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Big Dividends for an After-Hours Clinic Model

Using an after-hours clinic (AHC) that was off-site from a children’s hospital ED appears to significantly reduce length of stay (LOS) and charges. In a retrospective analysis, researchers found that the average LOS was 81.2 minutes shorter and average charges were $236.20 less for AHC-treated patients when compared with patients treated in a pediatric ED. The researchers reported that this approach may be an effective model to help address ED overcrowding and promote patient safety. Abstract: Pediatric Emergency Care, November...

Interpreters in the ED: A Look at Errors & Consequences

According to recent United States Census estimates, more than 25 million Americans have limited English proficiency (LEP), and many of these individuals are school-age children. Language barriers affect multiple aspects of healthcare for LEP patients, including access to care, health status, use of health services, and patient safety. LEP patients often defer needed medical care, have higher risks of leaving hospitals against medical advice, and are less likely to have a regular healthcare provider. They’re also more likely to miss follow-up appointments and to be non-adherent with medications. “Medical interpreters are an essential component of effective communication between LEP patients and healthcare providers.” Federal policy requires that hospitals provide adequate language assistance to LEP patients. Medical interpreters are an essential component of effective communication between LEP patients and healthcare providers. Professional interpreters are hired specifically to provide language services to LEP patients, but all too often, language services are provided by ad hoc interpreters. These individuals—who range from family members and friends to hospital/clinic employees and strangers from waiting rooms—are untrained in medical interpretation. A New Comparison of Interpretation Methods Previous studies have shown that family members and untrained bilingual people who provide ad hoc interpretation can commit many errors of interpretation. No investigation, however, has been conducted comparing these errors and their potential consequences in encounters with a focus on professional interpreters versus ad hoc interpreters or no interpreters. In the March 2012 Annals of Emergency Medicine, my colleagues and I had a study published in which we performed a cross-sectional error analysis of audiotaped ED visits during a 30-month period in the two largest pediatric EDs in...

Making the Communication-Quality Care Link

Rapid fire delivery of critical information between clinicians is commonplace in the ED, but most departments rarely plan and assess the effectiveness of their communication methods. Research has indicated that more than half of all sentinel events—death or permanent injury due to treatment delays—occur in EDs, according to the Joint Commission. Analyses have shown that communication is the root cause for the majority of these events. “Few investigations have looked into how communication of information within the ED can be optimized,” says Shari Welch, MD, FACEP. In an effort to examine communication practices within the ED and assess strategies that may improve these efforts, the Emergency Department Benchmarking Alliance, which comprises 412 EDs in the United States, began to study its member’s communication strategies. The initiative demonstrated that most EDs use a variety of low and high-tech methods for communication (Table 1). In the 1980s, the whiteboard was commonly used to display and convey information within the ED. Now, that trend has given way to computerized systems, according to Dr. Welch. “Physicians and nurses could circle something on a whiteboard to denote importance, but the tracking screens that are used frequently now do not give the same visual cues.” Many EDs have begun using overhead paging more frequently. However, in the average ED, according to the World Health Organization, the decibel level of noise is often too high, causing stress for both staff and patients. Emergency Department Size & Needs “Smaller EDs are much more efficient with their communications than larger ones,” Dr. Welch says. “Larger EDs can be burdened by their structure. Many have long hallways, no central...
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