DiversityNursing Blog

ER Visits on the Rise, Study Reports

Posted by Erica Bettencourt

Wed, Nov 26, 2014 @ 11:49 AM

By Robert Preidt

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The number of emergency department visits in the United States rose from about 130 million in 2010 to a record 136 million in 2011, according to the U.S. Centers for Disease Control and Prevention.

The findings also showed that fewer people were going to ERs with non-urgent medical needs: 96 percent of patients were identified as needing medical care within two hours of arriving at the ER. In 2010, that number was 92 percent, according to the research.

Sixty percent of patients arrived at the ER after normal business hours (after 5 p.m. on weekdays). One-third of visits were for patients on either end of the age spectrum -- younger than 15 or older than 65, the researchers found.

Almost 30 percent of visits were for injuries. The highest injury rates were among patients 75 and older, the study noted.

"The report also finds that there are large numbers of admitted patients who wait long times for inpatient beds," Dr. Michael Gerardi, president of the American College of Emergency Physicians (ACEP), said in an ACEP news release.

"Nearly two-thirds of patients waited two or more hours for beds in 2011, and nearly three-quarters of hospitals continued to board patients, even when the emergency department was critically overloaded. Hospitals must move admitted patients out of the emergency department faster to make room for the increasing number of people coming," he said.

It's believed that there will be about 140 million ER visits in 2014, according to the ACEP.

"The growth in patient demand aligns with what emergency physicians have been seeing and predicting: demand is going to increase," Gerardi said.

"Given that our nation's population is aging, and emergency departments have a critical role as the front line of responding to disasters and infectious disease outbreaks in America, such as what we saw with Ebola, we need to prepare for increased numbers of patients," he added.

Despite increasing use of ERs, most hospitals had not expanded their ERs as of 2011 and had no plans to expand them in the following two years, according to Gerardi.

"Emergency departments are essential to every community and must have adequate resources," he said. "They continue to be under severe stress and face soaring demands, despite the efficiency of caring for more than 136 million of the sickest patients each year using only 4 percent of the nation's health care dollar. This report is more evidence that we are going to need more resources, not less, in the future."

Source: www.nlm.nih.gov

Topics: ER, emergency room, studies, health, healthcare, nurses, health care, medical, physicians, hospitals

Emergency department nurses aren't like the rest of us

Posted by Erica Bettencourt

Mon, Aug 25, 2014 @ 01:40 PM

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Emergency department nurses aren't like the rest of us - they are more extroverted, agreeable and open - attributes that make them successful in the demanding, fast-paced and often stressful environment of an emergency department, according to a new study by University of Sydney.

"Emergency nurses are a special breed," says Belinda Kennedy from Sydney Nursing School, a 15 year critical care veteran who led the study.

"Despite numerous studies about personalities of nurses in general, there has been little research done on the personalities of nurses in clinical specialty areas.

"My years working as a critical care nurse has made me aware of the difficulty in retaining emergency nurses and I have observed apparent differences in personality among these specialty groups. This prompted me to undertake this research which is the first on this topic in more than 20 years.

"We found that emergency nurses demonstrated significantly higher levels of openness to experience, agreeableness, and extroversion personality domains compared to the normal population.

"Emergency departments (ED) are a highly stressful environment - busy, noisy, and with high patient turnover. It is the entry point for approximately 40 per cent of all hospital admissions, and the frequency and type of presentations is unpredictable.

"Emergency nurses must have the capacity to care for the full spectrum of physical, psychological and social health problems within their community.

"They must also able to develop a rapport with individuals from all age groups and socioeconomic and cultural backgrounds, in time-critical situations and often at a time when these individuals are at their most vulnerable.

"For these reasons, ED staff experience high levels of stress and emotional exhaustion, so it's understandable that it takes a certain personality type to function in this working environment.

"Our research findings have potential implications for workforce recruitment and retention in emergency nursing.

"With ever-increasing demands on emergency services it is necessary to consider how to enhance the recruitment and retention of emergency nurses in public hospitals. Assessment of personality and knowledge of its influence on specialty selection may assist in improving this.

"The retention of emergency nurses not only has potential economic advantages, but also a likely positive impact on patient care and outcomes, as well as improved morale among the nursing workforce," she said.

Since this article is from Aulstralia, do you agree that Emergency Room Nurses in the US should have the same characteristics to be successful in a US Emergency Room?

Source: http://sydney.edu.au

Topics: US, ER, emergency, nursing, nurses, Aulstralia

With ERs, the Busier, the Better, Study Finds

Posted by Erica Bettencourt

Mon, Jul 21, 2014 @ 01:09 PM

By Robert Preidt

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Surviving a life-threatening illness or injury may be more likely if you're treated at a busy emergency department instead of one that handles fewer patients, a new study finds.

Researchers analyzed data on 17.5 million emergency patients treated at nearly 3,000 hospitals across the United States. The overall risk of death in the hospital was 10 percent lower among those who initially went to the busiest emergency departments rather than to the least busy ones, the study found.

"It's too early to say that based on these results, patients and first responders should change their decision about which hospital to choose in an emergency," said the study's lead author, Dr. Keith Kocher, an assistant professor of emergency medicine at the University of Michigan Medical School.

"But the bottom line is that emergency departments and hospitals perform differently, there really are differences in care and they matter," he added.

The survival difference was even greater for patients with serious, time-sensitive conditions. Death rates were 26 percent lower for sepsis patients and 22 percent lower for lung failure patients who went to the busiest emergency departments, compared to those who went to the least busy ones.

Heart attack patients were also more likely to survive if they went to the busiest emergency departments, according to the study published July 17 in the journal Annals of Emergency Medicine.

If all emergency patients received the kind of care provided at the busiest emergency departments, 24,000 fewer patients would die each year, the researchers said.

The finding held even when the researchers accounted for differences in the patients' health, income level, hospital location and technology, they said.

But the study wasn't designed to look into the reasons for the finding; it only found an association between better survival rates and busier ERs.

"The take-home message for patients is that you should still call 911 or seek the closest emergency care, because you don't know exactly what you're experiencing. What makes one hospital better than another is still a black box, and emergency medicine is still in its infancy in terms of figuring that out," Kocher said in a university news release.

"For those who study and want to improve emergency care and post-emergency care, we hope these findings will inform the way we identify conditions in the pre-hospital setting, where we send patients, and what we do once they arrive at the emergency department and we admit them to an inpatient bed," he added.

Source: http://www.medicinenet.com

Topics: study, researchers, ER, survival rates, busy, patients

Hospitals Put Pharmacists In The ER To Cut Medication Errors

Posted by Erica Bettencourt

Mon, Jun 09, 2014 @ 01:11 PM

By LAUREN SILVERMAN

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In the emergency department at Children's Medical Center in Dallas, pharmacists who specialize in emergency medicine review each medication to make sure it's the right one in the right dose.

It's part of the hospital's efforts to cut down on medication errors and dangerous drug interactions, which contribute to more than 7,000 deaths across the country each year.

Medication errors can be caused by something as simple as bad handwriting, confusion between drugs with similar names, poor packaging design or confusion between metric or other dosing units, according to the Food and Drug Administration. But they're often due to a combination of factors, which makes them harder to prevent.

At Children's in Dallas, there are 10 full-time emergency pharmacists, more than anywhere else in the country, and they are on call 24 hours a day. The pharmacists provide a vital safety net, according to Dr. Rustin Morse, chief quality officer and a pediatric ER physician.

"Every single order I put in," Morse says, "is reviewed in real time by a pharmacist in the emergency department prior to dispensing and administering the medication."

That may sound obvious, but Morse says doctors like him, are used to jotting down a type and quantity of drugs and moving on. If there's a problem, a pharmacist will hopefully catch it and get in touch later. But later won't work in the emergency room.

The extra review is particularly important at Children's because medication errors are three times more likely to occur with children than with adults. That's because kids are not "just little adults," says Dr. Brenda Darling, the clinical pharmacy manager for Children's Medical Center.

"They have completely different metabolic rates that you have to look at," Darling says, "so you have to know your patients."

On any given week, pharmacists at Children's review nearly 20,000 prescriptions and medication orders, looking at things like the child's weight, allergies, medications and health insurance.

There are also automatic reviews by an electronic medical record system designed to essentially "spell check" orders to prevent errors. You need both, says Dr. James Svenson, associate professor of emergency medicine at the University of Wisconsin, because the electronic medical record doesn't catch all errors.

Svenson co-authored a study in the Annals of Emergency Medicine that found that even with an electronic medical record, 25 percent of children's prescriptions had errors, as did 10 percent of adults'. Now his hospital also has a pharmacist in the emergency department 24 hours a day.

So why doesn't every hospital do this? The main reason, Svenson says, is money.

"If you're in a small ER, it's hard enough just to have adequate staffing for your patients in terms of nursing and techs, let alone to have a pharmacist sitting down. If the volume isn't there, it's hard to justify."

Hiring pharmacists is expensive, but Morse points to research showing prescription review can reduce the number of hospital readmissions, thereby saving money and lives.

"People do make mistakes," Morse says, and you need to make sure "a patient doesn't get a drug that could potentially stop them breathing because it's the wrong dose."

Source: npr.org

Topics: study, ER, health, hospitals, pharmacists

Boston Nurses tell of bloody marathon aftermath

Posted by Alycia Sullivan

Fri, Apr 26, 2013 @ 03:29 PM

BOSTON (AP) — The screams and cries of bloody marathon bombing victims still haunt the
describe the imagenurses who treated them one week ago. They did their jobs as they were trained to do, putting their own fears in a box during their 12-hour shifts so they could better comfort their patients.

Only now are these nurses beginning to come to grips with what they endured — and are still enduring as they continue to care for survivors. They are angry, sad and tired.  A few confess they would have trouble caring for the surviving suspect, 19-year-old Dzhokhar Tsarnaev, if he were at their hospital and they were assigned his room.

And they are thankful. They tick off the list of their hospital colleagues for praise: from the security officers who guarded the doors to the ER crews who mopped up trails of blood. The doctors and — especially — the other nurses.

Nurses from Massachusetts General Hospital, which treated 22 of the 187 victims the first day, candidly recounted their experiences in interviews with The Associated Press. Here are their memories:

THEY WERE SCREAMING

Megann Prevatt, ER nurse: "These patients were terrified. They were screaming. They were crying ... We had to fight back our own fears, hold their hands as we were wrapping their legs, hold their hands while we were putting IVs in and starting blood on them, just try to reassure them: 'We don't know what happened, but you're here. You're safe with us.' ... I didn't know if there were going to be more bombs exploding. I didn't know how many patients we'd be getting. All these thoughts are racing through your mind."

SHRAPNEL, NAILS

Adam Barrett, ICU nurse, shared the patient bedside with investigators searching for clues that might break the case. "It was kind of hard to hear somebody say, 'Don't wash that wound. You might wash evidence away.'" Barrett cleaned shrapnel and nails from the wounds of some victims, side by side with law enforcement investigators who wanted to examine wounds for blast patterns. The investigator's request took him aback at first. "I wasn't stopping to think, 'What could be in this wound that could give him a lead?'"

THEIR FACES, THEIR SMILES

Jean Acquadra, ICU nurse, keeps herself going by thinking of her patients' progress. "The strength is seeing their faces, their smiles, knowing they're getting better. They may have lost a limb, but they're ready to go on with their lives. They want to live. I don't know how they have the strength, but that's my reward: Knowing they're getting better."

She is angry and doesn't think she could take care of Tsarnaev, who is a patient at another hospital, Beth Israel Deaconess Medical Center: "I don't have any words for him."

THE NEED FOR JUSTICE

Christie Majocha, ICU nurse: "Even going home, I didn't get away from it," Majocha said. She is a resident of Watertown, the community paralyzed Friday by the search for the surviving suspect. She helped save the lives of maimed bombing victims on Monday. By week's end, she saw the terror come to her own neighborhood. The manhunt, she felt, was a search for justice, and was being carried out directly for the good of her patients.

"I knew these faces (of the victims). I knew what their families looked like. I saw their tears," she said. "I know those families who are so desperate to see this end."

On Friday night, she joined the throngs cheering the police officers and FBI agents, celebrating late into the night even though she had to return to the hospital at 7 a.m. the next day.

Source: Times Union

Topics: ER, tragedy, comfort, nurse, patients, Boston Marathon

ER on wheels: Mobile center opens doors to patients after Sandy

Posted by Alycia Sullivan

Wed, Nov 07, 2012 @ 02:21 PM

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By 

In anticipation of a forecasted Nor’easter – expected to usher in rain, snow and high winds to states already struggling to pick themselves up in the wake of superstorm Sandy – a mobile emergency department is bringing much-needed help to local hospitals.

Hosted by Hackensack University Medical Center, in Hackensack, N.J., the New Jersey Mobile Satellite Department has been deployed twice already in the past week-and-a-half at the request of the state health department.  

The mobile ER is made up of 15 trucks, including three large ones used as treatment areas.  There are also special trucks to produce oxygen and interconnect the vehicles. The trucks are ‘full-service’ ERs with monitor beds, ultrasound capabilities, pharmaceutical reservoirs and an entire support team of doctors, nurses and technicians.  In a 24-hour period, the service – including equipment, personnel and supplies – costs approximately $15,000.

“On the outside, they look like box trucks,” Dr. Joseph Feldman, the chairman of emergency services at Hackensack told FoxNews.com. “But from the inside, you would never know you were in a truck.  You would think you were in a state-of-the-art emergency department.”

According to Feldman, the 43-feet long trucks were designed as a prototype five years ago, funded by the Department of Defense to be designed and built as the hospital saw fit.  

“They can be rapidly deployed within an hour of driving to a place,” he said.  “We designed them in a way so they can be maneuvered in urban and suburban areas and set up [quickly].”

The first time the mobile ER was deployed this year, it was to New Jersey’s Somerset County, the Sunday before Sandy made landfall.  In 2011, the county was flooded by Hurricane Irene, and medical personnel were unable to move in and out of the area.

“We were requested to pre-deploy to that area, so we saw a bunch of patients there – we even delivered a premature baby,” Feldman said.

The mother, he explained, had had a ‘harrowing’ experience arriving at the site.  

“The initial ambulance go stuck in the mud, so they had to transfer her to a police vehicle, and then another ambulance [brought her to the site],” Feldman said.  “Because of high winds, we took the equipment to a church hall and did an ultrasound…We were able to deliver her in a very safe environment, and it was a healthy baby boy just over five pounds.”

The mobile ER was then re-deployed later in the week to Brick, N.J., to support Ocean Medical Center and three other hospitals in the area.  As of Monday, the mobile site had seen more than 150 patients, alleviating the burden of nearby emergency departments experiencing a massive surge in patients.

Dr. Doug Finefrock, the vice chairman of Hackensack’s emergency department said he was able to take care of a young women who had waited 10 hours at a local ER and couldn’t be seen.  

The woman, who was pregnant, was suffering from abdominal pains and was worried she was suffering a miscarriage.  She hadn't yet seen an OB-GYN, so Finefrock did an ultrasound and was able to determine the pregnancy was fine and show her the baby's heartbeat for the first time.

The mobile operation was supposed to end Tuesday, Feldman explained; but due to an incoming Nor’easter, the state’s DOH has requested the hospital keep its assets in place and monitor the situation through Thursday.  According to Feldman, the trucks, which can run on generators or landlines, can be set up indefinitely.

Due to the utility of the mobile ER in the aftermath of Sandy, Feldman said “we’ve gotten a lot of interest around the country, inquiring about our assets and how they work, not only from medical centers but other government agencies…On a good day, ER rooms are congested and crowded; add a disaster on top, and it’s much worse. These vehicles, along with a tent hospital, allow communities to expand emergency service and provide needed health care to citizens.”

Topics: hurricane sandy, ER, nor'easter, New Jersey

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