Emergency medicine clinics of North America
-
Emerg. Med. Clin. North Am. · May 2020
ReviewEmergency Department Evaluation of the Adult Psychiatric Patient.
Many patients with acute behavioral or mental health emergencies use the emergency department for their care. Psychiatric patients have a higher incidence of chronic medical conditions and are at greater risk for injury than the general population. ⋯ This article addresses high-risk areas of the treatment and management of emergency department patients presenting with behavioral emergencies. This article identifies methods successful in determining whether the patient's behavioral emergency is the result of an organic disease process, as well as recognizing other potential acute medical emergencies in this high-risk population.
-
Burnout is a work-related condition. Although stress may be a part of emergency medicine, excessive levels of chronic stress can lead to maladaptive behaviors and burnout. ⋯ Efforts can then be made to identify modifiable or unnecessary sources of stress to help reduce chronic stress and burnout. Solutions should be found to eliminate or ameliorate individual-level and system-level sources of stress.
-
Emerg. Med. Clin. North Am. · May 2020
ReviewEmergency Department Operations I: Emergency Medical Services and Patient Arrival.
The emergency department (ED) is by its nature inherently an environment with the potential for chaos because of the high volume and varied types of patients cared for in an ED setting. This article discusses potential system opportunities from the prehospital environment through arrival in the ED before provider evaluation. ⋯ Management and the reduction of risk to waiting room patients and patients who leave without being seen is explored. Description of the risks and mitigation strategies are discussed to decrease risk to patients, providers, and hospitals.
-
Emerg. Med. Clin. North Am. · May 2020
ReviewHigh-Risk Chief Complaints III: Neurologic Emergencies.
A careful history and thorough physical examination are necessary in patients presenting with acute neurologic dysfunction. Patients presenting with headache should be screened for red-flag criteria that suggest a dangerous secondary cause warranting imaging and further diagnostic workup. ⋯ Most patients presenting with back pain do not require emergent imaging, but those with new neurologic deficits or signs/symptoms concerning for acute infection or cord compression warrant MRI. Delay to diagnosis and treatment of acute ischemic stroke is a frequent reason for medical malpractice claims.
-
Emergency departments have always been busy, but persistent annual increases in volume and rates of admission have led to high levels of boarding patients, adding additional risk to the situation. This article reviews specific areas of risk as patients progress through their care in the emergency department and methods by which to mitigate this risk. Beginning with an overview of the current state, commonly used throughput metrics are reviewed before proceeding to a discussion of best practice strategies to decrease risk exposure at input, throughput, and output phases of the patient visit.