ED management : the monthly update on emergency department management
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The use of telemedicine to diagnose patients before they come to the ED may benefit the operation of your ED, as well as the emergency medicine system in general. Potential advantages include the following: By identifying nonemergent cases, it can help reduce overcrowding. Since nonemergent patients have the longest wait times, it may reduce rates for patients who leave without being seen and boost satisfaction. It can help avoid unnecessary transfers to and from the ED.
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Make your staff aware of the resources that are available to them, and create an atmosphere in which they will feel more comfortable to seek help: State physicians' health programs and employee assistance programs offer confidential services. Hold regular staff inservices to create a dialogue about stressful situations and to discuss signs and symptoms of depression. Approach staff members who appear troubled and let them know you are there to help them.
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Eliminating time-consuming processes up front and taking a hard look at how you treat nonemergent patients can yield dramatic results: One ED cut pain-to-first meds in half, cut 30 minutes off door-to-discharge times, and reduced left before being seen rates by about one-third. Having a doc in triage can help speed and ensure appropriateness of advance ordering. If your fast-track process is not meeting its turnaround goals, consider other alternatives such as Mid Care.
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Subdividing the major management tasks of one ED lightened the manager's load and gave staff a clearer idea of where to take their problems, helping to drop average length of stay from 85 minutes to 45 minutes, reduce throughput from 308 minutes to 230 minutes, and improve patient satisfaction from 74.6% to 84%. Where possible, divide responsibilities according to the talents of the individual nurse managers. A manager with ED and observation unit responsibilities improves communication between the units. Tiered staffing structure creates ready-made "team leaders" for departmentwide initiatives.