While the U.S. Supreme Court has settled the issue of constitutionality, President Obama's signature health reform legislation, the Accountable Care Act (ACA), still faces significant political headwinds that could chip away at provisions in the landmark health care law.
In the intense focus of late on use of the ED by patients with non-emergent needs, it is perhaps easy to overlook another group of patients that is strongly linked with the ED: patients who are nearing the end of life.
On any given day, the ED at Mercy Hospital in Springfield, MO, has two zone captains acting as mini-charge nurses, for the east and west sides of the department. There is also an up-front triage nurse who is the first person most patients see when they walk in the door, and a lobby nurse who regularly rounds through the waiting room, taking vital signs and monitoring patients who have yet to see a provider.
Increasing payer scrutiny over diagnostic interpretations and continued belt-tightening at the private payer level has resulted in a resurfacing of the EKG interpretation payment issue for emergency physicians. There is no doubt that the interpretation of diagnostic tests for ED patients is an invaluable service.
As demand for emergency care continues its upward climb, The Joint Commission is taking steps to strengthen its accreditation standards pertaining to patient throughput, and it is putting hospital leaders on notice that they will be held accountable for patient flow challenges that occur in the ED.
Hospitals and EDs across the country continue to struggle with how to most effectively identify and treat patients who present with sepsis or develop the condition sometime after they have been admitted.
