Triage Protocols In Pros And Cons

The emergency department (ED) I worked for was a Level I Trauma Center, so patients were transferred by ambulances, most of whom were in very severe conditions, such as cardio-pulmonary arrest, unconsciousness and multiple trauma. There was no room for patients to choose a hospital. Roughly a third of patients coming to the emergency room (ER) died unfortunately. The other third admitted to the intentional care unit (ICU), and the remains stayed at other wards in the hospital or went back their home in a few days. In the ICU, the patients were laid on the beds that were lined toward walls and separated on the side from their next patients with only roll curtains hanging from the ceiling. Hence, they can

The RUC will be able to provide treatment to patients suffering from non-life threatening conditions and the most common illness, including pneumonia and flu, fevers, upper respiratory infections, sprains and strains, lacerations, contusion, and also necessary screening test, such as High Blood Pressure, mammogram, diabetes. Since the late 1980s and early 1990s, hospitals have looked to facilities such as RUCs as a means to reduce rate of inappropriate ED utilizations by triaging patients to less acute settings. The ED is not the most appropriate care setting for many patients, such as elderly patients and young children. Non-urgent patients account for well over 10 percent of the average ED’s caseload, and semi-urgent cases account for another

Professionalism in nursing has advanced greatly over the years. A cornerstone for change includes that of evidence based practice (EBP) as the drive of nursing intervention and patient care. According to the Quality and Safety Education for Nurses (QSEN), Evidence-based practice is described as the combination of the most recent evidence with clinical knowledge that includes the patient’s best interests in mind for greater patient outcomes (QSEN, 2017). The QSEN’s goal is to prepare nurses for improvement in quality and safety of patients (2017). Because of this goal, six competencies, including evidence-based practice, are listed for criteria of improvement in nursing practice (2017). I have been fortunate to have experience with implementing this practice and providing education in certain EBP protocols in my career. One EBP protocol in particular that our unit has been involved in since May of this year includes Enhanced Recovery After Surgery (ERAS) now referred to as Improving Surgical Care and Recovery (ISCR).

for the resident who sustain the injury and the Interprofessional team involved, to progress the injury

The RRT intervenes before a crisis, which the Code 100 will be to activate the RRT, as a result lives are saved and adverse events are prevented. Data collection from the initiative has proven to be a beneficial tool; it has decreased code blue calls and has produced positive outcomes (Rankins, 2006). The IHI initiative included clinicians in collaboration with hospital and nurse leads to implement best practice protocols to prevent unnecessary deaths. The RRT deployed at first sign of patient decline does save lives (Richard, 2005).

The Utilization Management and Care Coordination teams will be trained in small group sessions using oral presentations supplemented with handouts. The training will include demonstration of how to complete the LACE index and apply the risk stratification through the use of a patient case file review. The case file demonstration assists in establishing inter-rater reliability needs for consistent application of medical management decision making (McQuillan, 2001). Upon the completion of training the teams will be asked to complete a short training survey to assist in the measurement of change in behaviors associated with the training (APPENDIX G). The survey will ask the team to rate the effectiveness of the training based on a five point Likert scale rating from strongly agree to strongly disagree. The questions will

Imagine the following scenario: A 43 year old male and his 41 year old wife have just finished celebrating their twentieth wedding anniversary at a local restaurant. The husband had a cocktail at the bar while waiting for the table, and then had a couple of glasses of wine with dinner. After dinner, the happy couple drive their vehicle home on a snow covered highway. The car begins to swerve on the ice and enters oncoming traffic and hits a semi cab head-on. After an extended extraction of the driver by paramedics, the driver is found to be unconscious, has multiple head lacerations, chest contusions from the steering wheel, and his left leg is bleeding profusely from a compound femur fracture. The female is conscious, in shock, and states that she is 36 weeks pregnant and has pain in her abdomen. Both victims are flown via helicopter to the nearest level 2 trauma center where 2 teams of emergency room doctors, trauma surgeons, respiratory therapists, x-ray technologists, phlebotomists, chaplains, social workers, and of course, trauma nurses, are waiting to assess the patients and provide life-saving care. This scenario is not the exception in a level 2 trauma care center of the emergency-room, it is the average situation that a trauma nurse will find his or herself in every day. Because of the fast paced situations that require split-second critical decisions, the advanced life support training that is required, and the often unrewarded care, a career in trauma

The clinical element of emergency medical training can be considered one of the most important components prior to certification. This is where the students get their first real look at occurrences they may experience in the field. I decided to review an article “Clinical Rounds” written by Matt Vandzura, found on EMS World website, pertaining to such clinical rotations.

The group went back and forth on Registry FTEs. The comment that resonated the most is that not all trauma volumes are the same, that 1,400 annual visits could be done by one or three FTEs, depending on the complexity of the cases. ADHS is going to draft alternative language that gives flexibility, something along the lines of “sufficient resources to comply with ADHS requirements.”

In 2000, the Department of Health(DH), set a range of emergency care access targets in its NHS plan, and in 2001 the government published Reforming emergency care   (DH, 2001) which established waiting time targets for all UK emergency care patient contacts;. The new standard was introduced into the NHS in England in 2002; stating that 98% of patients presenting to ED’s would be seen, treated, admitted or discharged within four hours of arrival by 2004, no one was to wait more than four hours in an ED (from arrival to admission to a bed, transfer elsewhere or discharge). Whilst the author agrees that it has improved the overall for the patient’s experience within the ED. It must be borne in mind that before the decision ‘to come into’ hospital (TCI), that the patient receives the correct clinical decisions prior to TCI.

Avoidable emergency department (ED) encounters places a significant burden on the health care system. Seniors 65 years or older have the highest rate of hospital encounters of any other age group (Bulut, Yazici, Demircan, Keles & Demir, 2015). The Center for Medicare and Medicaid (CMS) have placed stiff penalties on hospitals that are not able to reduce repeat encounters (“Coordinating better care & lowering costs”, 2017). These penalties result in the loss of guaranteed funding if the hospitals are not able to reduce readmission rates. Therefore, hospitals are seeking solutions to solving this challenge (“Coordinating better care & lowering costs”, 2017). Care transition teams are in place to help mitigate repeat encounters,

The article critiqued is titled Outcomes and Challenges in Implementing Hourly Rounds to Reduce Fallings Orthopedic Units,” and it was written by Tucker S.J., Bieber P.L., Attlesey-Pries J.M., Olson M.E., Dierkhising R.A., 2012. The article began with an abstract that was accurate, concise, and easily comprehensible. The abstract of this article summarized the purpose, aim, method, result, and conclusion of the study. The study was conducted on a two-29 beds post-operative orthopedic unit in a large academic medical center in the Midwest of united states. The study was designed to be implemented at three-point baseline,12 weeks of implementation and one year of follow up of implementation of Structured Nursing Round Interventions (SNRIs)

Sacred Heart Medical Center at RiverBend (SHRB) is a 388 bed regional medical center with a level II Trauma designation, located in Springfield, Oregon. The emergency department (ED) consists of 42 beds with four designated trauma resuscitation bays. In 2014 the ED volume was approximately 58,000 patients, of which an average of 70% were ambulatory and non-ambulance access. Emergency department overcrowding has been identified as a national issue and it is effecting SHRB ED. Emergency department congestion effects patient arrival to provider time and this delay has been associated with suboptimal patient outcomes. Emergency departments must address patient length of stay and throughput for a multitude of reasons; the most acute concern being patient safety.

Tang N, Stein J, Hsia RY et al: Trends and characteristics and US emergency department visits, 1997 – 2007.  JAMA 2010; 304: 664-670

APRNs educational preparation has a proven track record to be successful when it comes to patient teaching. They possess all the needed tools that could have the greatest impact on improving patient satisfaction, improving communication, being cost effective, decreasing knowledge deficits, decreasing emergency room visits and potential hospital readmissions (Gaines-Dillard, 2015). The use of telephone follow up (TFU), a form of telemedicine was used in trauma patients to attempt to improve the percent of patients’ satisfaction. The APRN would follow up with the patient after discharge. This was a tool