if new primary care/specialty resources are not identified. Administrators of ED-based HCV screening programs in both Birmingham and Houston note that EDs with existing screening programs for HIV should have the easiest time implementing HCV screening. They also stress that patients are more accepting of HCV screening, and that the counseling process is easier.
-
With deaths from opioid medication-related overdoses reaching epidemic proportions, researchers at two academic medical centers in Boston have identified key characteristics or red-flags that patients may be exhibiting drug-seeking behavior. In a separate study, researchers note that the ED is a prime location for identifying and intervening with young people who are engaged in the non-medical use of opioid and sedative medications. ⋯ Physicians ended up writing more prescriptions for opioids once they had the PDMP data. Researchers at the University of Michigan in Ann Arbor found that one in 10 adolescents who presented to the ED between September 2010 and September 2011 reported that they engaged in non-prescription opioid or sedative use within the previous year.
-
To address declining volumes and suboptimal patient satisfaction in the ED, administrators at North Adams Regional Hospital used lean techniques to eliminate waste and streamline the triage process. A few months into the new approach, administrators say that average daily visits to the ED have increased from 42 to 54, and patient satisfaction scores have jumped 25 points on Press Ganey surveys. Participants also report the approach has resulted in improved cooperation among ED staff and lower noise levels. ⋯ The team also divided the ED into pods so that nurses can be assigned to three or four contiguous rooms. This approach eliminates unnecessary movement and makes it easier for physicians to find a patient's assigned nurse. The hospital is now leveraging the same improvement process to work on ED-to-hospital admissions and a process for handling unexpected patient surges.
-
Faculty at Indiana University School of Medicine are set to launch a community paramedicine program aimed at preventing repeat hospital and ED visits for acute exacerbations of asthma in children. Under the program, all children who are treated in the hospital or ED for asthma will receive home visits by specially trained paramedics within a few days of discharge. Paramedics will conduct a comprehensive assessment and make referrals as necessary for followup care. ⋯ The one-time home visits will be comprehensive, enabling EMS providers to initiate stop-gap measures so that if a child is starting to get sick, paramedics can make sure the appropriate medicines are started and that acute care needs are met. Developers will monitor 30-day, 90-day, and one-year readmission metrics among patients who have received home visits. They hope that resulting cost-savings will sustain the program beyond the initial period, which is being funded through a grant from the Department of Health and Human Services.
-
A new study bolsters earlier findings that children who present to the ED with minor blunt head trauma can benefit from a period of observation before physicians decide whether to order computed tomography (CT) scans. Researchers note that the strategy significantly reduces the number of CTs that are required in these cases, reducing the risks associated with exposure to ionizing radiation. In a single-center study, researchers compared children who were observed with children who were not observed prior to CT decisions being made. ⋯ Just 5% of the patients who were observed proceeded to undergo CT scans; 34% of the patients who were not observed underwent immediate CT scans. Researchers note that troubling symptoms such as headache, vomiting, or altered mental status often resolve with time, negating the need for a CT scan. While more than 500,000 children present to EDs in the United States each year with blunt head trauma injuries, very few are found to have significant traumatic brain injuries.