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A large number of emergency medicine observers agree that the inability to fully staff ED call panels has reached a critical point.
Why has the problem become so serious?
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There was a long history of frustration over lab specimen turnaround time but not anymore. Thanks to a successful Six Sigma initiative, turnaround time for the EDs criteria draws (draws based on specific patient criteria that indicate lab work will be needed) has dropped from about 46 minutes to 16 minutes.
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A series of 27 lawsuits aimed at organizations controlling about 250 nonprofit hospitals in 15 states and the Chicago-based American Hospital Association (AHA) have shone the spotlight on the Emergency Medical Treatment and Labor Act (EMTALA) and its requirements concerning the treatment and admission of uninsured and underinsured patients.
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Headache is a common chief complaint encountered by emergency physicians (EPs). It may be a symptom of benign diseases such as migraine headaches or a common virus. Unfortunately, it also may represent other, more life-threatening illnesses, including subarachnoid hemorrhage. Delineating which patients need radiologic imaging, spinal fluid testing, and even angiography is part of the challenge encountered by the EP. This issue will outline strategies for reducing risk in the headache patient. Specifically, diagnosis and management of subarachniod hemorrhage will be detailed.
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This article points out the disadvantages of partial DNR ordersfor both clinicians and patientsand offers clear steps for mitigating the problem by developing a supplemental patient care plan for patients who are less than full code.
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In this randomized, controlled trial, European investigators looked at the role of vasopressin in treating out-of-hospital cardiac arrest. Although the study did not show any benefit of using vasopressin when compared to epinephrine in terms of survival to hospital, this study nonetheless makes a weak argument to use vasopressin in cardiac arrest patients with asystole.
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Documentation requirements for every patient encounter have increased, leaving less time for the actual practice of medicine. While documentation is a burden to physicians and nurses, it does have unlimited value. Documentation allows for appropriate billing for the time and efforts of the physician, nurse, and other medical specialists. Thorough documentation allows for maximum reimbursement without fear of subsequent legal retribution from various government programs. Furthermore, the medical record is an essential historical document of the patients previous medical encounters. Documentation of the patient encounter and treatment will provide a defense to potential subsequent litigation that may ensue. The emergency physician may be unaware that a medical expert is reading a case of a previous patient encounter right now. The documentation of the care provided may preclude the plaintiffs expert from making assumptions and opinions adverse to the physician. This months issue will detail the importance of documentation and outline strategies for reducing risk.
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The first part of this two-part series addressed the use of US for complications of early pregnancy in adolescent females and for testicular complaints in pediatric and adolescent males. This issue focuses on the use, role, and limitations of US in the evaluation of cardiac, abdominal, and renal disease processes.
