ED management : the monthly update on emergency department management
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With funding from the Duke Endowment, the Albemarle Hospital Foundation in Elizabeth City, NC, implemented a telepsychiatry program aimed at decreasing patient backlogs in the health system's EDs, while also quickly connecting patients with needed mental health care. The approach has more than halved LOS for patients who are discharged to inpatient treatment facilities. The approach is also credited with reducing recidivism rates and the need for involuntary commitments. ⋯ Patients in the ED are connected with psychiatric providers at a remote location through the use of telemedicine carts that are equipped with wireless technology. With expedited psychiatric treatment, administrators say that nearly 30% of patients with involuntary commitment (IVC) orders stabilize to the point that their IVC orders can be rescinded and they can be discharged from the ED to outpatient care. Since the start of the pilot program in March of 2011, project administrators report that the average LOS in the ED for patients discharged to inpatient treatment facilities has decreased from 48 hours to 22.5 hours.
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Establishing alarm management as a new National Patient Safety Goal (NPSG), The Joint Commission (TJC) is calling on hospitals to make the issue a safety priority, and to begin establishing policies and procedures designed to minimize alarm fatigue among clinical staff. Beginning on January 1,2014, hospitals need to begin identifying the most important alarm signals to manage based on input from staff as well as factors such as patient risk, and the potential for harm as demonstrated by the device's history. By January 1,2016, hospitals need to have policies and procedures in place for managing alarms identified in the first phase of the NPSG's requirements. Also, staff and independent licensed practitioners need to be educated about the purpose and proper operation of alarm systems that they are responsible for.
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In a pilot study, researchers at the University of Cincinnati have found that when a peer referral program is combined with an ED-based HIV screening program, more cases of undiagnosed HIV can be detected, providing a preventive health benefit to the community. However, more studies are needed to determine how to best capitalize on the yield of ED-based screening programs, and to get better estimates on the potential benefits of combining social networking programs with screening programs. Dedicated testers and a streamlined process for enabling patients to be signed in as outpatients rather than ED patients were key aspects of the program. ⋯ In particular, program staff targeted any companions or partners of patients who were in the ED with them when they came in for testing. Between May and September of 2011, 466 patients were tested, with four patients testing positive for HIV. Among participants in the testing/peer-referral program, 34% had no prior visit to the ED, and 69% had never been tested by the ED-based HIV testing program.
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To address identified patient safety risks in the handoff process, a group of emergency providers developed Safer Sign Out, a paper-based template that prompts clinicians to jointly review issues of concern on patients who are being passed from one clinician to another at the end of a shift. Already in practice at 12 hospitals in the Mid-Atlantic region, the approach is now being disseminated nationwide with the help of the non-profit Emergency Medicine Patient Safety Foundation. ⋯ Safer Sign Out seeks to prevent communications failures by putting structure into the handoff process. In addition to prompting incoming and outgoing physicians to discuss each patient being handed off, the approach involves having both physicians round at the bedside of these patients so that patients fully understand when their care is being transitioned to a new provider.
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In a study dubbed Emergency Department Telemedicine Initiative to Rapidly Accommodate in Times of Emergency (EDTITRATE), investigators at the University of California San Diego Health System are gauging whether remote physicians can be quickly and cost-effectively mobilized to evaluate patients when the ED is busy. While there have been administrative hurdles involved with implementing the approach, investigators say the strategy could offer big savings in terms of time and efficiency. ⋯ While both patients and providers give the telemedicine encounters high marks, managing the workflow is challenging. Investigators say the approach could produce significant gains in efficiency, including the possibility that a single on-call physician could remotely treat patients from multiple ED sites.