ED Management (Vol. 34, No. 2) - February 2022

Underpayment Is Major Concern for EDs with New Surprise Billing Law

This landmark consumer protection took effect Jan. 1, but litigation from advocacy groups is pending as insurers are jockeying with providers for reimbursement rate advantages.

ED Visits for Alcohol and Substance Use Disorders Surging Nationally

Presentations often are bundled with a host of comorbid conditions and chronic or acute traumatic events. Providers should suspect and expect an underlying potentially serious coexisting medical complication in each patient encountered until proven otherwise.

Few EDs Screen Patients for Excessive Alcohol Use

The ED is where patients often go during their most vulnerable times. Emergency providers can help vulnerable patients prevent a future crisis if they can show patients that help is available and how to access it.

Ransomware Attacks Pose Unique Danger to ED Patients

Integrate ransomware response training with emergency preparedness training. To stay ahead of this risk, leaders can create packets with all documents needed to convert to non-digital care on short notice. Staff can switch to manual processes for ordering labs and imaging, following care protocols, and calculating drug dosages.

Unexpected Gaps in Opioid Overdose Treatments

Patients presenting to EDs for opioid overdose should go home with a naloxone prescription or a naloxone take-home kit. Alternatively, these patients could start buprenorphine when it is clinically feasible, or they could be connected directly to outpatient treatment for opioid use disorder.

Stroke Patients Visit EDs Often After Discharge from Hospital

Repeat visits to the ED are quite common, even for patients who experienced mild or moderate strokes and are managing their conditions at home. This suggests home care models for these complex patients are important to evaluate and modify, if needed, to improve long-term care outcomes.

CT Scans Rarely Change Management of Acute Pancreatitis

For acute pancreatitis patients, efficient and clinically accurate triage is the singular most vital function to help eliminate potential claims — but more importantly, to provide safe and effective treatment to ED patients.

Older Adults with Abdominal Pain Risk Mistriage, Inadequate Diagnostic Tests

ED providers should not think of abdominal pain in older adults as the same as abdominal pain in younger patients. At the department level, consider adding abdominal pain in older patients to the list of automatic ECG criteria.

Damages, Causation Are Obstacles in Abdominal Pain Med/Mal Cases

Many older ED patients are living with a host of preexisting conditions, which, coupled with the patient’s age, argue against investing the needed time and money to pursue a malpractice claim. Even if there is clear liability and causation, the case of misdiagnosed abdominal pain still might not be worth pursuing from a financial standpoint.

Rapid-Access Psychiatry Encounter Might Reduce ED Use Rate

The lack of access to outpatient psychiatric care could contribute to the medical emergencies seen in EDs. Most emergency providers are well aware of the shortage of available mental healthcare providers in both inpatient and outpatient settings.

ED Is Focus of Reduction in Sepsis-Related Mortality

Using a sepsis alert, combined with nursing protocols and physician order set usage, can improve core measure compliance and related mortality rates.

ED Management – February 1, 2022

February 1, 2022