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A root-cause analysis (RCA) is a complex tool that requires professional training, but an ED manager can utilize it with the help of an expert, says Kenneth A. Hirsch, MD, PhD, a practicing psychiatrist and director of Medical Risk Management Associates, a consulting firm in Honolulu.
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In addition to increased numbers of mentally ill patients, EDs are seeing more uninsured patients than in the past, and the numbers could grow, warns Brian Hancock, MD, president of the American College of Emergency Physicians (ACEP) in Irving, TX. Your budget planning should factor in more uninsured patients, not just the same level you have coped with for years.
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Question: How do we avoid patient hoarding, in which nurses or physicians intentionally delay moving a patient out to delay the next patient and give themselves a breather? Weve already warned that hoarding wont be tolerated, but it still happens and thwarts our efforts to improve patient flow through and decrease waiting time.
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Question: I know EMTALA signs are to be placed in registration areas, EDs, and public entrances. Right now we have signs in each of our four ED rooms, in the front hospital entrance, and the registration area. But I need to know if I should hang a sign in our back entrance leading to the ED. This entrance is not considered a public entrance, so do I need to put a sign there?
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Your ED is overflowing with patients, the wait time is heading toward double-digit hours, and youre short-staffed again. So when you walk by an exam room and see a patient sitting there sipping contrast fluid the same contrast he was drinking an hour ago your blood pressure goes through the roof.
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When working with your radiology department to reduce the time it takes to get abdominal computed tomography (CT) scans for emergency patients, be sure to look at the issue from their perspective, suggests the nations leading radiologist.
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If it seems youre seeing more patients with mental illnesses recently, youre not imagining it. The number of people with mental illness seeking care in the ED has surged recently, and the increase is taking a toll on other ED care, says J. Brian Hancock, MD, president of the American College of Emergency Physicians (ACEP) in Irving, TX.
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Hsu J, Reed M, Brand R, et al. Cost sharing: Patient knowledge and effects on seeking emergency department care. Med Care 2004; 42:290-296. Saketkhoo DD, Bhargavan M, Sunshine JH, et al. Emergency department image interpretation services at private community hospitals. Radiology 2004; 231:190-197. Lyons MS, Lindsell CJ, Trott AT. Emergency department pelvic examination and Pap testing: Addressing patient misperceptions. Acad Emerg Med 2004; 11:405-408.
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Azithromycin therapy failed in a patient in San Francisco with a primary syphilitic chancre which subsequently resolved after administration of a single dose of benzathine penicillin. Sequencing of the 23S rRNA genes of Treponema pallidum from 2 San Francisco patients who had failed azithromycin therapy revealed the presence of a mutation identical to that previously associated with macrolide resistance in a single isolate (T. pallidum, Street 14 strain).
