ED management : the monthly update on emergency department management
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With a poor safety record and long waits for care, the ED at St. Vincent's Medical Center in Bridgeport, CT, launched a comprehensive improvement effort that has slashed door-to-doctor times, drastically improved patient satisfaction, and reduced serious safety events to zero during the past year. Key to the approach is a team-based operations system that makes care teams responsible for specific zones in the ED. ⋯ Door-to-doctor times have been reduced from 126 minutes to less than 25 minutes. Team approach to care improves clinician satisfaction while reducing errors. A streamlined triage system has eliminated several steps for low-acuity patients.
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With patient satisfaction in the single digits and door-to-doc times unacceptably high, the ED at Sumner Regional Medical Center in Gallatin, TN, initiated a staff-driven improvement effort aimed at weeding out inefficiencies. By putting the triage process under close scrutiny, staff members were able to eliminate dozens of tasks from the triage process, thereby slashing wait times. ⋯ A 44-step triage process has been streamlined into four steps, and average door-to-doc times have decreased from 67 minutes to 18 minutes. Further improvements are anticipated when ED administrators put staff scheduling under the same scrutiny.
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When a sudden increase in volume overwhelmed Ochsner Medical Center in New Orleans, LA, in the wake of hurricane Katrina, ED administrators created QTrack, a new ED protocol that effectively doubled the capacity of the ED by taking full advantage of waiting-room space while preserving beds for only the sickest patients. The approach requires firm policies and procedures and continual provider reinforcement, but the results are dramatic. ⋯ Average door-to-doc times have been slashed from hours to about 33 minutes. The LWBS rate is below 1% at facilities where QTrack has been implemented.
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A new study suggests that EDs across the country are experiencing difficulties because they don't have adequate on-call coverage by surgical specialty providers. The lead author indicates the root cause of this problem may have more to do with a lack of incentives for providers to accept on-call coverage responsibilities than an actual shortage of surgical specialists. ⋯ Respondents from the South reported the most difficulty, with 81% indicating they have problems with on-call coverage. The most serious problems reported with on-call coverage pertain to plastic surgery (81%), hand surgery (80%), and neurosurgery (75%).
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New data strongly suggest that the routine practice of administering i.v. fluids in trauma patients before transport to the hospital may do more harm than good. The study's lead author suggests that ED leaders have a strong role to play in changing a decades-old protocol that was implemented without sufficient scientific evidence. ⋯ Administration of i.v. fluids delays time to treatment and may exacerbate bleeding by raising blood pressures. There might be specific types of patients who would benefit from pre-hospital i.v. fluids, but the issue requires further study.