Quality Efficiency Utilization
Incorporating Kaisen in Everyday Practice and the rise of LEAN in Emergency Care.
October 12th, 2011by: Dr. Vipul Kella
As a child, I remember my father would come home with stacks of spreadsheets, charts and graphs with the words “throughput”, “bottlenecks” and “LEAN” on them. Growing up in Detroit and being the son of a “Big Three” employee, I just assumed this was normal jargon in the automotive world. My father made many an […]
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Death at UMass Memorial: Is the Problem “Alarm Fatigue,” or Something Bigger?
September 27th, 2011by: Dr. Angelo Falcone
Last week, the Boston Globe reported on the second death in four years at UMass Memorial Medical Center related to “alarm fatigue.” Anyone who works in a hospital, particularly an area like an emergency department where critical patients are seen, can understand how a tragedy like this happens. Monitor alarms go off all the time. The […]
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CT Scan Use Increasing. Now, What?
August 31st, 2011by: Dr. Angelo Falcone
A recent review of data from the University of Michigan Health System revealed what many of us working to make Emergency Departments more efficient already knew: more emergency doctors are ordering more CT scans. Using data from 1996 through 2007, researchers found nearly 1 in 7 ED patients now get a CT scan. The rate […]
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Emergency Medicine – Where Do We Go From Here?
May 30th, 2011by: Dr. Angelo Falcone
We cost too much. We take care of URIs and ankle sprains. We don’t coordinate care well. We use too many resources. We’ve all heard it in the media, even our President taking passing shots at the usefulness and cost effectiveness of emergency care. Of course the reality is federal law requires us to see […]
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Reducing Medical Errors Through Improved Communication
May 24th, 2011by: Dr. Jeremy Tucker
The most important take away point from this WSJ article “Hospitals Overhaul ER’s to Reduce Mistakes” is communication. The article states that most errors in judgment involve missing pieces of critical data or information that one team member may be aware of and assume that others know. In an ideal world, the best model for […]
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To CT, or not to CT, That is the Question.
May 12th, 2011by: Dr. David Friedman
A 13-month-old girl falls out of her high chair and strikes her forehead on the ceramic floor. She cries right away and vomits one time. A large area of swelling develops in the middle of her forehead. She is seen by a physician at an urgent care center who promptly refers her to the emergency […]
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Patient satisfaction vs. Unnecessary testing—Who wins?
April 20th, 2011by: Dr. Jeremy Tucker
“You have chronic back pain, sir. You had a back x-ray in this ED 2 months ago for this and have not had any new trauma. In fact, you have had a MRI 6 months ago to look at your back. You do not need an x-ray today.” “Ma’am, you have been here 8 times […]
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Discharging Low Risk Chest Pain: The Holy Grail
April 4th, 2011by: Dr. Mike Perraut
“Missed MI has the highest settlement amount of any malpractice case brought against ER physicians.” That, after where the bathrooms were, was probably the first thing I learned when I started my residency. Chest pain is both dangerous and common with many deadly and benign causes. Thanks to public health outreach efforts more patients present […]
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What Does “Meaningful Use” Mean to You?
March 8th, 2011by: Dr. Jeremy Tucker
The passage of the HITECH Act in 2009 has lead to a rapid push to implement electronic health record (EHR) use in both the hospital setting and by outpatient providers. Unfortunately, it is not quite as simple as purchasing an EHR system from a vendor and flipping on the switch. Many organizations are now trying […]
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Pain Control and the Law of Unintended Consequences
March 3rd, 2011by: Dr. Mike Perraut
While medicine can carry an aura of nearly miraculous treatments in the minds of many of our patients, we know that there is not much we can really do to alter the disease processes for many of our patients. Relieving patients from acute pain is one of the greatest gifts physicians and nurses can offer. […]
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