Speed was the chief difficulty. Success required having an array of equipment and people at the ready—helicopter-rescue personnel, trauma surgeons, an experienced cardiac anesthesiologist and surgeon, bioengineering support staff, operating and critical-care nurses, intensivists. Too often, someone or something was missing. So he and a couple of colleagues made and distributed a checklist. In cases like these, the checklist said, rescue teams were to tell the hospital to prepare for possible cardiac bypass and rewarming. They were to call, when possible, even before they arrived on the scene, as the preparation time could be significant. The hospital would then work down a list of people to be notified. They would have an operating room set up and standing by.
Recently, I spoke to Markus Thalmann, the cardiac surgeon on the team that saved the little Austrian girl who had drowned, and learned that a checklist had been crucial to her survival. Thalmann had worked for six years at the city hospital in Klagenfurt, the small provincial capital in south Austria where the girl was resuscitated. She was not the first person whom he and his colleagues had tried to revive from cardiac arrest after hypothermia and suffocation. They received between three and five such patients a year, he estimated, mostly avalanche victims (Klagenfurt is surrounded by the Alps), some of them drowning victims, and a few of them people attempting suicide by taking a drug overdose and then wandering out into the snowy forests to fall unconscious.
Medicine today has entered its B-17 phase. Substantial parts of what hospitals do—most notably, intensive care—are now too complex for clinicians to carry them out reliably from memory alone. I.C.U. life support has become too much medicine for one person to fly.
They are playing a big role in the financial struggle with lower reimbursement rates for federal insurance programs, implementation of EMTALA laws, development of services offered by other local competing hospitals, changes in service area demographics, which have all contributed to five sequential negative operating margins for EMC....
In 2001, though, a critical-care specialist at Johns Hopkins Hospital named Peter Pronovost decided to give it a try. He didn’t attempt to make the checklist cover everything; he designed it to tackle just one problem, the one that nearly killed Anthony DeFilippo: line infections. On a sheet of plain paper, he plotted out the steps to take in order to avoid infections when putting a line in. Doctors are supposed to (1) wash their hands with soap, (2) clean the patient’s skin with chlorhexidine antiseptic, (3) put sterile drapes over the entire patient, (4) wear a sterile mask, hat, gown, and gloves, and (5) put a sterile dressing over the catheter site once the line is in. Check, check, check, check, check. These steps are no-brainers; they have been known and taught for years. So it seemed silly to make a checklist just for them. Still, Pronovost asked the nurses in his I.C.U. to observe the doctors for a month as they put lines into patients, and record how often they completed each step. In more than a third of patients, they skipped at least one.
The story of one of my patients makes the point. Anthony DeFilippo was a forty-eight-year-old limousine driver from Everett, Massachusetts, who started to hemorrhage at a community hospital during surgery for a hernia and gallstones. The bleeding was finally stopped but his liver was severely damaged, and over the next few days he became too sick for the hospital’s facilities. When he arrived in our I.C.U., at 1:30 A.M. on a Sunday, his ragged black hair was plastered to his sweaty forehead, his body was shaking, and his heart was racing at a hundred and fourteen beats a minute. He was delirious from fever, shock, and low oxygen levels.
336) team meeting was a collaboration of team members that included: the Emergency Room (ER) Director, ER physicians, and ER nurses, ER Head Health Unit Coordinator, ER Business Manager, Senior Process Excellence Coordinator, Director of Information Management, and the Senior Marketing Specialist....
Since emergency rooms are for critical and urgent cases, most people do not go there frequently. However, people who cannot access quality health care go to emergency rooms, where they are assured of treatment. Thus, one finds that some people can wait in the emergency room for some time before they are treated. While emergency rooms are low cost in some places, other hospitals gain profits from them. There are different levels of emergency rooms in some hospitals, which are designed to serve the patients better. For instance, the trauma departments take care of patients who have gunshot wounds and they deal with accident cases. Others are especially designed to deal with sicknesses (Greenwald, 2010).
Emergency rooms are a necessity in every hospital and healthcare facility. The government should ensure that emergency rooms are affordable and they have all resources and facilities required. Patients should not be turned away because they cannot afford quality health care or the hospital lacks the required resources, including doctors. If the government ensured quality and affordable health care for all the people, there would be less traffic in the emergency rooms since they would only be required for people who are involved in accidents. After acquiring this information, I was glad that I was in a country that realized the importance of having emergency rooms in the hospitals.
A hospital’s emergency room (ER) is the part of the hospital where patients with the most urgent needs, such as accidents are first taken. A person does not require an appointment to visit the emergency room. Normally, the ER is the busiest part of the hospital. Patients can access the ER using the ambulance or they can come using other means. Since there are no appointments made, doctors, nurses and other hospital staff in the hospital must be ready for any eventualities. This means that the ER must have a wide assortment of medicines and other medical facilities to take care of the patients. Emergency rooms are usually operational everyday and are open for twenty-four hours. This means that a patient can have access to medical care irrespective of when the need occurs.
Wake County EMS (WCEMS) is the sole entity with in the Wake county Government structure that is charged with providing prehospital emergency medical care to the visitors and citizens of Wake County.
Presentation of Case. Dr. Amy E. Yuan (Medicine): A 30-year-old man was admitted to this hospital during the summer because of fatigue, rash, fevers, anemia, and thrombocytopenia. Three years before this admission, the patient was involved in a motor vehicle accident that resulted in a large…