Grand Rounds Recap 6.28.23

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Admit-Transfer-Discharge WITH Dr. Paulsen

  • There are many factors that influence disposition, including independence of the patient and family/friend support, access to follow up, resources at your hospital, and transfer environment 

  • Why Transfer? 

    • Regionalized certified care centers, specialty procedural interventions, higher level of care

  • Why Consult? 

    • Immediate critical interventions needed, procedural interventions outside of EM scope, specific diagnosis/management question, discharge needing close follow-up, “courtesy call”

Breaking bad News WITH Dr. McDonough

  • Pre-SPIKES: Prepare, Setting (including if they want other people in the room or not), Perception, Invitation, Knowledge, Empathy, Summation/Second Touch

  • Medical error disclosure: patients and their families want all errors disclosed that could cause harm, and an apology with the error is appreciated

  • Helpful tips when about to give bad news: 

    • Hand off phones

    • Close door/curtain

    • Know your patient

    • Give brief summary

    • Give warning

    • Say what you know

    • Give space for processing

    • Give a next step

The History of EM WITH Dr. Pancioli

  •  Past 

    • Started as home call for physicians with “emergency room”

    • First residency began at the University of Cincinnati and the specialty of emergency medicine under its own department began in 1977 with a breadth of expansion of scope of practice for emergency physicians.

    • Scope of practice fights includes many common procedures we do today (intubations, chest tubes, central lines), use of POCUS, and even expansion into AirCare. 

    • Primary Board certification was not official until 1989!  

  • Present

    • Barriers that still need to be broken, and our boundaries must be decided by us because of our “Anyone, Anything, Anytime” mentality. 

  • The Future will continue to have threats to the way we practice:

    • Expansion of workforce both with exponential growth of EM residencies and APP hiring in emergency departments makes the workforce “tighter”

    • For profit healthcare has significantly changed the way emergency medicine is practiced

    • ED boarding - how are we going to find the solution(s)?