ED Management – January 1, 2022
January 1, 2022
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Creating Robust Solutions to Prevent Workplace Violence
Changing the way ordinary people think about how they interact with healthcare, how providers are there to help, not to be a subject of abuse, harassment, or violence, is vital.
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TJC’s Revised Workplace Violence Prevention Requirements Take Effect
The revised standards address data collection and analysis, leadership oversight, training, and post-incident procedures. Recognizing incidents of workplace violence are underreported in healthcare, The Joint Commission created a comprehensive definition of workplace violence that should be incorporated into an organization’s policies and procedures.
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Defuse Tensions and Protect Healthcare Workers with a Mix of Unique Tactics
The focus should be on de-escalating situations before they spiral out of control.
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‘STRAUMA’ Protocol Activates Care for Patients with Concurrent Symptoms of Stroke, Trauma
Researchers designed STRAUMA specifically for patients who exhibit symptoms of stroke and show visible signs of trauma. Typically, EMS activates the protocol, but other emergency providers can call for it after an appropriate patient has presented to the ED. An activation pages stroke and trauma teams to respond so they can evaluate the patient jointly.
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EMTALA Violations, Malpractice Claims Possible if ED Goes on Diversion Inappropriately
Diversion procedures should include community-based policies, created in agreement with EMS and other area hospitals, so everyone is handling the issue similarly. Create a formal activation procedure that specifies who must order diversion, acceptable reasons for diversion, how it is handled, and how the diversion is communicated to fire/EMS/police dispatch and other facilities.
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No Reassessment of Patients in Waiting Room or Hallway Is Malpractice Risk
CMS has been clear: EMTALA applies no matter where a patient comes to the hospital, as well as no matter where the patient is seen. That includes the ED waiting room and hallways. Boarding in the hallway should include periodic checking in with the patient to be sure there has not been a significant adverse change that requires the patient to be moved to a higher level clinical setting.
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Effective Defense for ED if Allegation Is Failure to Rule Out Aortic Dissection
Aortic dissection is not an easy diagnosis to make, and providers cannot order advanced imaging on every person who comes through the ED. But the mere act of documenting why aortic dissection was thought to be unlikely could make the provider reconsider the decision to discharge — and end up saving a life.
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Patients’ Involvement in Decision-Making Linked to Lower Malpractice Risks
When there is more than one reasonable treatment option, discussing the options with the patient and documenting the discussion may mitigate malpractice risk, especially in the event of a bad outcome.
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ED Plays ‘Central Role’ in STEMI Care
This includes prehospital cath lab activation, knowing when it is appropriate to bypass the ED, understanding the sequence of events for patients presenting to the ED, knowing what to do to shorten ED dwell time, and knowing what is best to do if awaiting cath lab arrival.
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In ED, Medication Harms Often Caused by Nontherapeutic Use
Of the 96,925 cases included in an analysis, 69.1% involved therapeutic use. Medication-related misuse, abuse, or self-harm caused approximately 62% of ED visits for medication-related harms in patients age 15-24 years, but only 22% of visits for patients age 55-64 years. For patients younger than age 45 years, 52.5% of ED visits involved nontherapeutic use.
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Legal Action Possible, But Not Always Advisable, for Bad Reviews of ED Visit
Providers must put emotions aside and make hard calculations on what they are looking to achieve — and how much they are willing to spend.