Save Lives Now: Five Ways to Improve Patient Safety in the ED

From Hospitals & Health Networks Magazine, part of their Save Lives Now series.

Save Lives Now: Five Ways to Improve Patient Safety in the ED

Hospital emergency departments are the theater of valiant American medicine. Every day, approximately 300,000 patients visit EDs across the country, with conditions ranging from a twisted ankle to severe trauma. The overwhelming majority of these patients are treated quickly, efficiently and successfully. Physicians, nurses and others who staff EDs routinely perform lifesaving care under apparently chaotic, unpredictable conditions, and for this they are often considered heroes.

Yet the same conditions that confer special status on emergency medicine also make it dangerous. “Anything can come in the door at any time,” says Charles Pattavina, M.D., an emergency physician in Worcester, Mass. Decisions have to be made and executed quickly, without time for reflection or even, in many instances, consultation with a patient’s medical record. Consequently, the ED is also home to a high number of medical errors, including many that lead to permanent injury or death—and many of which can be avoided.

Newsweek Article on Resuscitation

Published in this week’s Newsweek:

To Treat the Dead: The new science of resuscitation is changing the way doctors think about heart attacks—and death itself.

Consider someone who has just died of a heart attack. His organs are intact, he hasn’t lost blood. All that’s happened is his heart has stopped beating—the definition of “clinical death”—and his brain has shut down to conserve oxygen. But what has actually died?

Quality Improvement in the ED

A link to an interesting article from Hospitals and Health Networks magazine, “Save lives now: Five ways to improve patient safety in the ED

Another link, to the Institute for Healthcare Improvement’s Operational and Clinical Improvement in the Emergency Department resource page

EM Blogs, in the News

One of our favorite bloggers, GruntDoc, was mentioned in the Annals of Emergency Medicine.

Here are his comments about this honor.

Here’s a link to the article and an excerpt:

Dr. Allen Roberts, an attending emergency physician at Harris Methodist Fort Worth Hospital, had a problem. He’d just raised the ire of the nurses who work with him – and many who don’t—by posting a provocative entry to his popular GruntDoc blog ( titled “The Lifesaving Foley.”

In August of last year, he decided to write about “a peculiar phenomenon” he’d recently noticed with his nursing colleagues. “I’ll be in the middle of a code, look around and see a nurse studiously inserting a catheter into the patient,” he wrote. Then, he added, “We’ll be getting ready to intubate an agitated patient; I look and see the nurse is busy intubating Mr. Johnson.” And then Roberts took a jab he later regretted:

“I have no idea why. Really, I think they’re stressed out, and want to ‘Do Something.’ They see a task they’re comfortable doing, and so they do it. Indication or not, right time or not, utility or not. I’ve taken to calling it The Lifesaving Foley, for obvious reasons, though I don’t think it’s saved a life yet.”

Oops. Comments from, shall we say, moderately peeved nurses came fast and furious to the GruntDoc blog. A week later he posted a mea culpa entry to the blog titled “Some Nurse Love,” and listed a number of reasons why he appreciated nurses.

“I try not to write anything on the blog that I wouldn’t want to see on the front page of the newspaper,” Roberts said. “But in that case I don’t think the nurses were amused.”

Crocs Cause Medical Machinery Malfunctions?

From Medgadget:

Blekinge hospital in southern Sweden suspects the slip-on shoes, made by US firm Crocs Inc, are to blame for at least three incidents in which respirators and other machines malfunctioned. The mishaps caused no injuries.
Hospital spokesman Bjorn Lofqvist said staff wearing the clogs could turn into “a cloud of lighting” because of the static electricity.

Use Criteria to Manage Febrile Infants in the ED Without Antibiotics

From ACEP:

Screening criteria can predict which febrile infants presenting to an emergency department will not have serious bacterial infections and can be safely discharged home without antibiotics. This conclusion was drawn from a retrospective analysis reported by Dr. Taj Madiwale and colleagues at the southern regional meeting of the American Federation for Medical Research.

The study included 552 infants, aged 29-60 days, who presented to a tertiary care children’s hospital ED between January 2001 and December 2004 with a chief complaint of fever. A fever, defined as 100.4° F or higher rectally, was present in 434 infants.

The inclusion criteria for absence of serious bacterial infection were based on previous research and included the following:
• Well appearance.
• CBC white-cell count of 5,000-20,000/mm3 with a band/neutrophil ratio of less than 0.2.
• Urine specimen with no more than 10 white cells per high power field, and negative for leukocyte esterase and nitrate.
• Cerebrospinal fluid with a white-cell count of less than 10/mm3, a negative gram stain, a glucose level greater than 40 mg/dL, and protein less than 120 mg/dL.

Exclusion criteria were:
• Ill appearance.
• Previous surgery, except circumcision.
• History of antibiotics.
• Immune deficiency syndromes.
• Signs of bacterial infection.

Also on the list of exclusion criteria was previous vaccination, other than hepatitis B, as this could cause a transient fever, said Dr. Madiwale, a pediatric emergency medicine fellow with the Children’s Hospital of Alabama at Birmingham.

Quick, Cheap & Easy Bedside Diagnosis of Brain Injury

From Medgadget:

Infrascanner™ is a hand-held, non-invasive, near-infrared (NIR) based mobile imaging device to detect brain hematoma at the site of injury within the “golden hour”. This refers to the period following head trauma when pre-hospital analysis is needed to rapidly assess the neurological condition of a victim. Pending FDA clearance, the Infrascanner™ will be an affordable, accurate and clinically effective screening solution for head trauma patients in settings where timely triage is critical. It is intended to aid the decision to proceed with other tests such as head Computed Tomography (CT) scans. In environments where access to CT scan is restricted or not available, Infrascanner™ will facilitate surgical intervention decisions.