[6 MIN READ]
The overwhelming majority of malpractice lawsuits in emergency medicine and other acute care venues involve the failure to diagnose. In most cases, these patients are discharged home where the missed diagnosis results in an adverse outcome or death. Fortunately, the patient “bounces back” in some cases, creating another opportunity to make the right diagnosis.
[4 MIN READ]
All of us experience a never-ending number of first impressions.
Consider that first visit to a restaurant that was highly recommended by friends. After being seated, five or ten minutes go by without a server coming to the table. When the server finally arrives, they seem distracted with no discernible facial expression. How does this indifference make you feel?
Or what about the flight attendant who treats you like an empty seat when you try to ask a simple question?
In either case, the chance for a warm, enjoyable experience is diminished after such a cold beginning.
The same is true for patients in their initial encounter with healthcare providers, whether they’re physicians, nurses or other personnel.
The national nursing shortage makes recruiting and retaining quality nursing staff extremely competitive. While facilities may have traditionally required 3-5 years of emergency department (ED) experience before training a nurse for triage, the lack of resources has forced some organizations into reducing the requirement to one year or less. As this requirement decreases, it is increasingly critical to have a well-defined onboarding path for nurses new to triage.
A steady increase in maternal mortality and morbidity in the U.S. prompted a comprehensive, collaborative response by the federal government and leading medical organizations focused on maternal health to improve outcomes. The Prevention of Maternal Death Act of 2018 directed DHS to develop programs that support the states in their work to save and sustain the health of mothers during pregnancy, childbirth, and in the postpartum period; to eliminate disparities in maternal health outcomes; and to identify solutions to improve health care quality and health outcomes for mothers.
[5 MIN READ]
In recent years, emergency department providers have regularly faced an expanding volume of patients with mental health needs. Then COVID-19 happened, dramatically taxing the healthcare system and increasing demands on providers while also challenging patients’ mental health across the board. In response, it is essential that ED providers increase their knowledge and comfort with the assessment, treatment, and disposition of mental health patients in order to improve timely care for these patients, many of whom require behavioral healthcare in the ED.
Psychiatric and substance abuse issues had already more than doubled prior to COVID-19 disrupting our lives more than doubled, rising from 6% to 15% 1. And while traditional visits to the emergency department decreased during the pandemic, visits requiring care for adult psychiatric and substance abuse issues increased substantially. This often presented as anxiety or depression diagnoses, trauma, and stress-related disorders, and increased substance use. Some of these problems manifested as an increase in suicide ideation and attempts.
In 2019, the World Health Organization categorized burnout as a syndrome resulting from chronic workplace stress that has not been successfully managed. While burnout was a concern before COVID-19, its onset has exacerbated the problem.
According to an ACEP October 2020 poll, 87% of emergency physicians reported feeling more stressed since the start of the pandemic, and 72% reported experiencing more burnout on the job.
On the surface, burnout may be classified as a workforce issue; however, its far-reaching effects can threaten patient safety. In fact, research suggests that physicians experiencing burnout are twice as likely to make a medical error. Burnout should absolutely be considered one of the root causes of medical error.
I want to take a collective pause with you for a moment to recognize a very special individual in The Sullivan Group’s world, Dr. Tom Syzek. Tom has decided to step down from his position as TSG’s VP of e-Learning. I hesitate to say retire because Tom has a long list of things that will keep him busy, including swimming across Tampa Bay regularly in support of our veterans, long treks at high altitudes, family activities, and who knows what’s next!
I know that whatever the next chapter is for Tom, he will approach it with the same energy, thoughtfulness, creativity, friendliness and loving spirit that defines him. If you have had the great fortune of working with Tom over the years, you definitely know what I am talking about.
Despite almost two decades of attention and study, diagnostic error continues to be a main issue in healthcare, affecting an estimated 12 million people each year and causing harm in one-third of these cases.
The most comprehensive literature on this topic comes from “Improving Diagnosis in Health Care,” in which the first recommendation is to “facilitate more effective teamwork in the diagnostic process among health care professionals, patients, and their families.” Specifically, it calls for increasing nursing engagement in the diagnostic process; no longer is the diagnostic process the sole purview of a physician. Here we use a case review to demonstrate the importance of nurses in reducing diagnostic error and saving patient lives.
[3 MIN READ]
When most people think of triage, they think of nurses making sense of the chaos caused by 141 million annual visits to the ED.
Patients who are part of this massive onslaught of unscheduled care arrive daily at any hour, and the first person they see is someone in triage, usually a nurse, whose job is to quickly figure out who needs to be seen in what order.
In my early practice years, my ignorant impression was that triage was for dummies – all one had to do was just sit there and assign patients to a room.
Many years of experience and observation have taught me otherwise – that triage is where the best and brightest nurses should be.
