ED management : the monthly update on emergency department management
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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.
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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.