altThe CDC reports that 123.8 million patients visited an emergency department last year. That’s 41.4 visits per 100 population. That number has risen every year despite numerous, concerted efforts by the government and the insurance industry to stem the rising tide. Could it be that patients see what the politicians and planners seem to be missing, that the model of emergency care by qualified specialists, when and only when you need it, is a good model for health care delivery?

altImagine you are the CEO of St. Elsewhere Hospital, which is a suburban hospital with a 35,000 yearly visit emergency department (ED). The ED is a mess: average door-to-doctor times of 110 minutes, a left-without-being seen (LWBS) rate of 7%, and poor Press Ganey scores. Most everyone in the hospital, including the patients, refer to it as “That ER.”

An emergency physician recently contacted me to tell me a story. It all started when her local hospital emergency department received notice that they were on an award list published by a well-known health care grading company. “Terrific!” she said.

A patient is suffering from two life threatening events. Treatment for one condition may exacerbate the other condition. The standard of care is based upon a “reasonable person” standard, so I asked my friend what a reasonable doctor would do in the same or similar circumstances. He wasn’t sure.

Many EMS providers use devices like the King Laryngeal Tube or Sheridan Combitube as primary or rescue airways (if tracheal intubation fails). The pharyngeal balloons on the King LT or Combitube make them very secure to dislodgement. They are also blindly inserted and require relatively little training.

Each year at the Scientific Assembly of the American College of Emergency Physicians over 300 Council members convene to consider, debate, and vote on a slate of resolutions put forth from the membership through their various state chapters. Many members of ACEP – even after years of membership – know little of these resolutions.

Building a team is one of the most important components of a medical director’s job, and it starts with finding the right people. Many factors come into play in this process, but in many ways it starts with timing.

Dr. Adam Levine, an assistant professor at Brown University Medical School, traveled to Libya with International Medical Corps (IMC) during August, just as rebels were beginning to overthrow the Gaddafi regime. The following are excerpts from his travel blog, which first appeared on www.epijournal.com .

Pain is the most common symptom prompting one to seek emergency care. Over the past two decades numerous studies have addressed the inadequacy of pain management provided by the medical community. In 2005, approximately 10 million Americans were being treated on long term opioid therapy for non cancer related pain.

I’m a believer that if an adult patient presents to the ED with chest pain, unless you are very, very positive the diagnosis is not cardiac, you owe it to the patient to pursue a cardiac work-up. Sounds pretty straight forward to me – but many would disagree.

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