ED Management – November 1, 2023

CDC Unveils Sepsis Core Elements Initiative to Address Gaps in Care

Agency leaders believe sepsis programs in every hospital — regardless of size, location, and resources — can strengthen the quality of care delivered to patients and ensure their survival.

A Fresh Approach to Helping High-Needs Patients Who Repeatedly Use the ED

Care providers treat frequent ED visits as a symptom rather than the problem itself.

Paramedicine Program Chips Away at High ED Use, Links Patients to Appropriate Care

Chicago-based Medical Home Network is partnering with community paramedics at the Chicago Fire Department on a program aimed at helping patients manage their chronic conditions and appropriately navigate the health system. The program is focused on steering patients away from calling 911 or presenting to EDs with nonurgent care needs.

Housing Instability Increases Likelihood of Discharge Against Medical Advice

It is important for emergency medicine providers to recognize that patients facing housing instability might be more inclined to self-discharge, even when dealing with severe medical conditions.

EDs Can Make Discharges Against Medical Advice Safer

Recognizing a discharge as higher risk could encourage physicians and care providers to engage in risk assessment and risk reduction.

Was Child Brought to ED by EMS? Medication Dosages May Be Incorrect

ED personnel should ensure a good handoff report is received from EMS providers, and that the dose of any medications administered by EMS is recorded. ED personnel should be mindful in carrying out weight-based dosing calculations, and should follow recommendations of national guidelines.

Many Pediatric Patients Leave EDs Without Being Seen

As pediatric patients become more medically complex, inpatient pediatric beds across the country continue to consolidate, and pediatric EDs are expecting to see higher volumes of children. Healthcare leaders must build these considerations into their staffing and patient flow approaches if they hope to prevent more patients from leaving without before they are seen.

Onsite Pharmacies Can Boost Medication Access to Patients, Surrounding Communities

There are some other possible workarounds, such as leveraging electronic prescribing from the ED so providers will know quickly whether medications are available in a specific outpatient pharmacy, administering first antibiotic doses in the ED, and providing a few days’ worth of medication to patients about to be discharged.

Irritable Patient Behavior Affects Emergency Nursing Assessments

For encounters during which the patient exhibited irritable behavior, nurses reported more anger and unease. They also judged the patients as likely to exaggerate pain, as poorer historians, and less likely to cooperate and return to work and recover. In their documentation, nurses were more likely to use negative descriptions of patients and more likely to omit information, such as whether tests were ordered.

Is ED Patient Rude or Insulting? Risk Mitigation Needed

Patients who behave in this manner could be at risk for a missed diagnosis caused by poor communication with the treatment team. They may be so difficult to tolerate that they receive less attention and nursing care than they would have otherwise. The best approach is to recognize the risks with these types of patients and mitigate them.

Emergency Medicine Residents Should Be Aware of Legal Exposure

To alleviate malpractice risks involving residents, attendings should implement a reasonable and adequate plan for the patient along with the resident; review the patient’s lab and imaging results; and, ultimately, be the decision-maker as to the patient’s ultimate disposition.