Parkland hospital streamlines emergency room procedures | News for Dallas, Texas | Dallas Morning News | Life/Travel: Health

Parkland hospital streamlines emergency room procedures | News for Dallas, Texas | Dallas Morning News | Life/Travel: Health
Parkland hospital streamlines emergency room procedures

09:44 PM CST on Tuesday, February 10, 2009

By SHERRY JACOBSON / The Dallas Morning News
sjacobson@dallasnews.com

Parkland Memorial Hospital officials on Tuesday announced changes in emergency room procedures to improve care and reduce long waits.

Included is a new process for evaluating patients entering the ER, allowing them to confer immediately with a nurse or paramedic….

The new check-in process already is persuading patients to stay in the emergency room long enough to receive treatment.

Last month, Parkland said, 14 percent of ER patients left without seeing a physician, compared with the 24 percent who walked away in July.

A 14% LWBS rate would cost most ED groups their contract.  Astonishing this is tolerated.

Those drug-interaction warnings sure are irritating | Booster Shots | Los Angeles Times

Those drug-interaction warnings sure are irritating | Booster Shots | Los Angeles Times
Those drug-interaction warnings sure are irritating
10:30 AM, February 10, 2009

One can imagine how electronic drug-prescribing systems could be annoying to doctors — all those warnings about potential interactions and allergies and whatnot when all you really want to do is give a patient a drug he or she needs and be done with it. It’s probably easier to just ignore the blasted alerts and keep going.

That seems to be what’s happening. In a study published in the Feb. 9 issue of the Archives of Internal Medicine, most doctors simply shrugged off the warnings issued by their helpful electronic systems.

Out of almost a quarter-million medication safety alerts produced during the study period, the doctors involved accepted only 9.2% of the interaction warnings and 23% of the allergy warnings. In other words, they ignored more than 90% of the drug interaction alerts and more than 75% of the allergy alerts.

As a fellow practitioner of blog-snark I’m impressed with the slant of the article, that doctors treating patients ‘ignore the blasted alerts’ and ‘shrug[ged] off warnings’.  As a doctor who uses a very good EMR tool daily I can tell you that a terrific number of the medication alerts given by the system are of such exceedingly minimal value they need to be over-ridden for accurate and adequate patient treatment.

For instance, if a patient reports an allergy to ‘Demerol’ in our EMR, giving Zofran (an anti-emetic) yields an allergy interaction.  It’s a theoretical connection and not founded in reality, or practice.  Want to prescribe pain meds for a patient being admitted? We get an alert that the patient has already been prescribed pain meds, even though the earlier meds were given in the ED (only) and the order in question is for inpatient treatment.  Very helpful.

The LATimes article doesn’t indicate if any harm came to any patients (I certainly hope not), but the finding that practicing docs didn’t heed a zillion electronic drug warnings just means the electronic systems need to tell us when the sky is actually falling, and not squawk continuously without cause.