Blog & Articles

We hear the overhead announcements all the time in the hospital … Code Blue … Code Red … and more recently, Code Trauma … Code STEMI … Code Stroke … and Code Sepsis. From the standpoint of risk and safety, these latter four are the “Codes” that practitioners and nurses must master in order to deliver the best possible care in the safest manner, thereby reducing risk to patients and clinicians alike. Previous blogs featured two time-sensitive emergencies: Code Stroke and Code Sepsis. Today I will highlight a third time-sensitive “code” — Code STEMI (ST-elevation MI.)

Acute ischemic stroke affects about 800,000 patients a year in the U.S.; 600,000 of these cases are a first stroke. Stroke is a leading cause of permanent cognitive and function-limiting disability, and it ranks fifth among all causes of death. Prompt recognition of an acute ischemic stroke is crucial, as studies show that the volume of irreversibly damaged brain tissue expands rapidly until reperfusion occurs. The American Heart Association guidelines call for rapidly recognizing a neurological deficit, ruling out the mimics of a stroke, and making the early diagnosis of stroke.

Every healthcare professional is familiar with the traditional learning methods of classroom lectures, texts, conferences and hands-on clinical training. For “experienced” older clinicians (like me) educated during the pre-internet era, these were the exclusive methods employed during college, medical/nursing school, internship, residency and beyond. You went to lectures, hit the books, and relied on the “watch one, do one, teach one” process of mastering new procedures.

Electronic Medical Record (EMR) and Electronic Health Record (EHR) systems were developed to satisfy several important needs (I will use EMR and EHR interchangeably). Just to name a few: legible documentation of patient encounters, satisfaction of coding and billing requirements, regulatory compliance, prevention of medication errors, clinical pathway utilization, medical-legal defensibility, and data compilation. Having seen and used several EMR systems, I can tell you that they were not developed with the primary goal of improving user efficiency.

One of our goals at The Sullivan Group is to bring you practical pearls to reduce risk, improve patient safety, and enhance quality in your everyday practice. To that end I thought I would share with you this “alphabet soup” of healthcare risk management and patient safety tips assembled from years of observation and experience.

There are four time-sensitive emergencies that that every practitioner of acute care medicine should master to deliver the best possible care in the safest manner: Code Trauma, Code STEMI, Code Stroke, and today's topic – Code Sepsis. Depending on the specialty, practitioners are involved in sepsis care at one or more stages of sepsis. In the office, urgent care or ED, the first two stages are paramount – early recognition and aggressive resuscitation. Hospitalists and admitting practitioners continue the initial management through recovery.

Based on our experience, research, and an analysis of
thousands of malpractice cases in acute care, including
emergency departments and urgent care centers, we
have uncovered several critical risk and safety issues
of which you may not be aware.

There are four time-sensitive and life-threatening clinical presentations that every acute care practitioner must master to deliver the best possible care in the safest manner. The first two have been around a while and should be very familiar – Code Trauma and Code STEMI. The next two are less dramatic than trauma and heart attacks, but are no less critical – Code Stroke and Code Sepsis. Here are some highlights of Code Stroke.

Too many patients in too little space subjected to inefficient processes. This is the essence of overcrowding in the Emergency Department. In the 40 years since 1975, the number of hospitals has declined from over 7,000 to about 5,700. Hospital bed capacity fell during the same period from 1.5 million to fewer than a million. Meanwhile, the number of ED visits has increased almost every year, totaling 136 million by 2011. The resulting formula for overcrowding is obvious: fewer hospitals + fewer beds + increased ED visits = overcrowding. Most hospital EDs (90%) experience overcrowding at some point. The practical consequence of overcrowding is boarding – when patients are kept in the ED for hours or days after the decision to admit them has been determined.

Anything and everything that improves patient safety is important. The sheer weight of that sentence can be overwhelming to healthcare professionals. Consider one conclusion from the Institute of Medicine (IOM) report “Improving Diagnosis in Healthcare” that states, “Advancing patient safety requires an overarching shift from reactive, piecemeal interventions to a total systems approach to safety in which safety is systematic and is uniformly applied across the total process.”