ED Management : the Monthly Update on Emergency Department Management

Now well-established throughout Europe, mobile stroke unit (MSU) programs are in the early stages of development in the United States. The concept aims to improve outcomes by bringing diagnostic capabilities and clot-busting care to the patients experiencing stroke, thereby reducing the time to treatment. In October, New York Presbyterian/Weill Cornell Medical Center in New York became the first medical center on the East Coast to deploy an MSU, and in July, the University of Tennessee College of Medicine in Memphis deployed a first-of-its-kind MSU that is larger and more robust than other MSUs currently in use...

Some health systems are piloting telemedicine solutions in the ED to address crowding and decrease patient wait times. One new program, implemented at the Lisa Perry Emergency Center at New York Presbyterian (NYP) Weill Cornell Medical Center in New York, involves offering low-acuity patients the option of visiting an off-site physician via telemedicine hookup. Administrators note that the approach can get patients in and out of the ED within 30 minutes, and patients have thus far been highly satisfied with the approach...

New findings from the Mission: Lifeline STEMI Systems Accelerator program suggest that a regionalized approach to ST-segment elevation myocardial infarctions (STEMI) can cut time-to-treatment for patients modestly, thereby improving the prospects for better outcomes. The approach encourages hospitals, emergency medical services (EMS) and cardiologists in a region to work together to optimize treatment and efficiency so that patients in need of percutaneous coronary intervention (PCI) receive this care more expeditiously...

No abstract text is available yet for this article.

By working with the police department and area addiction treatment centers, Beth Israel Deaconess Hospital in Plymouth, MA, (BID-Plymouth) has been able to persuade many more patients who present to the ED with addiction problems to seek needed treatment. The approach involves the creation of an outreach team that visits patients in their homes within a day of discharge from the hospital following an overdose. A behavioral health team embedded in the ED sees all patients who pres- ent to the ED with addiction issues...

No abstract text is available yet for this article.

The Community Hospital of Monterey Peninsula (CHOMP) has spearheaded a multiagency collaborative that has been successful at more than halving the prescriptions for narcotics in the region and trimming ED visits among frequent users. Known as "Prescribe Safe," the approach can be credited, in part, with nudging emergency providers to view addiction as a disease and to reevaluate their role in linking patients with needed treatment. Under its recurrent visitors program, emergency providers at CHOMP reject the term "drug seeking," instead focusing on addressing the underlying reasons for a patient's addiction problem...

The ED at ProMedica Toledo Hospital, a Level I trauma facility in Toledo, OH, has been able to chart impressive metrics on patient processing measures year after year. Administrators credit an overhaul in their triage process, a comprehensive approach to providing staff with regular feedback on their performance, and a system that relies on optimally sized teams to deliver care. Department leaders are hoping to boost patient satisfaction scores with an initiative that will leverage champions, fresh metrics, and a new mission statement to highlight the importance of the patient experience...

With the increasing frequency of mass-casualty events, the American College of Emergency Physicians has assembled a High Threat Task Force to look for ways to improve the emergency response to these events. The panel intends to focus on training and operations, but the ultimate goal is to find ways to eliminate preventable deaths. The panel intends to standardize and unify improvement efforts that have thus far been disparate. The co-chairman of the panel says one of the biggest gaps is the lack of evidence-based guidelines for how emergency personnel should respond to mass-shooting events...

Resource-challenged hospitals have long struggled to meet the needs of patients with limited English proficiency (LEP), often relying on ad hoc interpreters to communicate with these individuals. However, such shortcuts carry risks, and with the increasing diversity of the population, there is a new push by the Department of Health and Human Services' Office of Civil Rights and other organizations for hospitals to make the investments needed to ensure effective communications between providers and LEP patients...

Just one month after a mass shooting in Orlando, FL, emergency providers in Dallas were challenged to respond to another incident of gun violence. In this case, a sniper opened fire on a peaceful protest, hitting 14 people, including five police officers who died from their wounds. Emergency and trauma personnel from Parkland Memorial Hospital and Baylor University Medical Center report that their teams performed well, but having worked side-by-side with law enforcement many times, many providers and emergency staff are dealing with a heavy dose of emotional distress...

Infection prevention specialists at Henry Ford Hospital in Detroit have found that showing healthcare workers magnified pictures of bacteria found ontheir hands and in their surrounding units can be a powerful motivator for improved hand hygiene compliance. When tested in four units during a one-month period, the intervention boosted hand hygiene compliance by an average of 24%. Investigators note that to be successful, the intervention must be paired with an effective compliance monitoring program. For the study, investigators visited each unit twice per week, during which they would swab various items as well as employees' hands using and adenosine triphosphate (ATP) meter, a hand-held device that measures living organisms...

The ED often is the access point of choice for transgender patients who may be reluctant to interact with providers. Experts say there is a need for training and education of how to present a gender-affirming healthcare environment. Recommended steps include a review of policies, along with corresponding changes to electronic and paper intake forms to ensure that the language used is inclusive of all genders. While blanket discrimination may be declining, experts note that some providers are uncertain about how to interact with a transgender patient...

Emergency providers at Orlando Regional Medical Center in Orlando. FL, faced multiple challenges in responding to the worst mass shooting in U.S. history. As the scene of the shooting was only three blocks away from the hospital, there was little time to prepare when notified that victims would begin arriving shortly after 2 a.m. on June 12. Also, fears of a gunman near the hospital briefly put the ED on lock down. However, using the incident command system, the hospital was able to mobilize quickly, receiving 44 patients, nine of whom died shortly after arrival...

Investigators at the University of Michigan have shown promising results from an ED-based intervention designed to curb risky opioid use among patients who have reported opioid misuse within the previous three months. The intervention includes a 30-minute counseling session with a therapist who utilizes motivational interviewing techniques to strengthen their desire to move away from opioid use behaviors. The randomized clinical trial included 204 emergency patients, divided between patients receiving printed educational materials and patients receiving printed materials as well as counseling sessions...

To meet the needs of critically ill patients with time-sensitive needs, the University of Maryland Medical Center (UMMC) created the Critical Care Resuscitation Unit (CCRU), a six-bed, short-stay ICU designed to accelerate care to resource-heavy patients who require immediate evaluation and treatment. The CCRU is modeled after UMMC's trauma resuscitation unit, but with resources and staff geared toward non-trauma, critically ill patients, many of whom require life-saving care. The unit is largely staffed by emergency providers who have undergone additional training in critical care...

While EDs are well positioned to identify incidents of elder abuse, providers often miss the opportunity. Experts say providers find only one in every 24 cases, and that the pendulum must swing toward over-detection. Investigators acknowledge elder abuse is difficult to confirm, given that disease processes can explain some of the signs. Further, older adults are often reluctant to report abuse because they fear they will be removed from their homes or separated from their caregivers. Given the complexity involved with addressing the issue, investigators recommend EDs establish a multidisciplinary approach to the problem...

To address problematic provider behaviors that can affect patient safety, physician leaders at Vanderbilt University Medical Center (VUMC) developed the Coworker Observation Reporting System (CORS), a systematized approach for retrieving and addressing concerns about providers reported by staff. To encourage staff members to report concerns, they have to trust that the organization is going to respond, and they also have to feel that they have a certain element of psychological safety. Selected peer messengers share staff complaints with providers, enabling them to offer their perspectives on the issues or events in question...

No abstract text is available yet for this article.

A one-page tool has shown promise for facilitating shared decision-making between clinicians and patients who present to the ED with low-risk chest pain. The tool, dubbed Chest Pain Choice, was developed by researchers at the Mayo Clinic. It is designed to more effectively communicate risk to patients so that they can make more informed decisions with their providers regarding treatment options. Investigators devised a study involving 898 low-risk chest pain patients in six EDs in five states. Half the patients were randomized to standard physician consultations and half received consultations facilitated by the Chest Pain Choice tool...