Transition ED to EDOU assignment help

Transition ED to EDOU assignment help ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Transition ED to EDOU assignment help I’m studying for my Health & Medical class and need an explanation. Transition ED to EDOU assignment help Please find the attchad assignment c_01_assignment_instrux__5_.docx c_01_r_07_ross_aurora__1_.pdf c_01_r_08_ross_hockenberry.pdf c_01_r_09_stead.pdf c_01_assignment_del Component 1: Assignment – Clinical Workflow Mapping (ED observation unit) Introduction: Emergency department observation units (EDOUs) are specified areas within hospitals for patients admitted to an emergency department (ED) AND whose diagnostic or therapeutic needs require more than 6 hours (beyond the length of an ED visit) but less than 24 hours (an inpatient stay). EDOUs are useful for streamlining diagnosis and decision-making for emergent medical problems by using standardized protocols to optimize care, resource utilization and payment. Reference documents: 1. Ross MA, Aurora T, Graff L, Suri P, O’Malley R, Ojo A, Bohan S, Clark C. State of the Art: Emergency Department Observation Units. Crit Pathways in Cardiol 2012;11: 128–138. 2. Ross MA, Hockenberry JM, Mutter R, Barrett M, Wheatley M, Pitts SR. Protocol-Driven Emergency Department Observation Units Offer Savings, Shorter Stays and Reduced Admissions. Health Affairs 32, no.12 (2013):2149-2156. 3. Stead LG. Stead, Bellolio MF, Suravaram S, Brown Jr RD, Bhagra A, Gilmore RM, Boie ET, Decker WW. Evaluation of Transient Ischemic Attack in an Emergency Department Observation Unit. Neurocrit Care (2009) 10:204–208. 4. Urban Hospital Center ED Patient Throughput Document 5. Forms and documents list Scenario: The Urban Hospital Center (UHC) Emergency Department (ED) is a referral center for primary care practices and urgent care centers within the community. UHC has planned and developed a 10-bed EDOU to manage a number of specific medical and surgical problems and is installing interfaces to an existing hospital electronic patient record (EPR). UHC has a commercial computerized provider order entry (CPOE) system for its ED and inpatient units as part of the institutional EPR. The EDOU is covered 24/7 by a staff of hospitalists and nurses. Figure 1: Emergency Department Throughput Schematic As the ED/EDOU manager, you have been tasked by the hospital leadership to implement and coordinate the care protocols for the many conditions with which patients present to the ED, but which may take longer than 6 but less than 24 to determine a disposition (See Figure 1). The Department of Emergency Medicine in conjunction with the Division of Neurology has decided to implement a protocol for the management of TIAs (Reference 4) that incorporates EDOU care. Your task is to map and document the care of a patient with TIA in terms of patient throughput within the context of an ED-EDOU visit and the information that needs to be transferred in the care transition that occurs between the ED on the first floor to the EDOU on the second floor of the hospital (which is distinct from the Neurology inpatient unit on the fourth floor). Part 1 Answer the questions below (a-f) so that you can respond to the assignment Deliverables. DO NOT submit your answers to questions a-f. The questions are designed to prepare you for the Deliverables. The EDOU accepts patients only from the UHC ED. Once a patient is in the ED for 5 hours, the process of disposition (discharge, inpatient admission or transfer to the EDOU) should have started. Transition ED to EDOU assignment help You may discuss these on the Discussion Forum for Component 1. a) What are common problems and/or procedures that may be handled in an EDOU (See Ross)? b) What is a TIA and why is it of concern as a diagnosis? What are the possible sequelae? c) Starting from the ED, list the steps, stakeholders and entities/artifacts that are involved in a transfer from the ED to the EDOU 1. Who are the providers involved in care (at both ends of the transfer)? 2. What information about the patient is necessary for the transfer? 3. How is this information encoded and formalized? 4. What documentation is required by the different providers on the sending end (the ED)? 5. What documentation is required by the providers on the receiving end (the EDOU)? 6. What administrative steps are required prior to transfer? d) What are requirements and benefits of an electronic record that connects to the ED to the EDOU? e) What contingency (emergencies, unexpected events) plans should be in place for the transfer process and what clinical resources and information/communication tools should be ready, prior, during and after the transport? f) During the EDOU stay, the hospitalist team (physicians, nurses) needs to assess the patient hourly, write a progress note and participate in discharge (or inpatient admission) planning. To what hospital information systems should the EPR connect? g) When a disposition on a patient in the EDOU is made (to discharge or to admit), what information needs to be communicated, by whom, to whom, and in what formats? 1. Discharge to home 2. Admission to an inpatient service Part 2 (Deliverable): Administrative 1. Use a single document in MS Word or portable document format (pdf) with a cover sheet that identifies the submitter with attestations. MS Word documents may be converted to pdf in Word 2007+ by using: File?Save As?.pdf From ED to the EDOU 2. Create a one page protocol (Form C_01_a05_Form_01.docx) that lists and describes the sequential steps required to admit/transfer a patient from the ED to the EDOU, in the form of a checklist (that can be used to track the patient’s progress, form provided): a. An overview of the ED to EDOU process is provided: i. Visual form (very high level): Component 1 Assignment Diagram ii. Written out (details): Component 1 Throughput Written Out iii. For a patient with a suspected TIA (See Stead et al, p 205 for TIA ED management) b. [Header] – Label/title the page with administrative data that will be important for identifying the patient and tracking the visit: i. Necessary patient-specific identifiers/data (What do you need to know to provide the correct care for the correct patient?) ii. Visit-specific identifiers/data (What does everyone (including the next team of providers) need to know about the care rendered to the patient?) 1. Interactions between the patient and providers (Is it important to know who the providers are?) 2. Significant dates, times and intervals c. [Timetable] List inclusively (on the form): i. All interactions of the ED with the patient in sequence (from patient entry to the ED, which can be listed as Time: 00:00) ii. A brief description of the task/step/interaction iii. Persons involved with the task/step/interaction (one is the patient) iv. Information and/or objects that are exchanged during the task/step/interaction v. Significant events/decisions/communications during the ED stay (Hint: one is the decision to discharge/admit/transfer) d. [Handoff] List (on the form): i. What administrative information is required in order to transfer the patient? ii. What clinical information needs to be established prior to transfer? iii. What event data must be recorded prior to transfer? iv. What artifacts (actual objects) of care need to be accounted for during transport? v. What personnel are needed for transport and what do they need to know and record? Transition ED to EDOU assignment help e. [Contingencies] List contingency preparations: i. Name one clinical (medical) contingency for which personnel must be prepared and what information would be required for such contingencies? ii. Name one administrative (system) contingencies for which personnel must be prepared and how should they prepare for it? Submission Instructions for Deliverable: a) Complete the Assignment (using and cover sheet b) Submit through your Course Dropbox REVIEW ARTICLE State of the Art: Emergency Department Observation Units Michael A. Ross, MD,* Taruna Aurora, MD,† Louis Graff, MD,‡ Pawan Suri, MD,† Rachel O’Malley, MD,§ Aderonke Ojo, MD,¶ Steve Bohan, MD?, and Carol Clark, MD** Abstract: Hospitals and emergency departments face the challenges of escalating healthcare costs, mismatched resource utilization, concern over avoidable admissions, and hospital and emergency department overcrowding. One approach that has been used by hospitals to address these issues is the use of emergency department observation units. Research in this setting has increased in recent years, leading to a better understanding of the role of these units and their unique benefits. These benefits have been proven for health systems as a whole and for several acute conditions including chest pain, asthma, syncope, transient ischemic attack, atrial fibrillation, heart failure, abdominal pain, and more. Benefits include a decrease in diagnostic uncertainty, lower cost and resource utilization, improved patient satisfaction, and clinical outcomes that are comparable to admitted patients. As more hospitals begin to use observation units, there is a need for further education and research in how to optimize the use of emergency department observation units. The purpose of this article is to provide a general overview of observation units, including advancements and research in this field. Key Words: emergency departments, observation units, accelerated diagnostic protocols, accelerated treatment protocols (Crit Pathways in Cardiol 2012;11: 128–138) CONCEPTS, PRINCIPLES, AND DEFINITIONS A ccredited Chest Pain Centers are required to document processes and performance in 8 key areas. One of these areas addresses chest pain diagnostic or observation protocols to avoid inadvertently discharging patients with acute coronary syndromes (ACSs) home. For many hospitals, it is not feasible to have a separate chest pain observation unit due to inadequate patient volumes to support staff for such a unit. Hospitals addressed this issue by either admitting chest pain protocol patients to an inpatient bed for their care or expanding the use of the chest pain observation unit to other conditions. We will review the scope of such multipurpose observation units. Observation of patients after their initial emergency department (ED) visit has been described for over 3 decades, beginning shortly after the formal development of EDs in the 1960s.1 A 2003 national survey estimated that emergency department observation units (EDOUs) are present in 19% of US hospitals, with 12% planning a unit.2 A subsequent analysis of 2007 National Hospital Ambulatory Medical Care Survey data indicated that the percent of US hospitals with an EDOU had increased to 36%, with more than half administratively managed From the *Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA; †Department of Emergency Medicine, Virginia Commonwealth University Health Systems, Richmond, VA; ‡Department of Emergency Medicine, Hospital of Central Connecticut, New Britain, CT; §Department of Emergency Medicine, Emory University School of Medicine Atlanta, GA; ¶Department of Emergency Medicine, Texas Children’s Hospital, Transition ED to EDOU assignment help Houston, TX; ?Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA; and **Department of Emergency Medicine, Beaumont Health System, Royal Oak, MI. Reprints: Michael A. Ross, MD, Medical Director, Observation Services, Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA 770-722-9305. E-mail: [email protected] Copyright © 2012 by Lippincott Williams & Wilkins ISSN: 1535–282X/12/1103–0128 DOI:10.1097/HPC.0b013e31825def28 128??|??www.critpathcardio.com by the ED.3 A 2003 survey of academic centers with an Emergency Medicine Residency Program reported that 36% had an EDOU, with another 45% planning a unit.2 Internationally, emergency observation services have been reported in several countries, including Canada, Britain, Australia, India, China, and Singapore, as well as throughout Europe and South America.4–11 In its discussion of “improving the efficiency of hospital-based emergency care,” the 2006 Institute of Medicine report supports the use of the EDOU as a means of decreasing ED boarding, ambulance diversion, and avoidable hospitalizations.12 The American College of Emergency Physicians’ most recent policy on EDOU recognizes that care “in a dedicated ED observation area, instead of a general inpatient bed or an acute care ED bed, is a ‘best practice’ that requires a commitment of staff and hospital resources.”13 However, from 2003 to 2007 the percentage of Medicare patients whose observation stays exceed 48 hours has risen from 3% to over 6%, suggesting that alternatives to traditional inpatient observation admissions may be needed.14 With the expansion of information in this area and pressing healthcare issues, a more contemporary review of observation services is needed. Perhaps the best way to understand patients eligible for an observation unit is in the context of time. The average ED length of stay (LOS) of an admitted ED patient is 5.5 hours, whereas the average LOS of an inpatient is 5 days.15 Hospitals are increasingly being scrutinized for inpatients whose LOS is 1 day or less.16 This defines a subset of patients whose clinical needs exceed what can realistically be achieved within the 6 hours of an ED visit, but if managed actively will require less than 24 hours of hospitalization. There are several options for where these “6- to 24-hour” patients may be managed after their initial ED care. They may be managed in the ED for prolonged periods of time, they may be placed in an inpatient bed anywhere in a hospital to be managed under outpatient observation status, or they may be placed in a dedicated observation unit (also managed under outpatient observation status). Furthermore, their care may be provided using accelerated diagnostic or treatment protocols (an “ADP” or an “ATP”) rather than discretionary care. Studies have shown that when these patients are mixed with inpatients throughout a hospital, it results in LOSs that are well beyond 24 hours, with associated decreases in patient satisfaction.17–21 The defining feature of ED observation services is the active management of patients after their initial ED care to determine the need for inpatient admission. Observation units are assigned various names based on local preferences and specific patient populations served. Some examples include the following: ED Observation Unit, Clinical Decision Unit, Chest Pain Unit, Short Stay Unit, and Rapid Diagnosis and Treatment Unit. It is important to distinguish “observation” patients from patients in the ED who already have a disposition but are “holding” or “boarded” while awaiting an inpatient bed, transfer, discharge, or going to the operating room. Some EDOUs allow “holds” to use their beds as needed. However, filling an observation unit with holds may result in ED patients being admitted who might have been observed and discharged, thus exacerbating a system problem rather than solving it. Critical Pathways in Cardiology? •? Volume 11, Number 3, September 2012 Critical Pathways in Cardiology? •?Transition ED to EDOU assignment help Volume 11, Number 3, September 2012 If an observation unit manages both observation patients and other categories of patients, then the unit may be considered a “hybrid observation unit.” This is generally done to maximize space utilization, meet secondary service needs, allow smaller units to maintain adequate patient volumes, and enhance overall ED throughput. Examples of other patient categories include ED patients, patients who are holds, and “scheduled procedure patients” (Table 1). Kelen et al22 described a hybrid emergency acute care model that improved efficiency and was associated with a decrease in ambulance diversion and patients who left without being seen. Ross et al21 described a hybrid scheduled procedure/observation unit that maximized use of nurses and cut scheduled procedure patient LOS in half. The need for a hybrid unit in a given hospital will depend on that hospital’s needs, their potential EDOU census, and whether that census is adequate to support a pure EDOU or whether a hybrid unit is needed to support the unit. OBSERVATION CONDITIONS There have been many studies of selected conditions managed in an EDOU, often using an ADP or ATP. Many are observational studies; however, there have been 8 prospective randomized controlled trials comparing care in the setting of an EDOU with that of an inpatient admission (Table 2). These studies have favored care in the EDOU, relative to inpatient care, for the outcomes measured. In addition, observational studies describe the care of several other conditions in an EDOU setting. Finally, studies of multipurpose observation units detail the unit case mix, LOS, percent admissions, and recidivism rates.24–26 Table 3 provides a list of commonly observed conditions and the type of studies available. Common pediatric EDOU conditions are listed in Table 4.27–32 EDOU MANAGEMENT The principles of managing an EDOU have previously been described (Table 5).102 Patients managed in an EDOU should have a well-defined reason for observation. This allows for appropriate patient selection, protocol development, and predictable outcomes. Patients may be observed for further diagnostic testing, continued treatment of an acute condition, or management of psychosocial needs. Patients TABLE 1.? Scheduled Procedure Patients Who May Share an EDOU to Optimize Resource Utilization Adult Scheduled Procedure Patients21 Blood transfusion Intravenous medication Myelogram Arteriogram Cardiac catheter Liver biopsy Thoracentesis Paracentesis Lumbar puncture Intravenous chemotherapy Transition ED to EDOU assignment help Peripherally inserted central catheter lines Lung biopsy Pediatric Scheduled Procedure Patients23 Sedation for procedure pH probe Infusion (eg, IV immunoglobulin, Remicade) Biopsy (eg, renal, liver, bowel, eye) Closed-circuit television electroencephalogram Intrathecal baclofen trial Orthopedic procedure Percutaneous endoscopic gastrostomy Sleep study Postcardiac catheterization Renal biopsy EEG indicates electroencephalography. © 2012 Lippincott Williams & Wilkins Emergency Department Observation Units selected for treatment should have at least a 70% probability of discharge, a relatively low severity of illness, and require a level of service that is appropriate for unit resources and staffing.40 Patients at risk of self-harm require a setting where they can be monitored. If this is not possible in the EDOU, then it may be safest to exclude them. Patients with multiple acute clinical conditions are also less likely to be appropriate for an observation unit setting, given their complexity. Protocol-driven observation units are associated with the best outcomes.24 However, protocols require collaboration with other departments for consensus and support services, such as consultation and cardiac or brain imaging. The process of protocol development can be summarized with the “4 Ds.” “Discovery”—a work group of relevant hospital specialties searches the literature and benchmark practices to design the optimal protocol. “Design”—a local expert consensus group drafts a protocol that addresses patient selection, ED and EDOU interventions, and criteria for disposition. This is then shared with relevant departments for final input. “Do”—the protocol undergoes pilot testing, reevaluation, then full implementation. Finally, “Data”—key metrics including volumes, LOS, percent discharge, and quality indicators are tracked to monitor ongoing protocol performance at monthly meetings so that adjustments are made in a timely manner. Although observation services were previously described as “23-hour admissions,” most studies of these patients have shown the LOSs to be roughly 15 hours.2,24,84 Actively managed patients who have not “declared” themselves as eligible for discharge by 18 to 24 hours are unlikely to do so with additional time in the EDOU. It is optimal to manage observation patients in a dedicated observation unit, rather than being mixed with patients on an inpatient floor or in the ED for several reasons. Most observation patients enter the hospital through the ED. Tran … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10