ED management : the monthly update on emergency department management
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To reduce mortality and improve the care of patients with sepsis, Wake Forest Baptist Medical Center in Winston-Salem, NC, created a new rapid-response protocol aimed at facilitating earlier diagnosis and treatment. In this approach, clinicians who suspect a patient may have sepsis can call a Code Sepsis, which will fast-track the series of tests and evaluations that are needed to confirm the diagnosis and get appropriate patients on IV antibiotics quickly. Administrators say the approach fits in with the culture of the ED, and it has quickly slashed time-to-treatment in this environment. ⋯ In the ED, where a modified version of the approach has been in place since April 1 of this year, the percentage of patients with sepsis receiving antibiotics within one hour of diagnosis has increased from 25% to 85%. Key to the success of the approach are specially trained rapid-response nurses who are called in on a case whenever a diagnosis of sepsis is suspected and a series of policy changes designed to facilitate needed diagnostic tests to confirm a diagnosis. A mandated online education module helped to bring all clinicians and staff up to speed on the new process quickly.
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With as many as five level I trauma centers, Boston is well-positioned to mount an emergency response, but the two terrorist bombs that went off near the finish line of the city's annual marathon on April 15 put high levels of stress and demand on emergency personnel. In post-crisis reviews, hospital administrators say that all the emergency planning and drilling that they carry out on a regular basis was instrumental in helping them quickly care for nearly 200 victims while also securing their facilities at a time when the threat to the city was not well understood. Medical personnel working in tents on site at the marathon were able to respond to the injured quickly, while also giving area EDs a heads-up on what to expect. ED leaders report that a robust effort from the upper floors of their hospitals was critical in: helping them clear their EDs for incoming patients; establishing a security perimeter around the facilities to thoroughly check any people entering or leaving to guard against potential external threats; and focusing on improving how many extra staff show up to help during the crisis because it actually requires extra resources to manage the personnel.
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The ED at Avera Marshall Regional Medical Center in Marshall, MN, has been able to implement a number of improvements in its throughput process by holding monthly "quick hits" meetings aimed at identifying opportunities for improvement and potential solutions. Among the improvements that grew out of this process is a 12-minute dent in the ED's average decision-to-admit times. ⋯ The ED director scheduled the meetings during the morning hours when the ED is typically not busy, and the physician has time to attend. Decision-to-admit times were reduced by giving charge nurses an earlier notification when patients presenting to the ED were likely to be admitted.
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As medical devices become more widely used in hospitals, there is evidence that providers are becoming overwhelmed by the alarms that emanate from these machines. Experts link the problem with 566 alarm-related deaths reported in an FDA database between January 2005 and June 2010, and 80 alarm-related deaths reported in The Joint Commission's (TJC) own sentinel event database between January 2009 and June 2012. The ED is among the hospital sites where the adverse events reported to TJC most often occurred. ⋯ Experts say with so much noise and so many false alarms, clinicians can become desensitized to the medical-device alarms. The types of alarms that administrators should be most concerned about in the ED are dysrhythmia alarms on heart monitors, oxygen saturation alarms, and signals that a patient has a low respiratory rate. Experts urge hospitals to develop cross-disciplinary teams to address alarm safety on an ongoing basis, and to assemble action plans for improvement that contain baseline metrics that can be used to chart progress.