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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:

In emergency medicine and presumably in urgent and primary care, one of the common failure-to-diagnose drivers is the failure to recognize or act upon abnormal vital signs. In one analysis of 90,000 patients that we published in Annals of Emergency Medicine, 16% of patients presented to the emergency department with an abnormal vital sign, and 10% of that group went home without a single repeat of the abnormal vital sign. That analysis came from over 200 emergency departments across the U.S., representing over 7 million patient visits annually. From a quick calculation, you can see there are a lot of patients with abnormal vital signs being discharged from EDs across the U.S., and there are undoubtedly failure-to-diagnose adverse events and significant morbidity in that patient group.

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.

The Maternal Fetal Triage Index (MFTI) tool developed by obstetric experts at AWHONN is a recent advance that deserves attention from all obstetric professionals. If you haven’t yet learned of it, stay tuned, because you will be hearing much about it as it goes “live” in the EMR of many institutions around the country.

Practitioners should employ Evidence-Based Medicine or Best Evidence whenever possible. No one would argue with that. If a patient presenting with chest pain has a very low probability of a pulmonary embolism based on good evidence, it would be inappropriate to order a CT scan and expose a patient to the dangers of unnecessary radiation. Alternatively, if an algorithm suggests that pulmonary embolism is likely or probable, it would be inappropriate to “fail to order” a CT scan of the chest.

Accurate triage of patients in an emergency department is critical to timely care and patient safety. 

Read these four clinical tips for triage nurses based on recent trends spotted by RSQ® Collaborative Triage Champion, Shelley Cohen, RN, MSN, CEN. 

Download these tips as a PDF.

In order to provide the highest quality and safest care, medical practitioners should have immediate access to clinical decision support. Medicine should not be a memory game; in fact, according to an analysis by Allan Kachalia, MD, JD, published in the Annals of Emergency Medicine, relying solely on memory could leave you more susceptible to cognitive errors that lead to malpractice claims. Kachalia’s closed claims analysis found that cognitive errors were present in 96% of the cases; furthermore, 58% and 41% of the time, those errors were related to gaps in knowledge and lapse in memory, respectively. It is simply not possible to remember all of the information needed to diagnose a patient, such as the factors that predispose to a pulmonary embolism or a subarachnoid hemorrhage; all the elements of the Modified Wells or PERC calculators; all the key tendons and ligaments in the body; all the names of the bones in the ankle and the wrist; or all the cranial nerves and exactly what they do. But these are key data points — risk factors or anatomy that MUST become front of mind at just the correct moment during a particular patient’s workflow to provide appropriate care and avoid error.