Hospitals Use Different Approaches to Reduce ED Wait Times

From Nurse.com:

While delays in obtaining ED care have become common, hospitals are taking steps to speed throughput and improve services.

“We don’t want people waiting in our waiting rooms,” says Mary Jo Stark, RN, MS, CEN, emergency services nursing director at Peconic Bay Medical Center in Riverhead, N.Y. “It’s not good for patients. It’s not good for business. It’s a big patient dissatisfier, and it’s dangerous.”

The U.S. General Accountability Office reports that emergent patients — those who needed to be seen within 14 minutes — waited an average of 37 minutes for care in 2006. The Centers for Disease Control and Prevention National Center for Health Statistics indicates there were 199.2 million visits to hospital EDs that year, with demand growing steadily since 1996 at about 3.2% a year.

Hospitals have attacked the complex wait-time problem by establishing multidisciplinary teams and securing leadership support. Northern Westchester Hospital in Mount Kisco, N.Y., spent nine months reviewing and overhauling its processes. Holy Name Medical Center in Teaneck, N.J., also analyzed the entire process and fostered a culture change. Now everyone in the facility shares responsibility for throughput.

Feasibility of intra-arrest hypothermia induction: A novel nasopharyngeal approach achieves preferential brain cooling

From Resuscitation:

In patients with cardiopulmonary arrest, brain cooling may improve neurological outcome, especially if applied prior to or during early reperfusion. Thus it is important to develop feasible cooling methods for pre-hospital use. This study examines cerebral and compartmental thermokinetic properties of nasopharyngeal cooling during various blood flow states.

Results

Effective brain cooling was achieved in all groups with a median cerebral temperature decrease of −4.7°C for NF, −4.3°C for ZF and −3.4°C for LF after 60min. The initial brain cooling rate however was fastest in NF, followed by LF, and was slowest in ZF; the median brain temperature decrease from baseline after 15min of cooling was −2.48°C for NF, −0.12°C for ZF, and −0.93°C for LF, respectively. A median aortic temperature change of −2.76°C for NF, −0.97 for LF and +1.1°C for ZF after 60min indicated preferential brain cooling in all groups.

Conclusion

While nasopharyngeal cooling in swine is effective at producing preferential cerebral hypothermia in various blood flow states, initial brain cooling is most efficient with normal circulation.