Why do we physicians chart the way we do? Hopefully, you do it perfectly well and have no concerns at all. But where I practice emergency medicine, we are approaching maximum inefficiency in charting.It all became much clearer when we started using our new EMR system. Let me make it clear, I'm not against EMR. In fact, typing and templates work better for me than dictating. My dictations were usually ...
Posts tagged Emergency
Can chest pain patients be evaluated in the ER waiting room?
by John GeverEmergency department patients with chest pain may safely be evaluated in the waiting room when necessary, researchers said.Among 303 patients triaged to waiting-room evaluation in a prospective study, no acute coronary syndromes were missed and adverse event rates overall were lower than among 804 patients who were assessed in conventional monitored beds, reported Frank Scheuermeyer, MD, of St. Paul's Hospital in Vancouver, British Columbia, and colleagues online in ...
Treating a child with fever and leukemia
I walked into Room 35 to find a three year-old lying on the hospital cot. Her father sat alongside her bed, whispering softly to her. The patient appeared quite tired, wiped-out even, and if it weren't for her complacent eyes tracking my every move, I would have thought she might be sleeping.She was visiting our ER because, after a few days of cough and congestion, she had developed a fever. ...
Interruptions in the emergency department can lead to errors
by Nancy WalshBusy clinicians in the emergency department reduce the time they spend on clinical tasks when interrupted, working faster and possibly cutting corners, a prospective observational study found.Overall, clinicians were interrupted 6.6 times per hour, and 11% of all tasks were interrupted, according to Johanna I. Westbrook, PhD, of the University of Sydney, in Australia, and colleagues.The mean "time on task" for uninterrupted tasks was 1 minute and 26 ...
A speeding ambulance may not benefit patients
How fast should an ambulance go?The stereotypical speeding ambulance with sirens blaring is the image that most conjure up.But recent data suggests that transport speed may be overstated.In a fascinating piece from Slate, emergency physicians Zachary F. Meisel and Jesse M. Pines examine that very question. They cite a recent study from the Annals of Emergency Medicine, which concluded that a fast transport speed didn't necessarily save lives:
The ...
Father of a patient with a sudden brain hemorrhage
She was 50. Prior to being transported to our ER, her only complaint had been for non-traumatic elbow pain over the past two weeks. She was on no medications and had no significant medical history.She was at home, preparing to visit her doctor for a scheduled visit, when she collapsed. Because she didn't drive, her elderly father had planned on swinging by to pick her up. He had just called ...
Defensive medicine starts early in residency training
Part of a resident’s job is to learn the ropes in preparing for independent practice. While you’re a resident, you get the benefit of having someone looking over your shoulder to critique you as you determine how you are going to manage patients.I frequently tell residents that different attending physicians practice medicine in different ways. Some practice defensive medicine more than others, some prescribe antibiotics more than others and some ...
Patient grief and the safety of doctors and nurses
A patient's grief can threaten the safety of health care providers when it crosses into rage.Emergency physician Edwin Leap illustrates some concerning instances:
In one instance, family members became angry because we did not leave the body in the ER for eight hours so that everyone could come and pay their respects. (Which I always thought was the purpose of a funeral home.) In another, a family was ...
Before quitting medicine, consider the children
There's little doubt that many doctors are frustrated, with some compelled to leave medicine altogether.And with the myriad of obstacles intruding on the doctor-patient relationship, combined with the factors contributing to burnout, that's certainly an understandable stance.So, why do so many continue the uphill climb to practice the best medicine they can?Emergency physician Edwin Leap gives his explanation, in a poignant column from Emergency Medicine News:
We may rail against ...
Causes of Beau Biden’s stroke
Beau Biden, son of Vice President Joe Biden, suffered a stroke today.
He is 41-years old, and is expected to make a full recovery according to the medical director of the Center for Heart and Vascular Surgery at Christiana Care Health System:
Biden has what the doctors "believe to be a mild stroke," according to Gardner. "[He is] "fully alert, ...
Children with fever may not receive antibiotics in the ER
by John GeverUp to one-third of children with febrile bacterial infections failed to receive antibiotics in a large emergency department, while 20% of youngsters without such infections received antibiotics unnecessarily, Australian researchers said.A computer algorithm based on standard test results could do a better job of assigning feverish children to the correct treatment sooner, Jonathan C. Craig, MBChB, PhD, of the University of Sydney, and colleagues reported online in BMJ.Although ...
False patient contact information worsens emergency care
One of the biggest emergency room problems is contacting patients after they leave.Patients sometimes leave false contact information -- which makes it difficult for the emergency room staff should problems arise after the visit.The issue was illustrated in a piece from msnbc.com. Many times, results like blood cultures or x-ray findings take time to return. And if there's something that needs to be acted upon, contacting the ...
The Vanishing Oath is a film patients must see
I recently watched The Vanishing Oath, a physician-directed documentary detailing the challenges impeding doctors to best care for their patients. It follows the travels of Ryan Flesher, MD, an emergency physician who took time off and traveled the country talking to university economists, an Emergency Medicine trailblazer, a malpractice attorney, medical academics, a divinity professor, current physicians, former physicians about what ails our health system. Here's a video excerpt:width="400" height="327" ...
Money prevents patients from seeking timely heart care
by Crystal PhendLack of insurance and financial concerns keep patients from treating a heart attack like the emergency it is, researchers affirmed.A delay in getting to the hospital for treatment of acute MI was 38% more likely among the uninsured and 21% more likely among insured patients with financial concerns, reported Paul S. Chan, MD, MSc, Mid America Heart Institute in Kansas City, Mo., and colleagues.More than two in every ...
Cardiac arrest resuscitation, with wife as witness
The patient arrived in cardiac arrest. He had been brought to our emergency department in the middle of the night. Although he had a significant cardiac history, he was only in his late-forties. His transport from his house to our department had been less than ten minutes and, along the way, the pre-hospital team had done an excellent job of intubating this patient and establishing an IV.His wife was with ...
Health reform won’t help the ER
Contrary to popular belief, those without health insurance are not flooding emergency rooms as a consequence of being cut off from routine and preventive care. Actually, frequent visitors to the local ER are far more likely to have insurance according to a new review of 25 studies on ER use published since 1990.
Frequent users account for about 8% of ED patients but 28% of ...
Psychiatric patients detained in the ER
Our state of South Carolina is a delight. From wonderful people to beautiful landscapes, from a vibrant Southern culture to excellent food like shrimp and grits, it’s a place I’m thrilled to live. But we do lack a few things. And one of the most striking is adequate mental health care.The state budget, like so many state budgets, has been trimming anything and everything. And of course, mental health coverage ...
Patients who visit the emergency department have insurance
by Joyce FriedenMost patients who visit the emergency department (ED) four or more times a year have health insurance and a primary care physician, a review of the literature found."The uninsured represent only 15% of frequent users and are no more likely to be frequent users than they are to be occasional ED users (<4 visits/year)," Eduardo LaCalle, MD, MPH and Elaine Rabin, MD, of the Mount Sinai School of ...
Healthcare workers in the ER hit hard by H1N1
by Michael SmithHealthcare workers in a New York City emergency department had the highest rate of infection among employees of an urban hospital system during the first wave of the H1N1 pandemic flu, researchers said.In a single-institution study using medical and administrative records, the adult emergency department had an H1N1 infection rate of 28.8% during April, May, and June of 2009, according to Robert Bristow, MD, and colleagues at New ...
Emergency departments are frequently used by young adults
by Kristina FioreTwenty-somethings rely on emergency departments (EDs) for care far more than do other age groups, researchers have found.In 2006, nearly a quarter of all young adult healthcare visits -- 22.1% -- took place at an ED, compared with 12.6% for children and adolescents and 8.3% for patients over 30.That rate has significantly increased over a 10-year period, Robert J. Fortuna, MD, MPH, of the University of Rochester Medical ...
