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(Editor's note: This is the second part of a two-part series on recent reaccreditation efforts made by the staff of the chest pain center at Oregon Health & Science University Hospital in Portland. In the first installment last month, the staff discussed the STEMI alert training procedures involved. These procedures not only involve the triage nurse, but the entire staff, including the valets. This month, we look at how the staff brought the hospital rapid response team into the process, and how the acquisition of atomic clocks enabled the ED and outside resources to accurately track their response times.)
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While telemedicine has proven successful in several ED settings, some observers have long been skeptical that it could be applied to behavioral health.
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Because many throughput problems experienced by EDs are not caused by EDs, those managers who find themselves operating in a vacuum have little chance of success.
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Not long ago, the ED at Palisades Medical Center in North Bergen, NJ, was struggling with waiting times hovering at about four hours.
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It was too good to last. In the 2007 ED Management Salary Survey, we noted that hospital administrators were reacting to the realities of supply and demand and showing a willingness to be more generous with salary increases.
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The National Quality Forum (NQF) has endorsed 10 national voluntary consensus standards for hospital-based ED care, with the goal of reducing overcrowding, decreasing patient wait time, and improving quality of care.
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The current economic crisis is creating "strenuous times for ED leaders because all prudence will be necessary," notes Steven J. Davidson, MD, MBA, FACEP, chairman, Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY. "They are going to be challenged to be creative in finding ways to do things," he says.
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Among the key challenges that have developed in the past 20 years and have not yet been addressed is the failure of the community's mental health system, according to James J. Augustine, MD, FACEP, director of clinical operations at Emergency Medicine Physicians, an emergency physician partnership group in Canton, OH.
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Generally when we review our annual ED Management Salary Survey for defining trends, we see patterns emerging by reviewing the results in several categories. And while we still went through that process this year, even a quick glance at the results of the 2009 ED Management Salary Survey showed that one statistic jumped off the page.
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Before the implementation of a LEAN initiative in the ED at Good Samaritan Hospital in Kearney, NE, the average door-to-doc time was 28 minutes, and the average length of stay was 103 minutes numbers that were nothing to sneeze at. Nonetheless, Paul O'Connell, RN, director of emergency services, wanted to see those numbers improve.