Grand Rounds Recap 7.3.19

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