ED management : the monthly update on emergency department management
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All patient complaints should be addressed appropriately, with the goal of improving care and boosting patient satisfaction. Address complaints immediately, while the patient is still in the ED. ⋯ Have a policy to address complaints. Make verbal contact with every patient who complains.
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According to a new report from the General Accounting Office, increased liability risks stemming from EMTALA regulations have made specialists reluctant to take call for the ED. If a consultant can't be reached or refuses to report to the ED, staff should not hesitate to call the chief of staff or administrator. Your policy should address obligations of on-call specialists for acceptance and refusal of transfer patients. To ensure adequate coverage, fee-for-service arrangements may be more effective than stipends.
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If you don't comply with new guidelines for pediatric emergency care jointly developed by the American College of Emergency Physicians and American Academy of Pediatrics, you risk adverse outcomes and lawsuits. When transferring a critically ill or injured child, use transport services with specific pediatric training. Have a physician and nursing coordinator ensure compliance with the guidelines. Ensure that staff are trained in pediatric resuscitation, and provide age-specific competencies for neonates, infants, children, and adolescents.
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Keeping an observation unit operating with current reimbursement might depend on successful implementation of cost-reduction strategies. A "hybrid" model with scheduled-procedure patients in addition to observation patients allows you to staff with fewer nurses per patient. Observe patients with only one specific acute problem who are likely to be discharged within 18 hours. By offering stress testing in close proximity to the observation unit, length of stay is reduced, and the hospital can provide stress testing to inpatients on weekends.