ED Management
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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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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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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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‘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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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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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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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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Discussions on Patient Care Could Become Discoverable
Evidence indicating the emergency physician conducted peer review diligently and in good faith could help the defense. Still, considering the possibility of discoverability, providers should avoid inaccurate, sarcastic, or unnecessary comments during peer review.
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Patients Offer Insight on ED Providers’ Communication Skills
With better communication, ED patients are more likely to follow recommendations and experience better outcomes.
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Time Spent in ED Hallways Raises Risk of Developing Delirium
Researchers analyzed 25,162 patients, including 1,920 who met delirium criteria. Patients with delirium spent a greater percentage of time in the ED hallway than other patients and stayed in the ED longer. Patients developed delirium in the ED more often than patients on the inpatient units. Out of the 1,920 patients who developed delirium, 1,488 did so while in the ED.