ED management : the monthly update on emergency department management
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A new study bolsters earlier findings that children who present to the ED with minor blunt head trauma can benefit from a period of observation before physicians decide whether to order computed tomography (CT) scans. Researchers note that the strategy significantly reduces the number of CTs that are required in these cases, reducing the risks associated with exposure to ionizing radiation. In a single-center study, researchers compared children who were observed with children who were not observed prior to CT decisions being made. ⋯ Just 5% of the patients who were observed proceeded to undergo CT scans; 34% of the patients who were not observed underwent immediate CT scans. Researchers note that troubling symptoms such as headache, vomiting, or altered mental status often resolve with time, negating the need for a CT scan. While more than 500,000 children present to EDs in the United States each year with blunt head trauma injuries, very few are found to have significant traumatic brain injuries.
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Establishing alarm management as a new National Patient Safety Goal (NPSG), The Joint Commission (TJC) is calling on hospitals to make the issue a safety priority, and to begin establishing policies and procedures designed to minimize alarm fatigue among clinical staff. Beginning on January 1,2014, hospitals need to begin identifying the most important alarm signals to manage based on input from staff as well as factors such as patient risk, and the potential for harm as demonstrated by the device's history. By January 1,2016, hospitals need to have policies and procedures in place for managing alarms identified in the first phase of the NPSG's requirements. Also, staff and independent licensed practitioners need to be educated about the purpose and proper operation of alarm systems that they are responsible for.
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In a pilot study, researchers at the University of Cincinnati have found that when a peer referral program is combined with an ED-based HIV screening program, more cases of undiagnosed HIV can be detected, providing a preventive health benefit to the community. However, more studies are needed to determine how to best capitalize on the yield of ED-based screening programs, and to get better estimates on the potential benefits of combining social networking programs with screening programs. Dedicated testers and a streamlined process for enabling patients to be signed in as outpatients rather than ED patients were key aspects of the program. ⋯ In particular, program staff targeted any companions or partners of patients who were in the ED with them when they came in for testing. Between May and September of 2011, 466 patients were tested, with four patients testing positive for HIV. Among participants in the testing/peer-referral program, 34% had no prior visit to the ED, and 69% had never been tested by the ED-based HIV testing program.
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To reduce mortality and improve the care of patients with sepsis, Wake Forest Baptist Medical Center in Winston-Salem, NC, created a new rapid-response protocol aimed at facilitating earlier diagnosis and treatment. In this approach, clinicians who suspect a patient may have sepsis can call a Code Sepsis, which will fast-track the series of tests and evaluations that are needed to confirm the diagnosis and get appropriate patients on IV antibiotics quickly. Administrators say the approach fits in with the culture of the ED, and it has quickly slashed time-to-treatment in this environment. ⋯ In the ED, where a modified version of the approach has been in place since April 1 of this year, the percentage of patients with sepsis receiving antibiotics within one hour of diagnosis has increased from 25% to 85%. Key to the success of the approach are specially trained rapid-response nurses who are called in on a case whenever a diagnosis of sepsis is suspected and a series of policy changes designed to facilitate needed diagnostic tests to confirm a diagnosis. A mandated online education module helped to bring all clinicians and staff up to speed on the new process quickly.
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To address identified patient safety risks in the handoff process, a group of emergency providers developed Safer Sign Out, a paper-based template that prompts clinicians to jointly review issues of concern on patients who are being passed from one clinician to another at the end of a shift. Already in practice at 12 hospitals in the Mid-Atlantic region, the approach is now being disseminated nationwide with the help of the non-profit Emergency Medicine Patient Safety Foundation. ⋯ Safer Sign Out seeks to prevent communications failures by putting structure into the handoff process. In addition to prompting incoming and outgoing physicians to discuss each patient being handed off, the approach involves having both physicians round at the bedside of these patients so that patients fully understand when their care is being transitioned to a new provider.