Emergency
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Pushback Against EMTALA Misinterpretation Emerges
Misinterpretation of the Emergency Medical Treatment and Labor Act (EMTALA) is the focus of a recently published policy statement from the American College of Emergency Physicians.
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Health Systems Tackle Opioid Epidemic With Comprehensive Initiatives
It has been nearly a year since The Joint Commission unveiled new pain management standards as part of an effort to combat the opioid epidemic. While all accredited hospitals are held accountable for their implementation and adherence to the standards, some health systems have responded by centralizing their opioid-related initiatives under a single, purposeful umbrella to produce more powerful results.
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Collaborative Slashes Sepsis Mortality, Produces Tool to Help All Hospitals
For the past six years, The Joint Commission’s Center for Transforming Healthcare (CTH) has been working with health system partners to identify the root causes for sepsis mortality as well as solutions that will address these problems effectively. In the process, participating organizations have reduced their own sepsis mortality rates by a collective 25%, although some organizations have made even greater strides. The work with CTH will culminate in a Targeted Solutions Tool that will enable all accredited hospitals to take on the issue in their own settings.
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Standardizing Diagnosis, Management of Young Patients Who Present With Head Injuries
New guidelines from the CDC have established practice-changing recommendations in the diagnosis and treatment of pediatric mild traumatic brain injury (TBI). This information is especially important to frontline providers, as statistics suggest an increasing number of children are presenting to the ED with concussions. The guidelines include 19 sets of recommendations pertaining to the diagnosis, prognosis, and management of pediatric mild TBI. The guidelines identify best practices based on current evidence and are intended to help standardize and improve the way these cases are managed, both while patients are in the doctor’s office or ED and after they have been discharged.
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Hospital Uses Hurricane Florence Near-miss to Improve Emergency Plans
Before the storm made landfall, leaders at East Cooper Medical Center in Mount Pleasant, SC, reduced the facility’s patient census to a minimum, arranged to house staff for the duration of the storm emergency, and appealed to the state for an exemption to the mandatory evacuation order. The facility avoided the worst of the storm but staff still practiced emergency preparedness anyway, learning lessons to better prepare for future incidents.
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Another Powerful Hurricane Season Underscores Importance of Strategic Planning
While emergency providers in the region proved up to the task, some hospitals report that it was fortuitous that forecasters originally anticipated that Hurricane Florence would make landfall with much stronger winds. This caused many to make additional preparations, which paid big dividends.
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Not All Round Rashes Are Ringworm: A Differential Diagnosis of Annular and Nummular Lesions
Although rashes are not usually an emergency, it is common for emergency physicians to see patients come in with a rash. Sometimes the rash is new onset, and sometimes it has been present for a while and refractory to treatment.
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Limited English Proficiency Associated With Significant Differences in End-of-life Care
In a retrospective cohort study, patients with limited English proficiency had lower rates of do not resuscitate orders, comfort measures orders, and advanced directives; higher rates of receiving certain types of life support; and longer hospital stays compared to their English-speaking counterparts.
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Can We Prevent Delirium in the ICU?
Low-dose nocturnal dexmedetomidine infusion was shown to prevent delirium in critically ill patients.
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Massive Hemorrhage and Transfusion Protocols in Trauma and Nontrauma Patients
Massive hemorrhage with hemodynamic instability or shock may arise from multiple causes and is a medical emergency requiring intensive care. Hemorrhagic shock typically develops with the loss of 30-40% of blood volume. Thankfully, its incidence is likely low. Treatment is focused on resuscitative efforts to restore blood volume and stop bleeding. Time is required to locate and secure the sources of blood loss. It is in this setting that resuscitation to maintain oxygen concentration, cardiac output, and circulating blood volume is necessary for survival. Massive transfusion protocols have been developed to provide rapid access to and administration of blood products in these situations.