Does Hyperglycemia at Discharge Matter?
Lowering glucose prior to discharge may negatively impact ED length of stay (LOS) without short-term benefit for the patient, but this study wasn’t able to prove it.
Urgent Care Siphons Off Emergency Patients
From 2008 to 2015, low acuity care in commercially insured patients has dropped 36% in EDs and increased 140% in non-ED settings, dominated by an increase in urgent care but also, less so, by increases in retail clinic and telemedicine utilization.
Triaging Children in Mass Casualty – Which Tool Is Best?
Four mass casualty incident (MCI) triage sorting systems performed similarly in children, each 57-59% accurate. Those considered were SALT, JumpSTART, Triage Sieve, and CareFlight.
High-Sensitivity Troponin Rapid Rule-Out Protocol in the U.S.
Use of a rapid rule-out MI protocol with hs-cTnT was safe, accurate, and would have reduced time to discharge and increased the proportion of patients ruled out in this U.S.-based implementation study.
Scribe Lovin’ in the PED
Scribes increased physician productivity in this single center low-acuity pediatric ED before and after study.
Why SEP-1 CMS “Quality” Metrics Are Dumb
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.
Sign-Out Bombs and Resident Productivity
With ED boarding, the burden of sign-out patients is greater than ever. This study shows just what I expected. All of these sign-out patients negatively affects how many new cases each resident is able to see on each shift.
Door to tPA Under 20 Minutes – Impressive or Dangerous?
A door-to-tPA in under 20 minute protocol at this center with 1015 stroke alerts resulted in a misdiagnosis rate of 14.8% and 8 people being harmed. The authors concluded this was safe. I'm not so sure about that.
Harvard Business Review – Servant Leadership
I recently read a helpful article in Harvard Business Review via Doximity. It was a feature on servant leadership. I'll briefly recap the highlights and make application to the ED.
Metabolize to Freedom On-Site Not in the ER?
An on-site alcohol sobering facility reduced EMS transports to local EDs by over 50% during a local multi-day mass gathering event.