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 Summer, 2007 Volume 5, Issue 4
 Consultant's Corner
Feature Article
Quote of the Month
New Articles / Abstracts
In the News
Upcoming Meetings
For free articles, abstracts, Emergency Care Briefs, and more, visit our Resource Center at PetrackConsulting.com...
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Consultant's Corner Emory Petrack, MD, FAAP, FACEP As I teach residents and students in the emergency department, I find myself at times becoming increasingly concerned about the medical-legal risk faced by practitioners - a concern I plan to address in more detail in a future Spotlight on Emergency Care. We all know that risk is not entirely avoidable; sometimes we just can't move quickly enough to avoid that Mack truck coming down the pike. However, the vast majority of risk we do encounter is within our control. One example you might be familiar with - something I frequently see - is the failure to address abnormal vital signs. Two other familiar examples are sub-optimal communication with families and lack of complete documentation in charts. We owe it to ourselves, our families and our organizations to do better in these critically important areas.
Feature Article Why Toys Alone Don't Work for Distraction
Trauma season is in full bloom. Children everywhere are playing hard; they're also sustaining lacerations and fractures right and left. I discussed in a recent Spotlight the importance of appropriately addressing pain management, a key element of which is addressing pain and anxiety in children undergoing minor procedures, such as laceration repair or fracture reduction.
I've seen several emergency departments and urgent care centers try to address this by providing children with toys or books in the hopes of distracting them during the painful part of the procedure. While the use of toys, books or music has its place, such tools, by themselves, rarely lead to the desired result: a great experience for the child and family.
What we need to do to ensure that great experience is to reframe the scenario so that our use of distraction modalities takes place within the broader context of creating a positive experience surrounding the procedure. The other elements, beyond toys, required to create this experience include:
2. Prepare the child and family. Let them know exactly what to expect. Show them the suture material. Let them hear the clicking sound of the needle holder. Remind the child that although it won't hurt after the wound is anesthetized, he or she will feel some pressure or pulling on the skin. Ideally, there should be no surprises after the procedure actually starts.
3. Offer choices. Find out if the patient would prefer hearing music, reading a book, playing with a toy, talking with a family member or even watching TV. Offering choices helps a child to feel in control - a critically important step given that the need to do the procedure is not within the child's control.
4. Consider the best position for the procedure. Restraining a child with a papoose board should be the method of last resort. Restraint can be frequently avoided by offering positions that help the child feel more in control, such as sitting on the parent's lap, or even lying down with the parent.
5. Now, give the desired distraction as you start the procedure. With trust established, the child feeling more in control and appropriate positioning, the child and family are now set for a much better experience as the procedure begins.
In the News
Quote of the Month
New Articles/Abstracts
Brief summary of recent new articles and abstracts from http://www.PetrackConsulting.com/articles.html
Brousseau, D. C., Hoffmann, R. G., Nattinger, A. B., et al.
The relationship between access to primary care and emergency department utilization remains controversial. This study sought to determine if parent-reported, high quality primary care was associated with decreased pediatric nonurgent emergency department utilization. The authors did a retrospective analysis of 8,823 children, using 2000-2002 data from the Medical Expenditure Panel Survey. They found that high quality family-centeredness was associated with a 42% reduction in nonurgent ED visits for publicly insured children and a 49% reduction for children ? 2 years old. Greater realized access was associated with a 44% reduction in nonurgent visits for children 3-11 years old, and a 56% reduction for children ? 12 years old. They conclude that parental perception of high quality care and realized access to primary care were associated with decreased nonurgent ED use for children.
Lack of health insurance is thought to be a major contributing factor to ED overcrowding in the U.S. Using the National Hospital Ambulatory Medical Care Survey for U.S. data, and the National Ambulatory Care Reporting System for Canadian data, this study compared all 2003 ED visits in the U.S. with those of Ontario, Canada. Health care in Canada is finance through a national health insurance program. There were no differences in the annual ED visit rate (both were 40 visits per 100 population). Other data were compared, with the conclusion that ED visit rates and patterns are similar in the U.S. and Ontario, Canada, and that differences in health insurance do not appear to impact overall utilization of emergency services.
Using case scenarios in a prospective, longitudinal study of emergency medicine residents at 5 programs, these authors sought to evaluate residents' evolution of defensive medicine and malpractice concern. 46 residents were evaluated during the course of their residency. Interns were found to enter programs with a "moderate" malpractice concern, which did not change significantly during the course of the residency. These concerns did not markedly impact their decisions to perform ED procedures.
Upcoming Meetings
Sept 26-29, 2007, Emergency Nurses Association, Annual Meeting, Salt Lake City, UT
Oct 8-11, 2007, American College of Emergency Physicians Scientific Assembly, Annual Meeting, Seattle, WA
Oct 26-27, 2007, Urgent Care Association of America, Fall Conference, Chicago, IL
Feb 28- March 2, 2008, Emergency Nurses Association, Leadership Conference, Honolulu, HI About Our Organization
Created in 2003, Petrack Consulting is dedicated to helping physician and hospital
leadership bring excellence to emergency services. We work collaboratively to
fully understand our client's needs, and then address programmatic initiatives
with measurable outcomes. Our unique background in emergency medicine, administrative
medicine, and organization development allows us to create uniquely effective solutions
for enhancing emergency services.
Website: http://www.PetrackConsulting.com |
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