ED Management – September 1, 2023

Boarded Mental Health Patients: Out of Sight, Out of Mind

Many EDs routinely board mental health patients for days on end, awaiting transfer to a mental health facility. An expert offers tips to help emergency medicine providers alleviate safety and medical/legal risks.

Consensus Panel Offers Guidance for Pediatric Mental Health Boarding

EDs nationwide continue to see pediatric mental health patients boarded in the department for long periods while awaiting inpatient bed placement. A group of 23 experts from 17 health systems sought to identify what EDs are facing, to learn how departments are handling the problem, and to offer recommendations to standardize practices.

To Alleviate Boarding, Consider Creating Discharge Lounge

Several months into the new process, leaders at Northwestern Medicine Palos Hospital report they have shortened the average discharge process from four hours to one hour, they have halved the ED’s leave-without-being-seen rate, and patient satisfaction scores have begun to rise in both the ED and inpatient settings.

Prioritize Bed Placement for Older Patients to Shorten Stays, Prevent Delirium

A team of emergency physicians gathered data showing that among older patients, there is an association between time spent in the ED and the development of delirium. Researchers found that for every hour spent in the ED, the risk of developing delirium increased by roughly 2%.

Make Headway Against Workplace Violence with Data Tracking, Interdisciplinary Initiatives

Two health systems have started several initiatives that attack the problem from different angles. Data show these systems are making a sizable dent in incidents of violence in their EDs and other vulnerable points. These leaders are sharing their roadmaps and best practices so others can benefit.

Prying Eyes Put EDs at High Risk for HIPAA Violations

Ensure policies are in place to protect the privacy of patients’ identifiable health information, train staff on those policies, implement measures to maximize compliance with the policies, and provide supplemental training if there are any incidents of non-compliance by an individual or group.

Did Emergency Provider Discuss Sensitive Topics with Adolescent?

Protecting confidentiality is the primary consideration for emergency care providers discussing sensitive topics with adolescent patients, including documentation in the medical record, discharge papers, lab results, and billing. Confidential conversations can be protected in the medical record several ways, including using confidential notes that are not visible to all.

EHR Flaws Contribute to Diagnostic Errors

Many, if not most, emergency care providers would agree there are some significant downsides to electronic health records, including usability, interoperability, and malfunctions, to name a few. But are these issues merely annoying, or do they actually contribute to diagnostic errors?

Vital Signs Are Unreported During Most EMS Handoffs

EMS holds a wealth of information about a very critical time in the patient’s treatment and evaluation for that episode. Physicians, EMS agencies, and hospital leaders should collaborate to figure out what gaps exist and develop specific tools to close those gaps.