ED Management – November 1, 2022

What Role Should Providers Play in New Rural Emergency Model?

In 2023, remote, financially stressed hospitals could convert to a new model and remain a critical part of small communities. This is an exciting opportunity for emergency medicine providers, although much depends on the final regulations that will govern these facilities.

Dozens of Facilities Predicted to Show Interest in Rural Emergency Hospital Model

Key targets are hospitals that operated three years with negative total margins, facilities that recorded an average acute and swing daily census of less than three, and centers running with net patient revenue of less than $20 million.

Frontline Providers Must Consider Dual Threats of AFM Resurgence, Polio Return

The CDC is advising frontline providers of a potential surge in cases of acute flaccid myelitis (AFM), a rare, polio-like complication of certain enteroviruses. Concurrently, there are concerns about the re-emergence of poliomyelitis.

How Did Paralytic Polio Re-Emerge in the U.S.?

Most outbreaks globally are attributed to vaccine-derived polio, or type 2. Cases of the type 2 form of polio stem from the large-scale, global use of the oral polio vaccine, a solution that contains a live (but weakened) virus.

Multidisciplinary Program Accelerates Care, Boosting Outcomes for Hip Fracture Patients

Returning Seniors to Orthopedic Excellence focuses on prioritizing early pain management and shortening the time to surgery for patients with confirmed hip fractures. Since implementation in early 2021, lengths of stay are shorter, time to surgery has declined, and attendance rates at follow-up appointments are higher.

Lack of EP Evaluation of Chest Pain Can Lead to Disaster

If an emergency physician never evaluates such a patient, leaving the care solely to a physician assistant or a nurse practitioner, this could lay the foundation for litigation.

Many Emergency Medicine Residents Struggle with Communication

Researchers studied how to objectively assess patient/physician interactions in the ED. They used an observational tool to assess emergency medicine residents’ non-technical skills in patient interactions. This tool allows educators to consistently measure several important interpersonal domains to pinpoint the reasons why interactions are poor.

Legal Implications if Adolescents Seek Confidential Care

Generally, emergency clinicians are required to obtain parental consent for care provided to minors. However, there can be exceptions if the minor is seeking treatment for sexually transmitted infections, mental health, substance use disorders, sexual assault, or pregnancy. Several federal and state laws apply. Healthcare professionals are advised to be aware of the laws where they practice.

Tracking Undertriage Can Help Prevent Medical Errors

Investigators found several issues were important to track using quality improvement methods, including discrepancy in exam or history between the triage and assessment nurses, along with discrepancy between the chief complaint and the physical exam. Also, they found failure to synthesize historic or objective information.

Repeat Visits Are Second Chances to Avoid Misdiagnosis

Conditions that start with subtle signs and evolve over time are traps for the practitioner who is too rushed to let the situation unfold.