Welch, Shari J. MD
Thomas Edison was one of the most prolific inventors this country has ever known, holding more than 1000 patents when he died. Some of his inventions included the light bulb, of course, the carbon microphone used in early telephones, the quadruplex telegraph, and closer to home for physicians, the fluoroscope.
The average emergency department is full of Thomas Edisons, unsung and underappreciated. Emergency physicians are great at improvisation. Take, for example, these innovations created using supplies on hand:
* Turning a bedpan upside down and placing it under a patient's sacrum to perform a pelvic examination when no pelvic bed is available.
* Using lidocaine in the ear to chase out a cockroach.
* Using a Foley catheter balloon as posterior packing in the nose.
* Using a central line kit to perform a retrograde intubation.
Every day emergency physicians figure out ways to jury rig what they need for their patients. They do this daily in ED processes as well. The 4500 emergency departments in the United States are living laboratories, and each one is trying to solve logistical and operational dilemmas. But the specialty suffers from an inability to have these innovations reach front-line practitioners and having them adopted into practice. This has been called the diffusion of innovation, and health care has a knowledge-action gap.
Peter Viccellio, MD, at SUNY-Stony Brook, for instance, developed the full capacity protocol, also called “adopt a boarder,” in which admitted ED patients being boarded in the ED hallways are placed into beds in hallways upstairs. (Ann Emerg Med 2009; 54:487.) The benefits of the protocol were spelled out in the literature in Fall 2009, but he developed the protocol in 2001! (And first wrote about it in EMN in August 2000: http://bit.ly/Viccellio.) Similarly, in 2005, Annals of Emergency Medicine published a study demonstrating that bedside registration was more efficient than traditional booth registration. (Ann Emerg Med 2005;45:128.) One problem: According to VHA's online data survey, by 2005 75 percent of EDs were already using bedside registration. (“Outstanding ED Performance,” presentation by Jeanne McGrayne, RN, the director of emergency department consulting for VHA, Eighth Annual ED Benchmarks Conference, March 6, 2005, Orlando.)
Many great operational improvements for the emergency department have never seen an editor's desk or a journal page. Todd Taylor, MD, developed a revenue capture protocol, also called the turnstile ED, to pass patients through a kiosk and process their insurance and demographic data at the back end of the visit. Many of the patients presenting to Good Samaritan Medical Center in Phoenix are indigent, but were eligible for state and federal benefits. They simply needed to be signed up properly, and his program did this as a service to the community and as a strategy to make his department financially viable. Thom Mayer, MD, of Best Practices, Inc., started a program called T3: Team Triage and Treatment, which aims to decrease turnaround times and the number of patients leaving without being seen. (Read about T3 in Urgent Matters' Patient Flow Enewsletter [2005;2: http://bit.ly/T3Triage.)
The point is, emergency medicine attracts creative and innovative thinkers. They are crafting new processes, strategies, and techniques every day in 4500 different locations. How can we disseminate these new ideas? How can we bring the work of our Thomas Edisons to front-line practitioners?
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