Emergency
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Paramedics, Screening Protocols, and Involuntary Psychiatric Holds
While there is no simple solution to ED crowding caused by a backup of patients with behavioral health concerns, a new study offers intriguing results on what could be part of the answer for at least some hospitals.
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Critical Access Hospital EDs Reap Savings by Using Advanced Practice Providers, Virtual Physicians
Thanks in part to a little-noticed policy shift by the Centers for Medicare & Medicaid Services, there is fresh evidence that telemedicine can offer rural hospitals a cost-effective solution to the serious challenges they face in trying to recruit and retain physicians to cover their EDs. Further, while efforts to build effective telemedicine networks in the emergency medicine arena have struggled, one network based in Sioux Falls, SD, is in expansion mode, with 185 hospitals in 13 states already hooked up to the network’s hub.
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Prehospital Providers Play Starring Role in Push to Regionalize Care of STEMI Patients
A push to regionalize the care and treatment of patients with ST-elevation myocardial infarction (STEMI) gains steam. Investigators documented improved time to treatment results and a significant decline in mortality among patients treated at sites adopting a regionalized approach. The data come from the Regional Systems Accelerator-2 project in which key stakeholders in 12 regions pledged to work together to improve STEMI care.
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Making Sense of Delirium in the Emergency Department
Delirium is a complex disorder marked by the acute onset of mental status change with an associated fluctuating course. Despite the fact that delirium is a common clinical entity in elderly hospitalized patients, the condition may present in any patient regardless of medical comorbidities. Recognition within the emergency setting is becoming increasingly important, as the diagnosis frequently is missed.
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Early Extubation to Noninvasive Ventilation Does Not Reduce Time to Liberation From All Mechanical Ventilation
In this multicenter, randomized, open-label trial of patients who failed a spontaneous breathing trial, those who were extubated to noninvasive ventilation did not have a shorter time to liberation from any form of mechanical ventilation compared to those who were randomized to protocolized standard weaning.
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Thiamine for Septic Shock: Is There a Benefit?
Based on a retrospective review, septic shock patients who were administered thiamine within 24 hours of admission showed improved lactate clearance and reduced 28-day mortality.
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Liberal Oxygen Therapy in the ICU: Time to Change Practice?
Over the last decade, more clinical studies have shown adverse effects of hyperoxia in different patient populations and its association with increased mortality. In a meta-analysis, investigators synthesized data from 25 randomized, controlled trials comparing a liberal oxygen approach to a conservative approach. They included thousands of patients with sepsis, critical illness, stroke, trauma, myocardial infarction, cardiac arrest, and emergency surgery. The authors found that liberal oxygen therapy was associated with increased in-hospital mortality, 30-day mortality, and mortality at longest follow-up. Read on to learn more details about specific subgroups relevant to ICU practice and to see a review of the current data on oxygen therapy in these patients.
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Speech Recognition Technology for EDs May Increase Malpractice Risks
Seven out of 100 words in speech recognition-generated documents contain errors, many of which involve clinical information, according to the authors of a recent study.
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After Malpractice Allegations, EP Productivity Decreases
One researchers says the results of one study suggest legal reforms surrounding damage caps may not fully address liability pressure for physicians and other healthcare providers. In other ongoing work, investigators are studying whether EPs adjusted practice patterns equally for all patient types after a malpractice litigation, or whether EPs used information from the allegation to adjust care for clinically relevant patients.
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Negligence or Innocent Mistake? Either Can Trigger Investigation of ED Nurse
The best way for an ED nurse to protect his or her license against both disciplinary action and malpractice allegations? Practice according to the standard of care with every patient encounter.