ABSTRACT
This clinical policy from the American College of Emergency Physicians is the revision of a 2003 clinical policy on the evaluation and management of adult patients presenting with suspected pulmonary embolism (PE).(1) A writing subcommittee reviewed the literature to derive evidence-based recommendations to help clinicians answer the following critical questions: (1) Do objective criteria provide improved risk stratification over gestalt clinical assessment in the evaluation of patients with possible PE? (2) What is the utility of the Pulmonary Embolism Rule-out Criteria (PERC) in the evaluation of patients with suspected PE? (3)What is the role of quantitative D-dimer testing in the exclusion of PE? (4) What is the role of computed tomography pulmonary angiogram of the chest as the sole diagnostic test in the exclusion of PE? (5) What is the role of venous imaging in the evaluation of patients with suspected PE? (6) What are the indications for thrombolytic therapy in patients with PE? Evidence was graded and recommendations were given based on the strength of the available data in the medical literature.
Subject(s)
Emergency Service, Hospital , Pulmonary Embolism/diagnosis , Age Factors , Aged , Decision Support Techniques , Female , Fibrin Fibrinogen Degradation Products/analysis , Fibrinolytic Agents/therapeutic use , Humans , Male , Middle Aged , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/drug therapy , Pulmonary Embolism/therapy , Risk Factors , Thrombolytic Therapy , Tomography, X-Ray ComputedABSTRACT
The purpose of this article is to explore some of the tools and technologies available in operations management in health care in general and in emergency medicine in particular. The intent is to stimulate the reader to explore some of these approaches and tools in further detail. Various theories are noted, but the intent of this article is to be eclectic so as to give the reader a feel for the rich variety of approaches available.
Subject(s)
Emergency Service, Hospital/organization & administration , Models, Organizational , Operations Research , Outcome and Process Assessment, Health Care/organization & administration , Total Quality Management/organization & administration , Cooperative Behavior , Emergency Medicine/organization & administration , Forecasting , Humans , Interprofessional Relations , Patient Care Team/organization & administration , Quality Control , United StatesABSTRACT
BACKGROUND: The microsystem, as agent for change, plays a critical and essential role in developing and deploying the macrosystem's strategic plan. STRATEGIC PLANNING AND MICROSYSTEM THINKING: To effectively deploy a strategic plan, the organization must align the plan's goals and objectives across all levels and to all functional units. The concepts of microsystem thinking were the foundation for the journey on which Overlook Hospital/Atlantic Health System (Summit, NJ) embarked in 1996. Six stages can be identified in the development of the relationship between macrosystems and microsystems. Five critical themes--trust making, mitigation of constraints and barriers among departments and units, creation of a common vocabulary, raising of microsystem awareness, and facilitation of reciprocal relationships--are associated with these stages. NOTES FROM A MICROSYSTEM JOURNEY: The emergency department (ED) experienced Stage 1--The Emergence of a Self-Aware Microsystem--as it created cultural and behavioral change, which included the actualization of staff-generated ideas and an ongoing theme of trust making. In Stage 3--Unlike Microsystems (Different Units) Learn to Collaborate--the ED's microsystems approach spread to other units in the hospital. Collaboratives addressed x-ray turnaround times, admission cycle times, and safety initiatives. SUMMARY AND CONCLUSIONS: The microsystem--the small, functional, front-line units--is where the strategic plans become operationalized.
