ED Management – August 1, 2022

The Case for a Team Approach to Manage Agitated Patients

While many EDs have instituted mechanisms to quickly trigger security staff, a Connecticut hospital created a unique team-based protocol that includes security and clinicians. Everyone works together to protect staff and prevent the need for restraints, sedatives, or other potentially harmful interventions. After three years, staff report they feel safer, and new data show the approach is associated with a lower rate of physical restraint use.

Remain Vigilant for Signs of Monkeypox

Emergency clinicians should include the possibility of monkeypox in any patient presenting with early symptoms suggestive of the illness and certainly for those with a new rash and epidemiological risk factors.

Call Patients to Reinforce Discharge Instructions, Stress Need for Follow-Up Care

Follow-up calls to patients after they have been discharged may be far down on the priority list for busy EDs. However new data suggest such calls can ensure patients understand their discharge instructions and prevent repeat visits.

New Checklist Offers Roadmap for Improved Diagnostic Performance

Researchers created 10 high-priority practices they maintain are key to promoting diagnostic excellence.

Documentation Mistakes Lead to Significant Malpractice Awards

Ensure charts are generated honestly, and check to make sure key care decisions are carefully documented regarding consent.

Legally Protective Charting Sticks to the Facts

Charts containing emotional statements, accusations, and speculations might be compelling reading, but they are legally problematic.

Misconceptions About Homelessness Put Patients, EDs at Risk

Engage these patients in care plans the same as anyone else. Ensure the patient understands the treatment plan, and can carry it out if discharged.

Many Charge Nurses Receive Little, if Any, Training

Charge nurses are responsible for patient flow, moving them from the waiting room to appropriate disposition. To be effective, these nurses must understand the clinical conditions of the patients in the waiting room. This informs good decision-making on which patients to bring in, in collaboration with the triage nurse, and which nurses to assign those patients.

Emergency Providers Uneasy About Recording Visits

Clinicians might need more information, such as specifics on who would record the discharge instructions, whether it would be recorded on the patient’s personal smartphone, and what safeguards could be required to ensure patient privacy. Combined with possible involvement of the hospital’s legal department, this might make providers more comfortable with the idea.

Admissibility of ED Recordings Depends on Multiple Factors

Even if the patient recorded the entire discharge instructions, relevant discussions might have happened throughout the visit. The defense can challenge the admissibility based on that argument, but the ruling could go either way.

Updated Abdominal Pain Guidelines Close Knowledge Gap

Without clear guidelines, patients could undergo unnecessary testing (or not receive tests they need), which could lead to misdiagnoses — or worse.

ED Visit Is Teachable Moment on Stroke Care

Researchers provided an ED-based educational intervention to 100 Black patients at an urban facility, including video, brochure, and verbal counseling. After, participants were much more likely to demonstrate confidence in the ability to recognize stroke symptoms in themselves or others and were more likely to feel confident about calling 911 in the case of stroke warning signs.