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[Editor's note: This is the second in what is now scheduled to be a three-part series on reducing violence in the ED, due to breaking news. In last month's article, our experts discussed the importance of a "zero tolerance" policy. In this article, we outline key steps recommended for reducing violence and discuss the importance of having clear procedures when it comes to dealing with patients and their families. Next month we will examine the Sentinel Event Alert just published by The Joint Commission that discusses why the ED is particularly susceptible to episodes of violence, outlines leading causal factors, and provides additional guidance for violence prevention.]
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[Editor's note: This article is the first in an ongoing series reviewing the latest findings of the Emergency Department Benchmarking Alliance (EDBA) and how ED managers are addressing the challenges that members have identified. This first article discusses how ED managers are combating steadily increasing volume. The EDBA for 2009 shows increases of 5%-10%. The EDBA findings are significant because they represent feedback from 376 high performing EDs serving 14.8 million patients in the calendar year 2009.]
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Unless your ED is planning an expansion, the amount of space you have to work with is finite. However, as the leadership team at Jersey City (NJ) Medical Center has shown, creative use of that space can significantly improve your department's capacity and help slash wait times and the number of patients who leave without being seen. In less than a year, average wait times went from 3-4 hours to 30 minutes, and the left without being seen (LWBS) rate went from 6% to 1.5%.
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In the first phase of a two-phase process, paramedics with Grady Emergency Medical Services in Atlanta now have the option of transporting patients with less-urgent ailments to Grady Health System clinics instead of the ED. Emergency leaders believe this strategy will provide the most appropriate care for these patients and help alleviate some ED crowding.
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Every year about this time, I see a couple of unhappy local residents who present with an intensely pruritic, erythematous papular mystery rash. In contrast to flea bites, which are simple raised papules, the lesions seem umbilicated or have a central bite mark.
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In this issue: New reports about proton pump inhibitors and the effects of gastric suppression, pioglitazone vs vitamin E for non-alcoholic steatohepatitis, metformin and vitamin B12 deficiency, and FDA Actions.
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Drug-related hepatotoxicity during treatment for tuberculosis is a common barrier to initiation of antimycobacterial. While most hepatotoxicity results in minimal to no gastrointestinal complaints, some patients experience significant nausea, anorexia, vomiting, or abdominal pain.
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A rifamycin antibacterial agent has been approved for treating patients with hepatic encephalopathy (HE). Rifaximin is a minimally absorbed oral antimicrobial that was originally approved in 2004 for the treatment of travelers' diarrhea caused by Escherichia coli. It is marketed by Salix Pharmaceuticals as Xifaxan®.
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You may think that because you're a case manager, you don't need to be aware of the implementation of the new International Classification of Diseases (ICD-10) codes. Or you may think that since they don't take effect until Oct. 1, 2013, you don't have to worry about them yet.
