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You aren't ready to rule out a cardiac cause to your patient's chest pain, but the ED physician orders a pain medication instead of nitroglycerin. When you question this, the physician insists the pain is musculoskeletal.
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In a septic patient, the normal defenses of the body against overwhelming infection are breaking down. Bacterial germs are loose and multiplying in the bloodstream.
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You're worried about the patient standing in front of you, but you can clearly see that not only the patient care areas but also the waiting room is completely packed. How do you protect this person from deteriorating during a possible long wait?
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Upon hearing that a 15-year-old girl was "just not acting right," an ED triage nurse at Phoenix Children's Hospital quickly recognized this statement as a risk factor for suicide.
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A well-kept elderly couple presented to triage and seemed knowledgeable about their medication regimen. The man told the nurse that his wife had become confused and lethargic over the past three days.
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Not long ago, the ED at Palisades Medical Center in North Bergen, NJ, was struggling with waiting times hovering at about four hours.
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Because many throughput problems experienced by EDs are not caused by EDs, those managers who find themselves operating in a vacuum have little chance of success.
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While telemedicine has proven successful in several ED settings, some observers have long been skeptical that it could be applied to behavioral health.
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(Editor's note: This is the second part of a two-part series on recent reaccreditation efforts made by the staff of the chest pain center at Oregon Health & Science University Hospital in Portland. In the first installment last month, the staff discussed the STEMI alert training procedures involved. These procedures not only involve the triage nurse, but the entire staff, including the valets. This month, we look at how the staff brought the hospital rapid response team into the process, and how the acquisition of atomic clocks enabled the ED and outside resources to accurately track their response times.)
