The higher cost, lower yield tests to consider avoiding for patients ≥60 with syncope were: EEG, head CT, MRA, cardiac stress test, and EP study.
Sepsis bundles like the CMS SEP-1 guidelines are too restrictive, requiring an all-or-nothing approach to achieve compliance. These bundles fail to prioritize the most important bundle components while penalizing providers for meaningless omissions that have no impact on mortality.
Failure of private hospitals to care for the uninsured resulted in informal ED to ED referrals, which meant up to 20% increased volume in public EDs for certain diagnoses, particularly orthopedic issues. This led to duplicate testing, increased cost, complications, delays in care, and poor treatment of the most vulnerable patients.
Patient satisfaction is important. But the most commonly used metric in the US, the Press Ganey survey, may not be a good measure of individual emergency physician and clinician performance. Giving emergency clinicians feedback on their Press Ganey scores, ostensibly so they could take steps to improve, did not lead to appreciable score improvements.