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This study from the University of Alabama Hospital in Birmingham reviewed administrative data from all patients admitted with the primary diagnosis of acute exacerbation of chronic obstructive pulmonary disease (COPD), or because of acute respiratory failure with a secondary diagnosis of COPD exacerbation.
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ED managers have the opportunity to increase reimbursements under the proposed 2009 rule for the Outpatient Prospective Payment System (OPPS), but they also will come under greater scrutiny by the Centers for Medicare & Medicaid Services (CMS) for the quality of their care.
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When an Aero Med helicopter crashed and burst into flames on the roof of an 11-story tower at Spectrum Health Butterworth Hospital in downtown Grand Rapids, MI, on May 29, 2008, during a training run, the ED team swung immediately into action to get to the two victims and prepare the department to receive them.
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When a flash flood hit Columbus, IN, in June, Columbus Regional Hospital had to be evacuated. But just two weeks later, the ED was able to reopen, thanks to a mobile unit called the Carolinas MED (Mobile Emergency Department)-1, which was first deployed in New Orleans in the wake of Hurricane Katrina.
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When an ED is forced to close due to a disaster and requests delivery of a mobile unit called the Carolinas Mobile Emergency Department-1 (MED-1), "we like to think we can be mobile in 72 hours," says Tom Blackwell, MD, medical director for the Center for Pre-Hospital Medicine, Department of Emergency Medicine, at Carolinas Medical Center, Charlotte, NC, and one of the two physicians who spearheaded the development of the mobile unit.
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Crowding is increasingly becoming a factor in litigation involving ED care and is putting nurses and physicians at increased risk for being named in a lawsuit.
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When you are faced with more patients than resources, and a lawsuit results, one possible defense argument that would encompass the hospital and the emergency physician is that everyone did everything that could be reasonably expected under bad circumstances.
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The ED physician has some liability to care for these tremendously ill patients, "and you are doing so in a unit that is not really designed for ICU patients," says Robert Shesser, MD, professor and chair of the Department of Emergency Medicine at George Washington University Medical Center in Washington, DC.
