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As reform helps more Americans gain access to health coverage, experts predict that the nation's EDs will be bulging at the seams.
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While emergency department (ED) volume is always going to be somewhat unpredictable, ED operations at Ochsner Medical Center in New Orleans, LA, used to hum along so optimally that there was no reason to rethink the way things were done.
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Hip fractures are among the most debilitating and expensive diagnoses to treat, but you can significantly improve outcomes and lower costs if you get hip-fracture patients into surgery quickly, explains Anthony Balsamo, MD, an orthopedic surgeon and head of the Geriatric Fracture Care Program (GFCP) at Geisinger Wyoming Valley Medical Center in Wilkes-Barre, PA.
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With all the talk about the shortage of primary care physicians, one would think there is an abundance of surgical specialty care providers ready and willing to answer the call.
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Case: A 40-year-old man with a history of hepatitis C and alcoholism presents to the ED with dental caries. A brief history and unremarkable physical examination is documented. The patient is discharged and fills his prescription for hydrocodone 5 mg/acetaminophen 500 mg (1-2 tablets every 4-6 hours as needed, #25).
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Given the fact that almost every patient, family member, and ED staff member is carrying a cell phone, it's not surprising that inappropriate photos or videos have been posted online which means increased legal risks for EDs.
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Corey M. Slovis, MD, professor and chairman of the Department of Emergency Medicine at Vanderbilt University Medical Center in Nashville, says to remember that requirements of the Health Insurance Portability and Accountability Act (HIPAA) apply not only to words, but also to images.
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Did an ear, nose and throat consultant refuse to come in for a critical-airway patient, a neurosurgeon for an intracranial bleed, or a hand surgeon for a patient with a tendon rupture? "Any of these instances could lead to poor or unsafe patient care and strained future relationships," says Chad Kessler, MD, FACEP, FAAEM, section chief of emergency medicine at Jesse Brown VA Hospital in Chicago.
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Michael Blaivas, MD, RDMS, professor of emergency medicine in the Department of Emergency Medicine at Northside Hospital Forsyth in Cumming, GA, says he has reviewed multiple cases involving consultants refusing to come to the ED, with a bad outcome resulting. "Mostly, this means an unhappy patient, but in critically ill ones can mean a lawsuit," he says.
