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This is the first of a two-part series on severe traumatic brain injury, focusing on the evidence for optimal care.
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Remember the principle of homeostasis from first-year physiology the idea that the human body has self-regulating processes to maintain a desirable internal state? What were we taught to do when disease disrupted the self-regulating processes, and physiologic parameters were abnormal? Use medical treatments to restore them to normal values. Well, now we know that this may not be the best way to enhance survival.
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The Advanced Trauma Life Support (ATLS) course for doctors was introduced in Nebraska in 1978 and given nationally for the first time in 1980 by the American College of Surgeons. The goal of ATLS is to serve as a safe and reliable method for managing patients with traumatic injury and provide a "common baseline for the continued innovation and challenge of existing paradigms in trauma care."
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With a vaccine shortage projected for novel H1N1 influenza A, only the highest priority groups are likely to be offered the shot when initial lots are cleared for distribution this fall.
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Several EDs have introduced physician scribes to free up doctors to spend more time with their patients, but most of those departments use paper charting. At Tri-City Medical Center in Oceanside, CA, physician scribes work within the context of an electronic medical record (EMR).
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If ED physicians and nurses could choose only one strategy for avoiding lawsuits, it should be to keep patient satisfaction levels high, say several experts interviewed by ED Management.
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Risk assessment might be a critical strategy to use in your effort to minimize lawsuits, but it shouldn't be the first, says Tom Syzek, MD, FACEP, director of risk management for Dayton, OH-based Premier Health Care Services.
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ED experts agree that when patients feel they have been treated poorly, or that medical mistakes have been made, the most effective way of diffusing the situation and avoiding litigation is to listen carefully to the complaint, admit mistakes if they have been made, and then take concrete action to demonstrate your desire to prevent such mistakes in the future.
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How can an ED manager reduce the risk of lawsuits once problem areas have been identified? Experts agree you've got to get to the root cause of those problems. Sometimes, they say, it might take the use of formal quality improvement tools such as root-cause analysis. Other times, it can be a simple as listening to patient complaints.