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A growing number of ED physicians and managers are gaining access to a training resource that its proponents claim boosts patient safety, improves training efficiency, and ensures a higher level of skills retention: lifelike mannequins that simulate real-world patients and case scenarios.
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Although a new paradigm can radically improve the rate at which psychiatric disorders are diagnosed in the ED, there is much ED managers can do short of a major staffing overhaul that can enhance the ability to identify such problems, says Seth Kunen, PhD, PsyD, director of research at Louisiana State University emergency medicine residency program at Earl K. Long Medical Center in Baton Rouge.
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If Seth Kunen, PhD, PsyD, had his druthers, every ED manager in America would have a staff or a call panel that included a substance abuse specialist, a psychologist, a psychiatrist, and a social worker.
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Because concepts from other industries can sometimes seem a bit obscure to the health care professional, this real-life synopsis of the use of lean manufacturing techniques (eliminating waste, or extra steps, in a process) at Doctors Hospital in Columbus, OH, may help illustrate how the approach can be applied practically in the ED. It involves the process of sending an ED patient to radiology.
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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.
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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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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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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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Its the first of its kind: a course in difficult airway management using mannequin simulations that is required for all practicing emergency physicians at the University of Pittsburgh Medical Center, says Paul Phrampus, MD, FACEP, director of the course, assistant professor of emergency medicine in the department of emergency medicine, and assistant director of the Peter M. Winter Institute for Simulation, Education, and Research (WISER).
