As the director of a single-coverage community ED with about 22,000 visits a year and about 20% admissions, I’ve been fortunate to be left alone by the administration. The nursing director and I – along with a team of scribes, advance practice clinicians and staff, have largely been free to do whatever we could to improve throughput in the ED.

What some call “the art of medicine” I call an unacceptable level of physician practice variability. Electronic medical records now allow us to compare apples to apples and begin bringing over- and under-utilizers in line with the evidence.    

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Can emergency physicians identify tests and procedures whose necessity should be questioned? In light of high-radiation, low-yield tests, we can – indeed we are obligated – to do more than that.

This is the third in a series of columns dealing with non-allergic, potentially serious reactions caused by antibiotics. In the column dealing with macrolides, the increased risk of sudden death was noted. Clearly, the absolute numbers of deaths associated with macrolides has to be small, but it makes sense to take this fact into consideration when prescribing these antibiotics to those prone to arrhythmias (such as patients with congestive heart failure).

Did you know that the macrolide group of antibiotics (erythromycin and all its cousins) could kill you? Drop dead – sudden death. Well there is a growing body of literature saying just that.

Emergency physicians need to lead the charge on halting unnecessary urinary catheterizations, for the sake of patient safety and the bottom line.

I often get asked to give presentations on what I think are the most important articles of the year. Clearly, one’s perspective regarding what is important varies from individual to individual, however, I tend to gravitate to articles that look at systems issues and those that I think can have a major impact on how we practice clinically.

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.

I think that I have made my view of electronic health records very clear to anyone who’s cared to listen. I think they are great for monitoring the movement of patients in larger EDs (electronic tracking boards). I have concerns that CPOE (computerized provider order entry) through the use of order sets has the potential to result in over-ordering (and will result in higher bills, unnecessary tests and less thought by providers).

Several years ago, during the last Joint Commission survey of our hospital lab, we got dinged because we failed to routinely do a strep culture whenever a “quickie” strep screening test was negative. And we weren’t alone; I’ve heard from a colleague whose hospital got their wrist slapped for the same thing.