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Improving ED Care for LGBT Patients

Improving ED Care for LGBT Patients

As the patient census has become increasingly diverse, it has become more challenging for EDs to provide quality care in emergency situations. Studies show that marginalized populations face greater social inequalities and healthcare disparities, placing them at higher risk for diseases and death. One patient group that is not immune to these disparities is the lesbian, gay, bisexual, and transgender (LGBT) community. Approximately 9 million people in the United States identify themselves as LGBT. “It’s important for emergency physicians to better understand the disparities and health risks that LGBT patients face in order to communicate more effectively with these individuals,” says Sara Jalali, MD. “An inherent challenge with treating this patient population is that sexual orientation and gender identity are not always evident. In many cases, patients hide this information from their healthcare providers for fear of discrimination. Compounding the issue is that there are few universal standards that are specifically applicable to LGBT health education. Healthcare providers are often poorly prepared to care for this at-risk population, which in turn can result in distrust and avoidance in seeking prompt medical care.” In Annals of Emergency Medicine, Dr. Jalali and Lauren M. Sauer, MS, had an article published that outlined strategies for improving care for LGBT patients in the ED. It discusses legal issues, healthcare considerations, and current educational practices pertaining to the LGBT community. The article also provides several tips for improving the care of LGBT patients (Table) and communicating more effectively with the LGBT community as a whole as well as transgender patients.   Legal Issues From a legal standpoint, the laws pertaining to LGBT healthcare rights are...
Analyzing the Effect of ACE Units for Older Patients

Analyzing the Effect of ACE Units for Older Patients

In order for the economic stability of the United States healthcare system to improve, hospitals throughout the country are striving to deliver high-quality care while containing cost. Current estimates suggest that the proportion of adults aged 65 and older will exceed 20% by 2030. This creates a need for the development of strategies that improve patient-centered care for older patients while reducing costs. Another important consideration in this patient population is reducing adverse outcomes resulting from hospitalization. In an effort to address care for older patients, many hospitals throughout the U.S. have been developing Acute Care for Elders (ACE) units for the past 20 years. These units use an interdisciplinary team model to provide hospital care as opposed to a multidisciplinary model. “An interdisciplinary model integrates disciplines to collaboratively develop patient-centered care plans,” explains Kellie L. Flood, MD. “With multidisciplinary models, providers from all disciplines deliver care, but tend to practice independently or operate in silos.” The primary purpose of the ACE model is to reduce adverse outcomes in older adults with frequent interdisciplinary team rounds. During these rounds, geriatric syndromes are recognized and managed, while transition planning is initiated from the day of admission. In previous studies, ACE units have been shown to improve processes of care, prescribing practices, physical functioning, and patient and provider satisfaction. These analyses have also suggested that ACE units help reduce rates of restraint use and institutionalization. Assessing the ACE Model To gain better perspective on the value of ACE models, Dr. Flood and colleagues at the University of Alabama at Birmingham published a study in JAMA Internal Medicine that examined variable direct...

The Impact of the Next Generation of Nursing

The Patient Protection and Affordable Care Act will mean the addition of as many as 35 million Americans with health insurance into a healthcare system already stretched to capacity with overcrowded EDs, shrinking resources, and a dramatic shortage of primary care physicians (PCPs). Even before health reform, the Association of American Medical Colleges estimated that an additional 45,000 PCPs would be needed by 2020 to keep up with demand. Yet, fewer and fewer medical school students are choosing primary care medicine. [polldaddy poll=6923076] Qualified, Experienced Nurses Can Help The professionals most qualified to fill this physician shortage are nurse practitioners (NPs), registered nurses who have completed graduate-level education, and nurses who have already worked 10 or more years and have accumulated practical, bedside experience that complements what was learned in the classroom. PCPs everywhere would be wise to look at NPs as a natural complement to their practice and a logical partner in caring for their patients. Nurse practitioners are already tasked with delivering some medical care, including: Prescribing or renewing prescriptions for most drugs. Ordering blood tests. Performing routine medical examinations. Monitoring chronic conditions. Counseling patients about prevention. Treating colds, sore throats, and the flu. Many states have expanded the scope of NP duties and responsibilities. For example, Montana allows NPs to work without any physician supervision. By contrast, Texas requires physicians’ direct, on-site supervision at least 20% of the time. Additionally, 28 states are debating whether to further loosen restrictions that prevent NPs from performing more tasks independently. The influx of newly insured patients into the healthcare system will also profoundly affect where people receive care. Some...
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