In this guest Waiting to Be Seen blog by Dr. Gaibrie Stephen, we discover the evidence supporting a more rigorous and professional approach to language translation services as well as some practical available options. If a lack of translation can have tragic consequences, the obligation of an ED to set a new and better standard of care for communicating with patients is now painfully clear...
Are there things we can do in the ED to reduce the risk of violence? We focus on some of the high-risk populations that are often involved in situations that escalate and suffer the consequences of ED responses. Let's move beyond non-violent de-escalation, examine our underlying attitudes, and explore strategies to prevent escalation on this Waiting to Be Seen blog...
We often face violence in the ED. Yet the ED is a sanctuary for care and support. Many EDs have a zero-tolerance policy for violence. In this Waiting to Be Seen blog Dr. Howard Ovens examines the issues we face in Emergency Departments as we try to make staff feel safe and ensure patients can access the care they need. He reframes violence in the ED as a public health issue and offers strategies for a safe ED...
Jesse McLaren outlines 10 Quality Improvement (QI) opportunities for reducing missed AMIs and the lessons learned from Ontario’s Emergency Department Return Visit Quality Program in this Waiting to Be Seen blog...
It’s been another trying flu season in the northern hemisphere—for patients and for emergency department (ED) providers. EDs that are crowded at the best of times come close to a tipping point, waits to be seen and for beds climb, and hospitals struggle to handle the load, sometimes coping by putting patients in hallways or lounges. Even well-written surge plans fall apart in the face of staff illness or unit outbreaks. Too often when trying to help the system cope, a hospital, health region, or government puts out a call for the public to stay away from crowded EDs unless absolutely necessary—but are such warnings ethical or effective?
It is both an evidence-based truth and almost a mantra of emergency department (ED) providers and leaders that the major cause of ED overcrowding is boarded patients. Yet 10 years of experience in more than 70 EDs has shown that impressive flow gains can be achieved despite a poor flow of admitted patients out of the ED. While I have always been and continue to be an advocate for improved admission processes and better ED resources, these issues should never excuse us from exploring our own role in improving flow in our departments. Fostering a culture in which all staff are committed to improving care through better flow will trump petty concerns about hierarchies and role descriptions—and it will improve morale.
In this EM cases Waiting to Be Seen blog we discuss how to make Emergency Departments safe places for transgender patients to access care that is informed and non-judgmental. A big part of our job is to advocate for our patients. Dr. Nadia Primiani helps us understand where some of our most vulnerable populations are coming from and aims to improve our familiarity and comfort with issues around gender to improve care...
Whenever discussions about conflict of interest (COI) come up, one of the first questions that’s inevitably raised is why are we focusing only on financial conflicts and ignoring all the other kinds. That’s a fair question. What about intellectual conflicts or ones based on political leanings? Why are we implementing a COI policy? Is it really necessary? I thought it best to answer that question by having COI expert Joel Lexchin express his thoughts on this subject for us in this month’s guest post to Waiting to be Seen...
What does the evidence say about the true utility of physician performance feedback and scorecards? Do they meet a real need for information to guide self-improvement or just scratch our competitive itches? What do we know about the best way to provide feedback? In this month’s guest blog Dr. Amy Cheng, the Emergency Department Director of Quality Improvement at St. Michael’s Hospital in Toronto with an interest in physician performance feedback, reviews what’s known and comments on her own experiences...
Succeeding with the dirty task of hand hygiene promotion How many psychiatrists does it take to change a light bulb? The punch line to that old joke is, of course, “One—but the light bulb has to want to change.” But just as it’s tough to get patients to modify their behaviour (quit bad habits, take up good ones, comply with their meds, etc.), it’s also difficult for ED leaders to get their staff to alter their practices for the better. One example I find many EDs struggle with is improving hand hygiene. Despite what research has shown, some staff may believe they wash their hands plenty, thank you very much. Others may accept the evidence but struggle to remember to comply with hand hygiene guidelines, or competing priorities in a busy shift may get in the way of even the best of intentions. Access to a sink or supplies may be a problem when we provide care in hallways or waiting rooms; on the other hand, we may encounter patients stealing and drinking unsecured hand sanitizer. (Practice tip: If a patient becomes more intoxicated or less responsive after arrival in the ED, they may have consumed sanitizer.) In this month’s guest post, Dr. Mike Wansbrough, a colleague of mine at Mount Sinai Hospital in Toronto, Ontario, talks about his journey as our department’s “hand hygiene champion” (which means I was smart enough to delegate this thankless task to someone else—thanks, Mike!). Mike is a creative guy, so when he faced frustrations in trying to change the “light bulbs” that are my medical staff, he thought an online movie in this era of YouTube sensations might help. A link to the short film is provided below; the content has been researched and vetted by infection control experts and is only four minutes long. You are welcome to use it if it helps with your own hand hygiene efforts. I plan to make it mandatory viewing for our staff. Do you have other tips, suggestions, or resources on this issue to share? Please share them in our comments section so we can all learn from each other!