Blog & Articles

There is only one thing that frightens an obstetrician more than a difficult shoulder dystocia delivery—getting a letter from a plaintiff attorney notifying you that you are being sued for alleged malpractice in a shoulder dystocia delivery you did several years ago. 

What is especially upsetting is that you remember that delivery, how quickly everything happened, and how well you performed in the heat of the moment to save that baby's life. You did your best, but the result was still a brachial plexus injury. 

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.)

Surgical Site infections (SSIs) occur in 2% to 5% of surgery patients. This category of infection comprises approximately 22% of all healthcare-associated infections and has a 3% mortality. Patients with SSIs require significant care and average 7 to 10 days of increased length of hospital stay. The cost of providing care for a single SSI ranges from $3,000 to $29,000. The total cost of care for SSIs is estimated at $10 billion dollars per year. There are of course additional expenditures for outpatient care, readmissions, and care of long-term disabilities.

Catheter-associated urinary tract infections are the fourth most common HAI. They comprise over 12% of all acquired infections in acute care hospitals. 93,300 of these UTIs are estimated to be acquired in hospitals each year, with an estimated death toll of 13,000 patients.

If you ask leadership at many hospital organizations to name their highest current quality priority, many will respond that it is sepsis. In recent years, medical researchers have identified that key interventions dramatically alter the course of sepsis. Key factors such as early identification, early administration of antibiotics, and appropriate fluid loading significantly reduce morbidity and mortality. Hospitals and organizations that have followed the evidence have consistently demonstrated significant improvements in patient outcomes.

Over the last several months, many of our articles have focused on the importance of redesigning physician documentation systems to increase patient safety and minimize diagnosis-related errors. If you are familiar with The Sullivan Group, you clearly understand the alignment of that topic with our mission and the role we have played with many health systems and EMR vendors to further that mission. However, we also recognize the importance of efficiency, speed, and productivity in the ED and how cumbersome physician documentation systems in the enterprise EHR can lead to an increased frustration and burnout by EM practitioners. 

The CDC defines a Central Line-Associated Bloodstream Infection as: “A laboratory-confirmed bloodstream infection (LCBI) where central line (CL) or umbilical catheter (UC) was in place for more than 2 calendar days on the date of event, with day of device placement being Day 1 and the line was in place on the date of event or the day before.” In other words, the patient must have had the device in place for at least 2 days and the diagnosis must be made while the device is still indwelling or was indwelling on the day before.

The Centers for Disease Control and Prevention defines healthcare-associated infections (HAIs) as: “Infections that patients acquire during the course of receiving healthcare treatment for other conditions.”

Healthcare-associated infections are very common, and the cost associated with them is enormous. It is estimated that 1 out of every 25 hospitalized patients is treated for an HAI, with costs ranging between $28 billion and $33 billion per year.

In general, practitioners don’t appreciate anything that “pops up” or gets in the way of their typical workflow. This aspect of some EMRs can cause dissatisfaction, even anger. A good example is warnings related to medication prescribing. In some programs, drug interactions of any severity and their complications litter the screen with overwhelming frequency. This simply becomes white noise and is soon ignored, sometimes to the peril of the patient as well as the practitioner.

When a patient presents with chest pain or chest-related symptoms, the role of the triage nurse is to critically evaluate the relationship of risk factors to outcome potentials to make the best triage decisions. The more risk factors a patient has, the greater the triage nurse’s concern for a potential high-risk scenario. In this blog, we will propose several triage questions for chest pain and consider several serious concerns that can prompt a patient to present with chest-related complaints, not all of which involve the heart: