ED Management – May 1, 2023

Health Systems Look to Duplicate California Substance Use Disorder Treatment Model

Administrators in several states want to leverage their EDs as a critical point of access to identify and treat substance use disorder.

Why Navigators Are Essential to CA Bridge

While not all participating EDs in California have a Bridge clinic on their campus, the essence of the model is to make it easy for patients to receive the care they need. To do this, each ED should designate a champion to drive the program and a navigator to facilitate treatment access.

ET3 Pilot Hailed as Big Step Toward Fully Leveraging EMS

In January 2021, the Centers for Medicare & Medicaid Services launched a five-year pilot program called Emergency Triage, Treat, and Transport (ET3), an approach that enables participating EMS programs to connect some patients with lower-acuity problems to emergency providers via telemedicine at the scene. Most participants are excited about leveraging the approach to accelerate needed care to patients, decompress EDs, and maximize the skills of the EMS workforce.

Tennessee Develops EMS Response Program for Low-Acuity Medicaid Patients

The program, modeled after ET3, once implemented statewide, is estimated to reduce unnecessary visits to the ED, ease crowding of emergency medical services, and generate more than $8 million annually in Tennessee Medicaid program savings.

Just One Malpractice Payout Means Far Higher Risk for Future Claims

Of 841,961 physicians with zero paid claims in the 2009-2013 period, only 3.3% were the subject of one or more claims in the next five years (2018-2023). Of 34,512 physicians with one paid claim in the prior period, 12% were the subject of one or more claims in the next five years. Of 4,189 physicians with two paid claims in the prior period, 22.4% were the subject of one or more claims in the next five years. Of 1,214 physicians with three paid claims in the prior period, 37% were the subject of one or more claims in the next five years.

EDs Can Mitigate Malpractice Perils of High-Risk Medications

Many emergency providers are hesitant to deprescribe medications taken by a patient they just met. Some are more open to the idea in certain cases, such as blood pressure medications associated with side effects or adverse outcomes. But if patients cannot identify the high-risk medications they are taking, or if the link between the medication and the chief complaint is weak, it makes the task harder.

New Processes ‘Close the Loop’ on Imaging Findings

University Hospitals Cleveland Medical Center, radiologists report imaging findings through a standardized form integrated in dictation software. This automatically sends an email to a nurse navigator, who documents the findings and coordinates follow-up with patients, primary care providers, and specialists. From July 2021 to May 2022, 1,207 incidental finding reports were submitted, with the vast majority identified on CT scans. Ten new cancers were detected as a result of the program.

ED Makes Discharge Safer for Pediatric Patients

Preventable, serious safety events related to discharge from the ED motivated clinicians at Boston Children’s Hospital to implement a standardized process. Staff follow and review all events locally within the department of emergency medicine, which can include some return visits. The emphasis is on family engagement and multidisciplinary communication.

Pediatric Mental Health Crisis Is ECRI’s Top Safety Concern for 2023

The ED assessment should include appropriate triage: screening for harm of self or others, a thorough assessment, and consideration of social determinants of health.

Endotracheal Intubation Lawsuits Often Name ED Providers

After analyzing 214 relevant claims, researchers reported payments averaged $2.5 million. Intubation injuries occurred in the operating room most often, followed by the ED (16.3% of cases). Most cases involving the ED resulted in some type of payout (either a settlement or a jury award). Anesthesiologists were most likely to be named in the lawsuits (59.8%), and EPs were second most likely (19.2%) to be named. The vast majority of claims (89.2%) alleged permanent deficits, half the cases involved death, and 37.4% of the cases involved anoxic brain injury.