ED Management – March 1, 2024

Ongoing Education, Outcomes-Focused Reviews Remain Key to Lasting Gains in Triage Accuracy

A recent investigation into the accuracy of ED triage decisions when using the most common triage system — the Emergency Severity Index — revealed that mistriage occurs in roughly one-third of patient encounters.

Triage: When Relying on Historical Data, Do Not Apply Bias from Past Decisions

There is no denying that in a system that relies heavily on clinician judgment regarding acuity designations, bias can influence triage decisions. Indeed, among the disparities identified in the study into Emergency Severity Index triage accuracy was that Black patients had a 4.6% greater relative risk of overtriage and an 18.5% greater relative risk of undertriage when compared with white patients.

Monthly Calls Dramatically Cut ED Visits by Super-Utilizers

Researchers at a Virginia hospital conducted a quality improvement project to get frequent ED visitors the care they needed and keep them out of the ED. The researchers identified the 50 top super-utilizing patients at Sentara Norfolk (VA) General Hospital’s ED in 2020 and contacted them about enrolling in a chronic care management program.

Reduce Patient Safety Risks for ED Super-Utilizers

Extreme ED super-utilizers pose significant risks and challenges for ED providers. Providers are at risk for missing signs of a serious condition because they have seen the patient in the ED so many times for the same complaint — whether back pain, headache, or abdominal pain.

Is Diagnosis Uncertain in the ED? Clear Communication Is Needed

Patients likely expect to leave the emergency department with a definite understanding of what is wrong. Yet many patients are discharged or admitted with an uncertain diagnosis.

Pediatric Boarding Increases Safety Concerns in EDs

Boarding is a common occurrence in most EDs. However, it has been studied more often in adult EDs than pediatric EDs.

A Concise Tool to Guide the Care of Patients with Community-Acquired Pneumonia

While patients with community-acquired pneumonia (CAP) commonly present to the ED, obtaining a proper diagnosis and determining the best treatment course is not always clear-cut. For one thing, while there are many evidence-based guidelines for CAP, many of these tools are more than 50 pages long, making it difficult to integrate them into clinical practice.

How a ‘Breaking the Rules’ Campaign Engages Staff and Uncovers Outdated Policies

With clinician burnout, a boarding crisis, moral distress, and other concerns making it tough for healthcare leaders to retain staff, it is nice to have an employee-pleasing strategy that can not only make healthcare workers feel as though they have an important voice but also boost operational efficiency. That is the idea behind the “Breaking the Rules for Better Care” initiative spearheaded by the Institute for Healthcare Improvement.

‘Safe Harbors’ Can Address ED Providers’ Malpractice Fears

Many emergency physicians want to follow evidence-based guidelines to reduce unnecessary testing — but worry about liability if they do not order a diagnostic test and a patient sues. The Choosing Wisely campaign, an initiative of the American Board of Internal Medicine Foundation, aims to reduce the overuse of potentially harmful tests and procedures.