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An ambitious collaborative involving an entire hospital system plus experts from a neighboring engineering school are systematically analyzing the causes of capacity constraints and developing strategies to address them at one hospital. To date, they have already achieved a nearly 33% improvement in the number of ED admits in under 90 minutes from 32% to 42.3%. Ultimately, they hope to develop a toolkit that will ensure a typical door-to-doc time of fewer than 20 minutes.
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The creation of two new positions in the ED has improved flow and increased patient safety, according to Gregory Smolin, DO, FACOEP, FACEP, medical director of the ED at Memorial Hospital of York (PA) County. The new staff members, called flow technicians or flow techs handle a wide range of responsibilities including handling discharge instructions, finding charts and results for the doctors, and checking to see that all patients have received the treatment that was ordered.
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The Centers for Medicare & Medicaid Services has posted answers to two new frequently asked questions (http://questions.cms.hhs.gov) about the Health Insurance Portability and Accountability Act administrative simplification standards.
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Its after lunch, and your volume is peaking. You think things cant get any more hectic, but here come accreditation surveyors visiting your department as part of an unannounced survey.
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Imagine that a patient with a chronic disease and taking multiple medications has an acute deterioration at home. The patient calls 911, and an ambulance arrives. The emergency technicians arent able to obtain all of the patients medication information from family members, and the patient is unable to communicate.
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Stroke remains the third leading cause of death, but more importantly the cause of severe morbidity particularly among the elderly. Up to two-thirds of strokes leave the patient with significant disabilities, often requiring institutional care.
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It is reasonably settled that from a legal and/or ethical viewpoint that a competent patient has the right to direct his or her own medical care in any scenario. However, when the patient who is receiving medical care is no longer legally competent or never was legally competent to undertake medical decisions, the legal and ethical waters become murky.
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One of the most challenging evaluations that an emergency department (ED) physician is asked to perform is the examination of a child with potential child abuse. The majority of ED physicians feel overwhelmed, and although they would like to perform the "ideal" history and physical examination, they find themselves feeling inadequate in these situations.
