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Emerging Trends in Emergency Medicine

The ED is one of the most hectic and complicated environments in medicine and the changing face of health care is adding a host of new procedures, measures, rules, and guidelines. To help you navigate this evolving landscape, QuantiaMD has brought together a team of EM leaders, led by Dr. Jesse Pines, who offer expert insight and guidance on some of the crucial issues facing ED clinicians today.

Moderated by:
Jesse Pines, MD, MBA, MSCE
Director, Office for Clinical Practice Innovation, Professor of Emergency Medicine and Health Policy, The George Washington University
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Expert Practice Series Presentations
Arjun Venkatesh, MD, MBA, MHS
Director, ED Quality and Safety Research and Strategy, Department of Emergency Medicine, Yale University School of Medicine
Jesse Pines, MD, MBA, MSCE
Director, Office for Clinical Practice Innovation, Professor of Emergency Medicine and Health Policy, The George Washington University
Kevin M. Klauer, DO, EJD, FACEP
Chief Medical Officer, EMP, Ltd, Director, EMP Patient Safety Organization, Medical Editor-in-Chief, ACEP Now, Speaker, ACEP Council, Asst Clinical Professor, MSU College of Osteopathic Medicine
Kevin M. Baumlin, MD
Professor and Chair Department of Emergency Medicine, Mount Sinai Beth Israel
Latest Comments
"I have a rather unusual perspective on this topic as I was an ER Doc for over 15 years before becoming a paraplegic and thus a patient in the ED.

 I have been to well-respected Academic Medical Center  ED (where I had done Residency training and was on the faculty)  where a Senior Neurology Fellow spent two hours sticking needles in various parts of my body, asking, "Does this hurt? Does this hurt?"  Regardless of my response he continued his pok-a-thon and while repeating, "Well,that is just clinically impossible!" (Great Communication!)

My next ED visit was necessitated by a nasty accident with my motorized wheelchair. I tried to turn into my driveway and thanks to San Francisco's steep hills the chair and I stared to turn head over heels down the street. Because I am a generally law abiding citizen I had attached the seat belt which now kept me attached to the chair. Because the chair weighs over 400lbs each time it rolled over me I heard another crunch indicating a broken bone, although since I was already in shock, I didn't feel anything.

As I lay in the street, I screamed until my neighbors heard me and came to my rescue. Ironically, I live on a street with only six houses and aside from myself, two other doctors, (who are sisters) live on the street and both are Family Docs. The father of these sisters, who is a retired orthopedist, happened to be visiting and helped to evaluate me. Aside from whatever might be going on internally he felt I would need a hand surgeon because my elbow was "smashed" and might not be salvageable.

My neighbors had called 911and the San Francisco City ambulance arrived. The protocol is that critical patients are supposed to be taken to the closest facility. The closest facility was a small community hospital. I knew there was no point in arguing with the Paramedics.

Once I reached the community hospital, been evaluated and stabilized it became clear that other than multiple contusions and abrasions my only significant injury was my elbow, which was fractured in 13 places. The ED Doc happily announced that the community hospital had just recruited an orthopedist, who would be able to take great care of my elbow! It was just that the orthopedist was gone for the weekend. They would admit me to the hospital, keep me comfortable over the weekend and then first thing Monday the new Orthopedist could fix me right up!

My neighbors and the father of neighbors tried to argue that I would need a higher level of care and I should be taken to the Academic Medical Center, where all of my medical records and my PMD are located.  This would be most easily facilitated with and ER to ER transfer. The ED Doc flatly refused. He insisted there was no reason for a transfer, that his hospital could handle my care.

As I was passing the nursing station on the way to my room I overheard a nurse say, " Guess Dr ED is going to win the bonus for getting the first ED ortho referral."

 The reason for the Doc's refusal to transfer me was now obvious. (Great,but Accidental Communication!)

Rest of Story? When the Orthopedist returned he said it would be "malpractice" for him to treat me when there were hand surgeons and an academic medical center less than 5 minutes away. I had to wait at the community hospital for 11 days because now I was an "elective" admission and had to wait for room on the operating schedule and an available bed.

Good news-I was able to have an elbow implant and have had very good results.

More good results- I spoke to the hospital ombusman and said that their plan to bonus the ED doc for ortho referrals had negatively affected my care. I wanted the policy stopped immediately!  They agreed to do so.

Because revenge can be sweet, Medicare refused to pay for those 11 days, I didn't have to wait 46 months and no lawyers received a penny!

My point in this long story, which may have been lost in the detail, are that many Doctors worry excessively about malpractice. There are many very bad Doctors out there. I don't know if they proportionally end up attracted to ED medicine, or if that happens because small ER's are willing to employ Docs w/o Boards or adequate training. If you are reasonably well trained, able to speak clearly, keep calm under stress and can manage to keep multiple priorities afloat at the same time you can do ER Medicine. To me, the Golden rule needs to be, Do The Right Thing!"
Dyan Dreisbach, MD
"This was an excellent, well-organized and succinct presentation on Quality and Safety Implications of Health IT in the ED.  Your lecture was greatly enhanced by your experience and expertise as a Physician, Professor and Chair Department in Emergency Medicine.   Great lecture concerning IT in the ED regarding communications related to EHR, safety, and the potential to hopefully improve health care, thus preventing safety issues.

Again, another an excellent power point with up-to-date research on Information Technology and  quality and safety implications in the ED.


Valerie Ting, APRN-BC
Nurse Practitioner, Comprehensive Health Center
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