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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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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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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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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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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.
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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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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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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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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).
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