Changes in ED?

Sounds like an interesting topic. Sorry no one has replied yet. I'm fairly new to the ED, myself, so no new changes that I am aware of. Good luck!

The question is unfair.

There are many personalities present in each and every ER.

How do you offer advice on change w/o knowing how yours is run?

Do your ER doctors actually work for the hospital or are they a physician group?

I find that staffing groups slow down patient flow by ordering stuff that makes their billing greater in their favor.

e.g- Efficasy of Levaquin PO vs. IV is the SAME. If the patient isn't being admitted why the 1-1 1/2hr IV therapy? PO & GO! (They can bill more $$$ for the IV).

How is the willingness of the patient floors with respect to receiving ER patients?

A backlog of ER patients isn't an ER problem it's a hospital problem.

Going into the meetings, I didn't know what the direction of the changes were going to be. But, this week, we've talked about resurrecting our Fast Track system, pulling those minor emergency patients out of the regular flow and using a smaller "care team" consisting of a PA/NP, RN and tech to focus on moving those patient through the system in 90 minutes or less, with a goal of 60 minutes or less. Has anyone done anything like this? What were your biggest hurdles? We have both the designated space and staff to do it.

Thanks!

More aggressive direct to room

Streamline triage

"admission unit" if you don't already have one

pharmacy well represented in the ED (med req's etc)

STAT lab of some kind (especially troponin)

good communication system (phones, pagers, trackers)

--just to name a few we have done in the last 4-5 years

More aggressive direct to room

STAT lab of some kind (especially troponin)

iStat does it all (if you can afford the cartridges).

Will run Chem-8 to include BUN/Creat & Lactate,

Blood Gas, Hgb/Hct, CK/Troponin/BNP, Pt/Ptt/INR

http://www.abbottpointofcare.com/PDFs/17845_CrtrdgeBrochure_M1.pdf