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Paramedics arrive with a man you recognize instantly from his many previous visits to your ED, always intoxicated. You learn that his vital signs are stable, and he was found on the ground by bystanders, says Tia Valentine, RN, CEN, clinical nurse educator for the ED at University of California-San Diego Medical Center.
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With intraosseous (IO) vascular access, patients are subjected to a minimum number of sticks, so there is less chance of creating a portal for infection, says Sean Hall, an ED nurse at Desert Island Hospital in Bar Harbor, ME. "The time which can be saved by using these devices can be lifesaving in a critical patient," he says.
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Our faces play a role in almost every part of our lives. The structure and components of the face are involved in our ability to eat, speak, and see, and often are the features first noticed when we meet someone.
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With volume on the increase and a leave-without-being-seen (LWBS) rate already at 5%, ED administrators at Methodist Hospital of Sacramento in Sacramento, CA, knew they needed to come up with a way to get patients moved through the ED more expeditiously at least until a planned expansion of the ED took place, but in early 2008, that was still more than a year away.
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Physical therapists (PTs) are carving a niche for themselves in a small but growing number of EDs. They're doing everything from splinting fractures and taking care of wounds to evaluating cases of low back pain to helping patients with musculoskeletal injuries learn how to use assistive devices.
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Analyze the types of patients who typically come through your doors. Most EDs see a significant percentage of patients with musculoskeletal issues, which is an area of expertise for PTs, but check what the patterns are in your department, and determine what hours of the day are optimal for PT coverage.
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Given that patients are keenly interested in wait times, an increasing number of EDs across the country are taking advantage of new media to make this information more accessible to the public.
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While faster throughput makes financial sense for EDs today, there is some concern that that the type of lower-acuity patient most influenced by advertised wait times may not make financial sense in the future because payers may not be willing to pay for non-emergency care in such an expensive setting, explains David Cummings, RN, CEN, corporate administrator, patient care operations, at Methodist Le Bonheur Healthcare in Memphis, TN.
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There is mounting evidence in the literature that the routine practice by paramedics of administering IV fluids to severely injured patients before they are transported to the hospital is not only unnecessary, but may also cause harm.
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It may be in the best interest of your ED patient with chest pain, seizures, or transient ischemic attack (TIA) to be admitted, but this may not occur due to factors beyond your control.
