Technology to advance dramatically in the ED
Are you ready for significant changes in emergency department (ED) technology, such as nurses' use of ultrasound? If not, you could be in trouble, some ED experts warn. "We will see a big shift in technology that will occur in the next five years," predicts Mike Williams, president of the Walnut Creek, CA-based Abaris Group, a consulting firm that specializes in ED management.
Today, technology plays a surprisingly small role in the ED, Williams acknowledges. He estimates that only 25% of EDs use electronic patient tracking and only 10% use electronic patient record systems. "The challenges have been poor productivity of the patient document systems," he explains. "Today, they simply are not designed to speed up the patient care process, and the patient tracking systems have a high cost of about $250,000 per hospital." Williams also estimates that less than one in 50 EDs has digital radiology or bedside ultrasound.
Here are forecasts for how technology will change ED nursing practice:
• Nurses will use ultrasound.
ED nurses soon will be using ultrasound to put in intravenous lines on difficult access patients, Michael Blaivas, MD, RDMS, associate professor and director of emergency ultrasound for the department of emergency medicine at the Medical College of Georgia in Augusta. In fact, his facility is beginning to train ED nurses to do this, he says. "This will initially include basilic and saphenous veins and will make for great access even in patients who have had cut downs and central lines."
Obtaining access and a line can be lifesaving in some instances, says Blaivas, adding that even in less critical patients, it can save hours of delays in lab draws or administration of antibiotics.
"We will be using a brand new SonoSite machine [Bothell, WA] developed just for vascular access," he reports. Blaivas says this technology offers direct visualization of the target vessel, and absence of visual or palpable landmarks is no longer relevant.
Nurses will be taught on inanimate models similar to those used by phlebotomists, but specially designed for ultrasound, he adds. After training is completed, policy and standards for this practice will be implemented. "Where we go with this from there is anyone’s guess," he says.
• Telemedicine use will increase.
In time, you’ll be able to obtain access to specialists in tertiary hospitals all over the country via telemedicine, predicts Blaivas. "You will be able to effectively practice with a variety of physicians," he says. He gives the example of a nurse at a rural ED with a patient with an unusual rash, strange repetitive movements, or some other odd physical finding. In this scenario, you’ll be able to contact a dermatologist, neurologist, infectious disease specialist or ED physician at the nearest tertiary care facility for help with diagnosis and treatment, he explains.
He reports that his ED is running a pilot program in which emergency nurses in outlying facilities contact Blaivas’ ED to evaluate stroke patients for possible tissue plasminogen activator treatment. The ED soon may be connected with a busy infirmary run by nurses at a large state prison, he adds. "We are hoping to one day avoid the need to transfer the majority of their patients for evaluation by using telemedicine," he says.
Telemedicine programs are being funded by state and federal dollars to improve care delivery to remote areas and areas in need, says Blaivas. "There are a number of large medical centers that offer telemedicine now, and I have seen it at two that I have worked at," he says. "This will take off like crazy in the near future."
• There will be more advanced testing at triage.
Blaivas says he expects to soon see nurses doing more advanced evaluation at triage, such as on-the-spot d-dimer and troponin I tests. As wait times increase, more evaluation and testing will need to be done before a patient gets to the treatment room, he says. For example, nurses may help determine if a patient with a swollen leg has a deep-vein thrombosis (DVT) with ultrasound or strain gauge plethysmography, Blaivas adds. This currently is being done by ED nurses in the United Kingdom, he reports.1,2
Doing this can cut hours from a patient’s workup and identify patients who should be seen right immediately, he says. "A negative d-dimer may mean a patient with a swollen leg can wait the two hours, while a positive one might need to be brought back a bit sooner since you are worried about DVT," he explains.
• Electronic patient records will improve.
Use of systems that match staffing to demand in "real time" will become critical, as more patients are managed with fewer resources, says Williams. Use of patient tracking will increase dramatically, as systems improve and costs are reduced, he says. "In particular, I see electronic patient record keeping being re-engineered to improve productivity instead of decreasing it," he says.
• Bedside testing for laboratory services will become more common.
Support for this technology is increasing due to automation of quality assurance parameters, says Williams. "That was the major stumbling block from before," he explains. "This is improving, as some bedside test machines will shut themselves down if they do not receive a QA check."
References
1. Maskell NA, Cooke S, Meecham Jones DJ, et al. The use of automated strain gauge plethysmography in the diagnosis of deep-vein thrombosis. Br J Radiol 2002; 75:648-651.
2. Robinson BJ, Kesteven PJ, Elliott ST. The role of strain gauge plethysmography in the assessment of patients with suspected deep-vein thrombosis. Br J Haematol 2002; 118:600-603.
Sources
For more information on technology in the emergency department, contact:
• Michael Blaivas, MD, RDMS, Associate Professor, Director of Emergency Ultrasound, Department of Emergency Medicine, Medical College of Georgia, Augusta, GA 30912-4007. Telephone: (706) 721-2613. E-mail: [email protected].
• Mike Williams, President, The Abaris Group, 700 Ygnacio Valley Road, Suite 250, Walnut Creek, CA 94596. Telephone: (925) 933-0911. Fax: (925) 946-0911. E-mail: [email protected].
Are you ready for significant changes in emergency department technology, such as nurses' use of ultrasound? If not, you could be in trouble, some ED experts warn.
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