Articles: hospital-emergency-service.
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This article discusses risk management and control of malpractice risk in the Emergency Department. Particular emphasis is placed on actuarial information related to Emergency Department losses.
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With regionalization of specialized health care services, some patients must be transferred between hospital to receive needed care. The authors evaluated 100 transfers to their emergency department as to the adequacy of stabilization prior to transport. Problems were identified in the areas of communication (nine cases), oxygenation (two cases), cardiac monitoring (one case), intravenous lines (eight cases), airway (two cases), ventilation (one case), equipment and personnel accompanying the patient (one case), bladder catheterization (four cases), nasogastric suctioning (one case), radiographs (nine cases), and spinal immobilization (seven cases). ⋯ A review of the literature shows that inadequacies in stabilization for transfer are widespread. This may be improved through physician education, use of transport teams, and judicious use of interhospital transport. The indications and responsibilities of transfer are discussed.
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We present a method for a microcomputer-assisted emergency department daily chart audit using a spreadsheet format. Computer technology allows the extraction of a large amount of information from audit data with a minimum of clerical time. The software automatically tabulates, sorts, and updates audit data, and depicts physician performance in a quantitative manner. ⋯ The spreadsheet model is flexible, and can be adapted to the needs of various emergency departments or quality assurance activities. The audit has a rapid turnaround time, with charts audited and returned to physicians for feedback within 24 hours of the patient being discharged. Individual physician confidentiality is maintained throughout.
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All emergency departments face the possibility of having insufficient personnel to provide adequate care for patients. Such occasions may present an emergency department with several severely injured patients or merely an unusually large number of that emergency department's usual patient profile. ⋯ In addition, emergency department directors have an obligation to consider their particular staffing and usage patterns in order to try to devise the most efficient back-up policy prior to need. Finally, assessment of the success with which such back-up policies are used is discussed.
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Exsanguination may be presumed in pale, mottled, unresponsive trauma victims with no palpable pulse nor spontaneous respirations with noncranial penetrating wounds. Under ideal circumstances, those victims initially witnessed to have some signs of life can be successfully revived in 5 to 25% of cases. ⋯ After confirming the witnessed cardiopulmonary arrest from presumed exsanguination, the four phases of resuscitation are restoring central oxygenation, controlling internal hemorrhage, re-establishing spontaneous cardiac function, and definitively repairing the injury. Regardless of the type or location of the noncranial penetrating injury, these phases must be accomplished sequentially to minimize the risks of cerebral and cardiac anoxia.