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 Winter, 2009 Volume 7, Issue 1
New: Dr. Petrack quoted in recent Business Network article on appreciative inquiry in emergency medicine.
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
I am struck by two major experiences over the past month, one personal, one global, both with a similar lesson to teach us.
The personal: I found myself one Thursday evening with sudden flank pain and vomiting. Given my history of kidney stones, I knew what was happening. And I was a bit panicked about my upcoming clinical shifts Friday, Saturday and Sunday.
I ended up in the ED as a patient Friday…an interesting experience in itself. Given how sure I was that the pain stemmed from another stone, the ED physician did a cursory exam, not even putting his hands on my abdomen. After pain meds and IV fluids, home I went. I then dutifully worked my weekend shifts, feeling fair to good, but knowing all was not well.
Monday night, I doubled over in sudden pain that made the kidney stone seem mild. It was a ruptured retrocecal appendix-nothing laproscopic surgery, IV antibiotics and a couple days in the hospital couldn't mend.
Personal aside, we turn now to the global: the abrupt, unexpected financial crisis that is on all of our minds. It seems that, suddenly, potentially millions of homes are in jeopardy of foreclosure. Major businesses are tanking. The stock market is plummeting.
Both of these appeared to be sudden, unexpected events. Or were they? This issue's featured article explores the nature of the unexpected-and what we can do to minimize our chances of being taken by surprise.
Feature Article
Is There More than Coffee Brewing at your Institution?
The reality is that while some events are sudden and unexpected, many supposedly unanticipated problems appear on the radar screen well before an actual crisis or adverse event occurs. However, if we are not "tuned in" to these possibilities - if we're not looking at the edges of the radar screen - we may not realize what's happening until it's too late.
The challenge is to be constantly vigilant for issues and problems that lurk around the edges of ongoing, normal operations. Here are some suggestions for staying on guard and attentive:
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
Chisholm, C. D., Weaver, C. S., Whenmouth, L. F. et al.
ED leadership constantly struggles with how to best implement the JCAHO requirement that patients receive appropriate assessment of their pain. This study looked at the discrepancy between actual observed physician pain assessment and what is documented in the chart for patients older than 5 years. 209 patient encounters were observed. Physicians acknowledged the patients' pain in 98.1% of the time, but documented its presence in 91.7%. Physicians attempted to quantify the patient's pain in 61.5% of encounters, but documented that attempt in only 38.9%. Similarly, treatment was offered in 79.9%, but only recorded in 31.7% of charts. Response to therapy was recorded only 28% of the time. The authors conclude that the chart is a poor surrogate marker for pain assessment and care by the physician. There is an accompanying editorial entitled "The Chart is Dead- Long Live the Chart."
Workplace violence in emergency departments is becoming a major issue for staff in many institutions. These authors collected data from 69 U.S. EDs, ultimately analyzing 3,518 surveys from 65 sites. Over a 5 year period, a median of 11 attacks per ED was reported. Key informants at 20% of EDs reported that guns or knives were brought to the ED on a daily or weekly basis. Nurses were less likely to feel safe when compared to other surveyed staff. This is clearly a major issue for staff in our nation's emergency departments.
These authors studied the relationship between two major concerns for ED leadership: overcrowding and pain management. They retrospectively studied a total of 1,068 visits at an academic, tertiary care ED in 2005. They found that fewer patients received analgesics during periods of high census, with a direct correlation between total ED census and increased time to pain assessment, time to analgesic medication ordering and time to medication administration. They conclude that ED crowding negatively impacts patient care in the area of pain management.
Upcoming Meetings
March 4-9, 2009, Emergency Nurses Association, Leadership Conference, Reno, NV 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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