ED Management 2005-05-01

End-of-life decisions can be complex, even when patients have a DNR

The widespread publicity surrounding the case of Terri Schiavo may have brought end-of-life issues to the forefront for the general public, but ED managers deal with these challenges on a daily basis. The proper way to treat these extremely ill patients in the ED whether or not they have a do-not-resuscitate (DNR) order is, like the Schiavo case, hardly cut and dried.

Are ED staff prepared to give palliative care?

While ED staff are well-versed in life-saving techniques, they are not as expert in making dying patients feel comfortable, asserts Tammie E. Quest, MD, assistant professor in the department of emergency medicine at Emory University in Atlanta.

DNR a small part of overall care plan

Its important for ED managers to remember that just because a patient has a do-not-resuscitate (DNR) order, that doesnt mean all of the patients wishes have been expressed in writing, says James Espinosa, MD, medical director of the ED at Overlook Hospital in Summit, NJ. A DNR is just one part of a continuum, Espinosa says.

Manufacturing techniques help turn ED around

About one year ago, the ED at Doctors Hospital in Columbus, OH, was facing what Marci Conti, RN, MBA, vice president of operations and chief nursing officer, calls a perfect storm.

Lean manufacturing means ‘keep it simple’

Because concepts from other industries can sometimes seem a bit obscure to the health care professional, this real-life synopsis of the use of lean manufacturing techniques (eliminating waste, or extra steps, in a process) at Doctors Hospital in Columbus, OH, may help illustrate how the approach can be applied practically in the ED. It involves the process of sending an ED patient to radiology.

Will staff restructuring improve psych diagnoses?

If Seth Kunen, PhD, PsyD, had his druthers, every ED manager in America would have a staff or a call panel that included a substance abuse specialist, a psychologist, a psychiatrist, and a social worker.

You don’t need a new paradigm to improve care

Although a new paradigm can radically improve the rate at which psychiatric disorders are diagnosed in the ED, there is much ED managers can do short of a major staffing overhaul that can enhance the ability to identify such problems, says Seth Kunen, PhD, PsyD, director of research at Louisiana State University emergency medicine residency program at Earl K. Long Medical Center in Baton Rouge.

Training with mannequins improves safety, efficiency

A growing number of ED physicians and managers are gaining access to a training resource that its proponents claim boosts patient safety, improves training efficiency, and ensures a higher level of skills retention: lifelike mannequins that simulate real-world patients and case scenarios.

Simulation competency course is a first

Its the first of its kind: a course in difficult airway management using mannequin simulations that is required for all practicing emergency physicians at the University of Pittsburgh Medical Center, says Paul Phrampus, MD, FACEP, director of the course, assistant professor of emergency medicine in the department of emergency medicine, and assistant director of the Peter M. Winter Institute for Simulation, Education, and Research (WISER).

EMTALA Q & A

Question: I am a chairman in an ED, and this case recently occurred: A man came to the ED after cutting his flexor tendon at home. He had 100% flexor cut on his non-dominant hand. He was also experiencing a loss of sensation around the ulnar aspect of the affected index finger. The patient was sutured in the ED, and the hand surgeon was consulted.

Managers at recently surveyed EDs warn: Surveyors target overcrowding standard

Its an ED managers worst nightmare: You have one of the most overcrowded and underfunded EDs in the country. Of the 40 patient care spaces for adults, five to 15 are filled at all times with admitted patients waiting for a bed. And here comes your accreditation surveyor wanting to know how youre complying with the new 2005 standard to ensure those patients are receiving the same level of care as inpatients (LD.3.11).

Overcrowding-Related Process Improvement Activities in the Adult ED (Excerpt)

Things Currently Being Done Triage Area Triage criteria prioritize patients by acuity. Patients with chest pain have electrocardiogram performed and read by faculty or senior residents. Patients at risk for tuberculosis have chest X-rays taken and read by faculty or senior residents. Emergency medicine residents care for lower-acuity patients in the triage area from 7-11 p.m. daily (moonlighting).

What do you do when there are no beds ready?

You can be certain that your accreditation surveyor will ask you what you do in the ED when you have admitted patients and no inpatient beds are available.

ED Management – May 1, 2005

May 1, 2005