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Could an ambulance diversion program work in your area? The answer is yes, according to one ED manager who co-chaired the San Diego Emergency Medical Service (EMS) Medical Oversight Committee (EMOC) that created a successful new diversion program in San Diego County.
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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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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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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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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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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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The widespread publicity surrounding the case of Terri Schiavo may have brought end-of-life issues to the forefront for the general public, but ED managers deal with these challenges on a daily basis. The proper way to treat these extremely ill patients in the ED whether or not they have a do-not-resuscitate (DNR) order is, like the Schiavo case, hardly cut and dried.
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While ED staff are well-versed in life-saving techniques, they are not as expert in making dying patients feel comfortable, asserts Tammie E. Quest, MD, assistant professor in the department of emergency medicine at Emory University in Atlanta.
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Its important for ED managers to remember that just because a patient has a do-not-resuscitate (DNR) order, that doesnt mean all of the patients wishes have been expressed in writing, says James Espinosa, MD, medical director of the ED at Overlook Hospital in Summit, NJ. A DNR is just one part of a continuum, Espinosa says.
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About one year ago, the ED at Doctors Hospital in Columbus, OH, was facing what Marci Conti, RN, MBA, vice president of operations and chief nursing officer, calls a perfect storm.
