Monday, January 23, 2012
The treatment of chronic pain has become a very complex and hot topic for providers. Little or no controversy exists about the treatment of acute pain; one just treats as necessary. Acute exacerbation of chronic pain is also less clear.
The goal is to treat patients humanely and appropriately without facilitating drug dependence and drug trafficking.
The pressures are complex and complicated. On the one hand, are those forces that make a physician more reluctant to prescribe pain medication, including:
1. States have created databases that keep, and make available online, records of all controlled medications prescribed, including the DEA number of the prescribing provider
2. Certain states, such as Florida, now require special licensure to treat non-cancer pain chronic pain.
3.Peer pressure from colleagues and support teams who feel everybody is a potential abuser. This puts certain patients with severe, painful conditions in the assumed category of “potential drug abuser”.
On the other hand, the real-time daily forces of clinical practice lead one to be less restrictive in administering pain medication. These include:
1. CMS has made pain a de facto “vital sign” that must be addressed and documented.
2. Patients request pain relief for a variety of complaints that are often very reasonable.
3. Patient satisfaction scores like PRC and Press-Gainey emphasize pain relief. These scores affect contracts, RVU’s and levels of complaint to administrators. The #1 complaint in our ED is that the doctor was insensitive to pain relief and refused treatment.
Monday, January 9, 2012
Time to click—Time to task—Time to everything
The modern tracking board has allowed the provider, the hospital consultants, administration to time multiple events in the ED.
The tracking board can be used to calculate
1. Door-to- Provider
2. Provider to Decision
3. Decision to Admit
4. Decision to Discharge.
5. Door- to End of Event –LOS
6. Last Lab to decision
7. Last x-ray to decision
Using Lean-Six Sigma techniques the ED efficiency can be improved dramatically. The only problem that “quality” is rarely brought into the mix. It is implied that “quality care” is fixed quotient without any variables that can be reproduced in the same time frame every time. After practicing more than 30 years, I am consistently surprised by certain events, results, and outcomes.
"Let the TRACK MEET begin”.