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When a gentleman of Middle Eastern appearance entered the ED at Warren Hospital in Phillipsburg, NJ, March 11, 2004, he began asking the duty nurse atypical questions relating to the hospitals bed capacity, the means by which care was delivered, and how many patients the department had at certain times.
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I am a chairman in an ED, and this case recently occurred: A man came to the ED after cutting his flexor tendon at home. He had 100% flexor cut on his nondominant hand. He also was experiencing a loss of sensation around the ulnar aspect of the affected index finger.
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Among the more challenging issues facing ED managers are those where there are no universal rules governing policies and procedures at least none that are clearly spelled out by nationwide organizations such as the Joint Commission on Accreditation of Healthcare Organizations or the Centers for Medicare & Medicaid Services.
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It began with the Joint Commission on Accreditation of Healthcare Organizations issuing formal warnings about people posing as surveyors to gain access to health care facilities. However, they may have been only a small piece of the problem. ED Management has learned of more than a dozen such incidents several involving EDs in which individuals claiming to be Joint Commission surveyors, physicians, or members of government agencies presented themselves at hospitals and began asking probing questions about areas such as staffing and bed capacity.
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The Centers for Medicare & Medicaid Services (CMS) has implemented the new $1 billion program for emergency health services furnished to undocumented aliens.
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Prior to spring 2004, the ED staffs at Ocean Springs (MS) Hospital and Singing River Hospital in Pascagoula, MS, would diagnose patients the old-fashioned way when treating unusual skins rashes. They would refer to medical texts which, if they were lucky, contained photographs of the rashes in question, and then make their diagnosis.
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You can be certain that your accreditation surveyor will ask you what you do in the ED when you have admitted patients and no inpatient beds are available.
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Things Currently Being Done
Triage Area
Triage criteria prioritize patients by acuity.
Patients with chest pain have electrocardiogram performed and read by faculty or senior residents.
Patients at risk for tuberculosis have chest X-rays taken and read by faculty or senior residents.
Emergency medicine residents care for lower-acuity patients in the triage area from 7-11 p.m. daily (moonlighting).
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Its an ED managers worst nightmare: You have one of the most overcrowded and underfunded EDs in the country. Of the 40 patient care spaces for adults, five to 15 are filled at all times with admitted patients waiting for a bed. And here comes your accreditation surveyor wanting to know how youre complying with the new 2005 standard to ensure those patients are receiving the same level of care as inpatients (LD.3.11).
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Question: I am a chairman in an ED, and this case recently occurred: A man came to the ED after cutting his flexor tendon at home. He had 100% flexor cut on his non-dominant hand. He was also experiencing a loss of sensation around the ulnar aspect of the affected index finger. The patient was sutured in the ED, and the hand surgeon was consulted.
