Nursefriendly.com: emergency

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Monday, April 11, 2011

McDonald's Medicine: Too Impatient to Wait for Care, Time

Doctor asks, "Why did you come to the ER today?"

This question — emphasizing today is common practice in emergency departments — helps us figure out how urgent a patient's illness might be. But it's a loaded question. Rephrased, it could easily mean, "Do you really believe you are seriously ill, or is it just that you couldn't wait to see a regular doctor?"

Behind the sanctimony is a cliché: McDonald's medicine. Spend time in a busy ER and you'll hear a recurrent theme among the harried staff: patients in the U.S. want their health care like they want their food — served up speedily and made "your way." According to the conventional wisdom among medical professionals, overcrowding in the ER is exacerbated by America's culture of instant gratification. (See Healthland's 5 rules for good health in 2011.)

via time.com

Click on the "via" link for the rest of the article.

With the high value we put on Instant Gratification, have to say they have a point here.

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Should Emergency Departments Turn Away Nonurgent Patients? - TIME

A few weeks ago, the American College of Emergency Physicians (ACEP) launched a campaign to derail proposed policies to reduce the use of emergency departments (EDs). ACEP's problem with the campaign is the logic that underpins it: policymakers think that ED use, in aggregate, is a costly problem and a major driver of unnecessary health care costs in the U.S. ACEP claims that rather than delivering unnecessary care, EDs treat many patients who have no alternative when they need comprehensive medical care in a timely manner; that is, EDs deliver altogether necessary care.

ACEP has challenged reports from South Carolina and Massachusetts suggesting that a high percentage of ED use is unnecessary and that reform efforts — particularly payment incentives — will reduce "inappropriate" usage. In South Carolina, a state legislator, Representative Bill Herbkersman, even recommended that special call boxes be placed in the homes of more than 3,000 Medicaid patients to give them 24-hour access to nurses who could diagnose them over the phone and reduce costly and unnecessary ED visits. Blue Cross Blue Shield of Georgia has also increased the co-pay on ED visits from $100 to $200 and has been steering its members away from EDs to urgent-care centers and retail clinics (with the help of a Google Maps application, soon be available as an app for members' mobile phones).

via time.com

Click on the "via" link for the rest of the article.

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Sunday, February 6, 2011

Most ED patients willing to wait longer to avoid nondoctor care :: Aug. 30, 2010 ... American Medical News

Nurse practitioners and physician assistants account for at least 10% of outpatient visits and increasingly are being used to handle patient care in emergency departments, according to previous research.

But a new survey said 80% of patients expect to see a physician when they come to the ED. Fewer than half would be willing to see an NP or PA for an ankle injury -- they would rather wait two more hours to be cared for by a physician.

See related content

The survey of 507 ED patients at three teaching hospitals in Pittsburgh and Dallas found that, even for a minor complaint such as a cold symptom, only 57% would agree to see a nurse practitioner and 53% would see a physician assistant, according to the study in the August American Journal of Bioethics. Patients also preferred to see a fully trained physician compared with a medical resident, but not by as wide a margin as their desire to avoid nonphysicians.

Given their strong preferences for care from physicians, patients deserve greater disclosure about who is providing care and what the level of training is, said study lead author Gregory L. Larkin, MD, professor of emergency medicine at Yale University School of Medicine in Connecticut.

via ama-assn.org

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Thursday, January 13, 2011

Saving Grace (Emergency Department Nurses)- LA Times Magazine

“I heard a guttural scream,” Rich says, “and a man was handing me his lifeless son.”

“How old?” I ask.

“Nine months. We worked on him for over an hour.”

Rich moves his chair, coughs. It’s freezing in the conference room. [Note: For privacy, nurses are mentioned only by first name.] The muffled din of the emergency room is audible through closed metal doors. It’s 7 a.m., and Rich’s 12-hour shift has just ended. “I flashed to something I heard once about how a casket doesn’t weigh very much—just enough to break a father’s heart,” he says, “and I lost it. I’m standing there, between beds one and two holding that dead baby, and I’m sobbing. I am in charge, and I’m crying.”

As an 11-year volunteer in Cedars-Sinai Medical Center’s emergency room, I’ve seen close up what ER nurses deal with. It takes rare emotional courage not to burn out when you know that every time those doors open—whether you are working triage in front, where a guy may stumble in with a heart attack, or in back, where paramedics may race in with a girl who has been knifed or shot—it’s bad news. Then there’s the physical strength required to survive 12-hour shifts with two half-hour breaks and 45 minutes for lunch. ER nurses never sit. But it’s the children—every ER nurse will tell you—who take the biggest toll

via latimesmagazine.com

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Tuesday, December 7, 2010

24 Hours in an ER - Boston Magazine - Trauma Pics - Graphic

With more than 132,000 patient visits last year, Boston Medical Center’s level-one trauma center is the busiest in New England. Granted nearly full access to the facility, photographer Christopher Churchill documented the scenes that play out here day after day.

Originally published in Boston magazine, December 2010

via bostonmagazine.com

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Monday, November 29, 2010

Tough To Say No To CT Scans In Emergency Rooms : Shots - Health News Blog : NPR

A trip to the emergency room today is likely to trigger a round of routine diagnostic tests from blood work to an electrocardiogram to a urine sample. And increasingly, there's one more on that list: the CT scan. A new study shows that CT, or computerized tomography, has increased in ERs nearly six-fold since 1995 and shows no sign of tapering off.

Andrew Ciscel via Wikimedia Commons
A CT scan of the brain shows the cerebellum, a small portion of each temporal lobe, and the sinuses.

CT, a radiology tool that once took nine days to finish, was used 16.2 million times in 2007 to diagnose headaches, stomach aches, back pain, chest pain and the like. That was a huge increase from 1995 when it was used 2.7 million times, according to the paper published online in the journal Radiology.

via npr.org

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Sunday, November 14, 2010

First aid rules that everyone needs to know-KevinMD.com

First aid is defined as the immediate care given to an acutely injured or ill person. It can literally be life-saving so it behooves all of us to know some basic principles.
What follows are some rules that cover common conditions and general practices:
Don’t panic. Panic clouds thinking and causes mistakes. When I was an intern and learning what to do when confronted with an unresponsive patient, a wise resident advised me when entering a “code blue” situation to always “take my own pulse first.” In other words, I needed to calm myself before attempting to intervene. It’s far easier to do this when you know what you’re doing, but even if you encounter a situation for which you’re unprepared, there’s usually some good you can do. Focus on that rather than on allowing yourself an unhelpful emotional response. You can let yourself feel whatever you need to feel later when you’re no longer needed.
First, do no harm. This doesn’t mean do nothing. It means make sure that if you’re going to do something you’re confident it won’t make matters worse. If you’re not sure about the risk of harm of a particular intervention, don’t do it. So don’t move a trauma victim, especially an unconscious one, unless not moving them puts them at great risk (and by the way, cars rarely explode). Don’t remove an embedded object (like a knife or nail) as you may precipitate more harm (e.g., increased bleeding). And if there’s nothing you can think to do yourself, you can always call for help. In fact, if you’re alone and your only means to do that is to leave the victim, then leave the victim.
CPR can be life-sustaining. But most people do it wrong. First, studies suggest no survival advantage when bystanders deliver breaths to victims compared to when they only do chest compressions. Second, most people don’t compress deeply enough or perform compressions quickly enough. You really need to indent the chest and should aim for 100 compressions per minute. That’s more than 1 compression per second. If you’re doing it right, CPR should wear you out. Also, know that CPR doesn’t reverse ventricular fibrillation, the most common cause of unconsciousness in a patient suffering from a heart attack. Either electricity (meaning defibrillation) or medication is required for that. But CPR is a bridge that keeps vital organs oxygenated until paramedics arrive. Which is why…

via kevinmd.com

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Friday, November 12, 2010

Violence in the ER-Emergency Department Nursing

A Maryland man made headlines last week when he shot and wounded a doctor at Johns Hopkins Hospital in Baltimore. But unfortunately, his story is no longer a rarity. Hospital violence is increasing in frequency — and ER nurses bear the brunt of the hostility.

According to the International Association for Healthcare Security and Safety and the Emergency Nurses Association, more than half of all emergency room nurses have been spit on, pushed, scratched and/or verbally assaulted on the job. Almost a quarter of ER nurses say they’ve been assaulted more than 20 times in the past three years.

ER nurses are particularly at risk because they often deal with intoxicated, confused or violent patients. Add to that increasing frustration over ER wait times and the healthcare system, and it’s easy to see why nurses are vulnerable.

While some hospitals are installing metal detectors in an effort in improve safety, many experts say that proper training is key to decreasing ER-based violence. All staff working in the ER should know:

Warning signs — If a patient is pacing with clenched fists, watch out. Also pay attention to patients’ speech patterns, history (have had they problems with authority in the past?) and diagnoses. Patients with psychiatric disorders and those under the influence of drugs or alcohol are more likely to lash out.

How to get help — Call for help as soon as you sense a threat.

De-escalation techniques — ER staff should be trained in special techniques designed to diffuse a potentially volatile situation.

What to do if violence occurs — Safety, of course, is number one. But after violent incident, report it! Hospital administration needs to know about each and every incident so that steps can be taken to create a culture of safety.

Have you ever been assaulted at work? Do you feel adequately trained to meet the threat of violence?

Tags: News, Workplace Safety, Workplace Violence

via scrubsmag.com

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Saturday, October 16, 2010

Emergency Department (ER, Casualty, Trauma) Nurses on: The Nurse Friendly

Emergency Department (ER, Casualty, Trauma) Nurses on: The Nurse Friendly:"Emergency nurses specialize in rapid assessment and treatment when every second counts, particularly during the initial phase of acute illness and trauma. Emergency nurses must tackle diverse tasks with professionalism, efficiency, and above all—caring. Emergency nursing is a specialty area of the nursing profession like no other. To provide quality patient care for people of all ages, emergency nurses must possess both general and specific knowledge about health care to provide quality patient care for people of all ages. Emergency nurses must be ready to treat a wide variety of illnesses or injury situations, ranging from a sore throat to a heart attack. There are approximately 90,000 emergency nurses in the US."
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Posted by Andrew Lopez, RN at 9:23 PM No comments:
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Labels: 911, accidents, acls, acute care, cpr, ed nurse, emergency, Emergency Department, emergency room, er nurse, hospitals, nurse, Nursing, trauma

Friday, October 15, 2010

Being an ER nurse is ‘like living on the edge - Little Falls, NY - The Times

Being an ER nurse is ‘like living on the edge - Little Falls, NY - The Times:"Being an ER nurse is ‘like living on the edge:"Countless number of patients pass through the emergency room doors every year and fall under the care of its nurses, doctors and staff. “I enjoy participating with my local hospital because it’s a way of giving back to the community,” said Heather Swartz, a registered nurse in Little Falls Hospital’s emergency room."
http://www.littlefallstimes.com/news/x123460206/Being-an-ER-nurse-is-like-living-on-the-edge#
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Andrew Lopez, RN
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38 Tattersall Drive, Mantua New Jersey 08051
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Posted by Andrew Lopez, RN at 1:12 PM No comments:
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Labels: 911, ed abuse, ed nurse, ed overcrowding, emergency, emergency care, emergency department nurses, emergency medicine, emergency nursing, er abuse, er nurse, er overcrowding, hospital admission

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Monday, April 11, 2011

McDonald's Medicine: Too Impatient to Wait for Care, Time

Should Emergency Departments Turn Away Nonurgent Patients? - TIME

Sunday, February 6, 2011

Most ED patients willing to wait longer to avoid nondoctor care :: Aug. 30, 2010 ... American Medical News

Thursday, January 13, 2011

Saving Grace (Emergency Department Nurses)- LA Times Magazine

Tuesday, December 7, 2010

24 Hours in an ER - Boston Magazine - Trauma Pics - Graphic

Monday, November 29, 2010

Tough To Say No To CT Scans In Emergency Rooms : Shots - Health News Blog : NPR

Sunday, November 14, 2010

First aid rules that everyone needs to know-KevinMD.com

Friday, November 12, 2010

Violence in the ER-Emergency Department Nursing

Saturday, October 16, 2010

Emergency Department (ER, Casualty, Trauma) Nurses on: The Nurse Friendly

Friday, October 15, 2010

Being an ER nurse is ‘like living on the edge - Little Falls, NY - The Times

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