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Emergency Department of the New Era

  • Alejandro GuerreroEmail author
  • David K. Barnes
  • Hunter M. Pattison

Abstract

The past 10 years have demonstrated a dramatic evolution in how patients are cared for overall. The emergency department (ED) is where technologic solution has the potential to be most helpful because of the unpredictable, time-sensitive nature of patient logistics. In this chapter we review the evolution of these approaches as they relate to the problems they address.

The availability of patient data may be the single greatest challenge and opportunity in the ED setting. The transition to electronic medical records and then electronic health records and the promise of networked health information exchanges are reviewed.

Patient flow is a problem that vexes nearly every ED. How to pair the right resources and the right patient in a prompt, cost-effective manner is a challenge which in the modern ED can be assuaged by a variety of approaches. The most common include the application of queuing theory, and lean methodology, in addition to simpler approaches such as adjustments to the triage liaison provider and separation of low-acuity patients.

Clinical documentation is a problem in nearly every healthcare setting, but the ED highlights this workflow bottleneck. The use of medical scribes, speech recognition software, and wearable computing devices has all shown promise, but each comes with their distinct advantages and disadvantages.

Finally, clinical decision support, crowd-sourced open-access medical information, the ED application of telemedicine, prehospital testing, and point-of-care testing are discussed. This chapter provides an overview of how the challenges of a modern ED are met with modern solutions and provides the evidence supporting these changes.

Keywords

Networked health information exchange Queuing theory Lean methodology Clinical decision support Free open-access medical education Triage liaison provider Wearable computing device Prehospital imaging Point-of-care testing Medical scribes 

Abbreviations

APP

Advanced practice provider

BPA

Best practice alert

CDS

Clinical decision support

CPOE

Computerized physician order entry

ECG

Electrocardiogram

ED

Emergency department

EHR

Electronic health record

EMR

Electronic medical record

EMS

Emergency medical services

FOAM

Free open-access medical education

HIE

Health information exchange

MI

Myocardial infarction

POC

Point of care

QT

Queuing theory

STEMI

ST-segment elevation myocardial infarction

TLP

Triage liaison provider

t-PA

Tissue plasminogen activator

US

Ultrasound

WCD

Wearable computing device

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Alejandro Guerrero
    • 1
    Email author
  • David K. Barnes
    • 2
  • Hunter M. Pattison
    • 3
  1. 1.Acute Care SurgeryInterTrauma MedicalNew YorkUSA
  2. 2.Department of Emergency MedicineUC Davis Health, UC Davis Medical Center, UC Davis School of MedicineSacramentoUSA
  3. 3.Department of Emergency MedicineUC Davis Medical CenterSacramentoUSA

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