Blog & Articles

[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. 

[6 MIN READ]

Any discussion of communication in healthcare must include the process of transferring patients and their vital medical information from one provider to another and/or from one healthcare setting to another.

Such transfers are known as healthcare handoffs.

Examples include when a patient is transferred from an ambulance to an ED or when a surgical patient is moved from the recovery room to a surgical floor.

A person-to-person handoff takes place when, for example, a physician going off duty signs off to the evening on-call doctor or when nurses report to each other at shift changes.

Handoffs are specific circumstances in healthcare that are prone to medical errors.

Updated: May 27, 2021

The emergence of the COVID-19 pandemic caused by SARS-CoV-2, a highly transmissible virus that can be spread by asymptomatic people, requires providers to make innovative changes in how patients are seen and treated in the ambulatory setting. Prenatal care requires frequent face-to-face visits, so it is particularly challenged to adapt to protect patients, providers and office staff. Ultrasound testing and fetal monitoring usually also require in-office visits. However, innovations in care such as increased use of telemedicine and self-monitoring at home by patients are being implemented to change the norm for prenatal care. This article will discuss the innovations offices and patients can implement to provide safe, comprehensive prenatal care to pregnant patients with COVID-19.

[5 MIN READ]

Before the COVID pandemic, the medical community in general, and physicians in particular, were dealing with and continue to deal with a pandemic of its own: Burnout. In 2019, burnout was categorized as a disease by the WHO. It is characterized as:

“…a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.”

There are 3 dimensions of burnout:

Updated: April 30, 2021

Pregnant women who have known or suspected COVID-19 infection need to be evaluated quickly to determine the severity of their symptoms and if they have risk factors that put them at risk for severe disease. New data on the outcomes for pregnant women have shown that pregnancy is a risk factor for increased severe mortality and morbidity; for example, respiratory distress requiring intubation and admission to ICU, maternal death, and obstetric complications such as preterm birth and stillbirth (Jama Intern Med 2021).

Seven percent of pregnant women who underwent testing for COVID-19 were found to be positive, with 75%-85% asymptomatic and 90% stable enough to be treated outpatient. Thus, most women diagnosed with this infection can be treated without hospitalization, but all known or suspected infected patients must be closely monitored.

In January 2020, the first case of the novel virus known as SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), responsible for COVID-19 disease, was found in the United States. Since that time, there have been 6 major vaccines developed to prevent infection with this virus. However, none of the original trials included pregnant women. Three of these vaccines – Moderna, BioNTech-Pfizer and Johnson & Johnson have received Emergency Use Authorization (EUA) for administration in the U.S. population, with 100 million doses given as of this article’s writing. Soon after the EUA was determined, the CDC, ACOG and SMFM released recommendations specific for pregnant women:

• COVID-19 vaccines should not be withheld from pregnant women.
• Counseling is not required, and more importantly, lack of counseling should not deter a woman from becoming vaccinated. (ACOG Practice Bulletin, March 4, 2021)

History

A 25-year-old man presented to the ED with the chief complaint of low back pain. The pain onset gradually about 10 days prior, days after he lifted some furniture. The pain was described as dull and constant, with an intensity of level 7 out of 10 and getting worse in the past few days. He also had milder pain in the mid-back. Nothing seemed to make the pain better, and movement made the pain somewhat worse. He denied any prior back injury or surgery.

It’s estimated that between 3,000 and 8,000 people in the U.S. have Vascular Ehlers-Danlos Syndrome (VEDS), although many are undiagnosed. Because 50% of those with the condition do not have a family history, the road to diagnosis and expert care can be long. Many individuals with VEDS are not diagnosed until they have a life-threatening event, and 80% of VEDS patients will experience a major medical event by age 40; too many are diagnosed during autopsy.

The likelihood of someone coming into the emergency department unaware of their VEDS diagnosis is high, but a VEDS diagnosis can change the approach to a patient’s emergency and surgical care and outcomes. Therefore, it is critical to be familiar with this condition. Here we present a missed diagnosis case and its impact on the invasive interventions.

[10 MIN READ]

Updated: August 20, 2020

Navigating the ever-changing landscape surrounding the coronavirus pandemic is keeping everyone on their toes. Healthcare administrators and provider inboxes are packed with notifications and updates. We are all trying to sort through what is pertinent to hands-on patient care while doing our due diligence to remain up to date and well informed.

Early pandemic guidelines were based on expert opinion with little evidence to support recommendations. As the pandemic wears on and high-quality evidence becomes available, new recommendations will evolve supporting standardization of practice. While keeping current can seem daunting, it remains crucial for the safety of both you and your patients that you continue to do your best to remain knowledgeable and informed. The Centers for Disease Control (CDC) and the American College o Obstetricians and Gynecologists (ACOG) offer ongoing updates; patient handouts are available on these sites as well.

Provided here is a brief synopsis of newer updates (July/August 2020) specific to COVID and the obstetric population.

[6 MIN READ]

The national nursing shortage makes recruiting and retaining quality nursing staff extremely competitive. While facilities traditionally might have 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.

Additionally, having well-defined role expectations – especially during onboarding – can have a significant impact on a nurse’s job satisfaction and the likelihood they will stay with your organization.