ED management : the monthly update on emergency department management
-
The ED at The Aroostook Medical Center (TAMC) in Presque Isle, ME, is a level II trauma center. It is the largest in the region, with only 89 beds. It has undergone a transformation in recent months, with average wait times to see a provider going from four to five hours down to less than five minutes, and the left-without-being-seen (LWBS) rate has been slashed from a high of 7% down to less than 1%. ⋯ Responsibilities for charge nurses have been redesigned so that they have the power to monitor and facilitate patient flow. The ED has initiated more point-of-care testing so that nurses and techs can conduct many routine tests on their own. While the lean model relies on staff-driven solutions, administrators make the difference when it comes to sustaining changes and minimizing employee resistance.
-
Several new studies presented at ACEP's scientific meeting in October poke holes in the conventional wisdom that frequent ED users are abusing the ED for routine health care needs. Instead, investigators say patients typically have urgent or emergent concerns, regardless of their insurance status. Experts suggest that rather than trying to keep patients out of the ED, cost-control efforts should focus on establishing better referral systems of care. ⋯ For frequent ED users, the distribution by payer type tends to reflect the community. Similarly, the most common diagnoses for frequent users are similar to that of occasional users. According to one study, while Medicaid patients use the ED roughly twice as often as patients with private insurance, the triage decisions for these patients show that they have urgent or emergent concerns.