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Managing a patient's compromised airway involves preparing for the possibility of not being able to complete the intubation procedure in a timely manner. To avoid ongoing hypoxia and hypercapnea, management should include being ready to use alternative or "rescue" methods, including a surgical airway.
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"Quit dreaming that your patients are being watched by physicians in the ED." That's what the vice chairman of the Department of Emergency Medicine at State University of New York at Stony Brook told physicians when he sought buy-in for a process to move patients boarded in the ED upstairs during high capacity.
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Many hospitals have been cited by the Centers for Medicare & Medicaid (CMS) for failure to provide an appropriate medical screening examination for mental health patients, or for discharging these patients in an unstabilized emergency medical condition, notes Barbara E. Person, JD, an attorney at the Omaha, NE-based law firm Baird Holm.
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A patient, Scruggs, presented to Danville (VA) Regional Medical Center (DRMC) ED about 2 a.m. complaining of two days of prolonged dry heaves. He was triaged in the usual manner, prioritized as "non-urgent," and instructed to wait in the waiting area until his name was called. The court pointedly noted that the triage nurse failed to document the patient's "diabetic ketoacidosis condition or his history of diabetes."
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One after the other, videotapes on primetime news showed a patient, Esmin Green, being ignored by ED staff as she lay dying on a waiting room floor in a Brooklyn psychiatric hospital after waiting almost 24 hours for a bed. What impact will this "horror story" case, and others like it, have on ED litigation?
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One key to discharge planning is understanding what might prevent your patient from following medication and other instructions.
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Sometimes the best response to regulatory and payer changes in health care is to improve the discharge planning process.
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Transitions in health care are changing more quickly than patients' expectations, which is why it's important to address these expectations head-on, an expert notes.
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Hospitals across the United States are seeing an increase in patients who have limited English proficiency (LEP), and this means discharge planners must plan accordingly.
