So what is it *really* like in the ED and why do emergency nurses often feel like they are at odds with the rest of the hospital? Kevin McFarlane from The Art of Emergency Nursing paints a picture of the ED while addressing important topics like frequent flyers, hand-off reports, and admit holds.
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Important Concepts
“The ED is the one department that cannot say ‘no'”
The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay.
Kevins points out that an inpatient floor or ICU can refused a patient due to staffing, lack of available beds, and patients acuity. The ED, on the other hand, cannot refuse patients for any of these reasons.
Admit holds are associated with worse patient outcomes
The article Boarding of Critically Ill Patients in Critical Care Medicine the Emergency Department found that increased ED boarding times of critically ill patients are associated with
- Increased duration of mechanical ventilation, longer ICU length of stay, and higher mortality
- Worsening organ dysfunction and a four-fold increase in the probability of poor neurologic recovery in patients presenting with stroke
- Delays in home medication initiation, fluid, and antibiotic administration, disease-specific protocolized care, and more medication-related adverse events than admitted inpatients