Grand Rounds Recap 7.3.19
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History of emergency medicine WITH DR. pancioli
The Past
First “ER Group” started at a large center in 1961
At UC in the 1960s, seeing >100,000 patients with attending staffing only during the day
Bruce Janiak started making Emergency Medicine residency curriculum in the late 1960s
ACEP formed in 1968
AirCare founded in 1984
First primary Emergency Medicine Board Certification in 1989
First formal statement by ACEP regarding the utility of emergency ultrasound in 2001
The Future
Emergency department visits continue to rise with a decrease in the number of EDs nationally, overwhelming the system
Reimbursement poses a constant challenge to emergency departments in today’s health care climate
Emergency medicine physicians will continue to fight for growth of scope of practice
Boarding has been associated with increased mortality of patients
Continue to fight to for the best care for your patients!
teamwork WITH DR. palmer
To Err Is Human published in 1999, reported there were up to 98,000 deaths per year due to medical error
In 2006, JACHO stated communication and teamwork failures caused about 3600 sentinel events
HHS reported adverse events cost $400 million per year in 2009
Based on The Speed of Trust by Covey, there are four cores to trust and credibility:
Integrity
Intent
Capabilities
Results
Emotional intelligence is composed of the skills of self-awareness, self-management, social awareness, and relationship management.
Basic principles of team-based healthcare:
Shared Goals that reflect patient and family values
Clear Roles that include expectations for each team member
Mutual Trust
Effective Communication
Measurable Outcomes with reliable and timely feedback
Breaking bad news WITH DRs. Mcdonough, hill, and lafollette
Why is breaking bad news challenging in the ED?
No prior relationship with the patient
Patient may have been previously “normal”
Time constraints of the ED
Things to consider when telling family a loved one has died:
Cut to the chase
Say “dead” or “died”
Don’t “understand”
Use “I’m sorry” instead
Maintain your personal safety
Utilize resources such as ODA, social work, or attending
Things to consider when delivering a new cancer diagnosis:
Give fair warning
Say what you know, don’t say what you don’t know
Use the cancer word, but cautiously
“We need more information”
Set a next step
Tips for disclosing mistakes:
Patients and public favor disclosure
MDs typically support disclosure, but cautiously
The legal implications of apologizing vary from state to state
Be honest and sympathetic
Note how this mistake can be prevented in the future
Discussing patient status with family members for critically ill patients:
Ask, “what do you know?”
Give the family time to process
Don’t prognosticate and avoid being overly optimistic