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Timing and diplomacy are keys to CT scans in the emergency department

Your ED is overflowing with patients, the wait time is heading toward double-digit hours, and youre short-staffed again. So when you walk by an exam room and see a patient sitting there sipping contrast fluid the same contrast he was drinking an hour ago your blood pressure goes through the roof.

Radiology’s point of view: Work with us on CT scans

When working with your radiology department to reduce the time it takes to get abdominal computed tomography (CT) scans for emergency patients, be sure to look at the issue from their perspective, suggests the nations leading radiologist.

Root-cause analysis is useful for ED problems

An analysis tool commonly used for investigating adverse events and other process errors in health care can prove useful in the ED as well, say experts who have seen it used to address long wait times and similar problems. The technique is called root-cause analysis (RCA), and chances are youve heard the term tossed around, but its not as likely that youve actually employed it in the ED.

Root-cause analysis requires multiple steps

A root-cause analysis (RCA) is a complex tool that requires professional training, but an ED manager can utilize it with the help of an expert, says Kenneth A. Hirsch, MD, PhD, a practicing psychiatrist and director of Medical Risk Management Associates, a consulting firm in Honolulu.

Mental illness taxing EDs, affecting other patients

If it seems youre seeing more patients with mental illnesses recently, youre not imagining it. The number of people with mental illness seeking care in the ED has surged recently, and the increase is taking a toll on other ED care, says J. Brian Hancock, MD, president of the American College of Emergency Physicians (ACEP) in Irving, TX.

EDs struggle with growing numbers of uninsured

In addition to increased numbers of mentally ill patients, EDs are seeing more uninsured patients than in the past, and the numbers could grow, warns Brian Hancock, MD, president of the American College of Emergency Physicians (ACEP) in Irving, TX. Your budget planning should factor in more uninsured patients, not just the same level you have coped with for years.

Reader Question: If nurses hoard patients, how can you improve flow?

Question: How do we avoid patient hoarding, in which nurses or physicians intentionally delay moving a patient out to delay the next patient and give themselves a breather? Weve already warned that hoarding wont be tolerated, but it still happens and thwarts our efforts to improve patient flow through and decrease waiting time.

Journal Reviews

Hsu J, Reed M, Brand R, et al. Cost sharing: Patient knowledge and effects on seeking emergency department care. Med Care 2004; 42:290-296. Saketkhoo DD, Bhargavan M, Sunshine JH, et al. Emergency department image interpretation services at private community hospitals. Radiology 2004; 231:190-197. Lyons MS, Lindsell CJ, Trott AT. Emergency department pelvic examination and Pap testing: Addressing patient misperceptions. Acad Emerg Med 2004; 11:405-408.

EMTALA Q&A

Question: I know EMTALA signs are to be placed in registration areas, EDs, and public entrances. Right now we have signs in each of our four ED rooms, in the front hospital entrance, and the registration area. But I need to know if I should hang a sign in our back entrance leading to the ED. This entrance is not considered a public entrance, so do I need to put a sign there?

ED Management – June 1, 2004

June 1, 2004