Insights from a trip to the ER:
- For even a minor laceration ("only" four stitches), cyanoacrylate-based surgical glues (e.g., Dermabond) will be ineffective unless the site is entirely free of blood. While cyanoacrylates have an advantage in adhesive strength, their toxicity for internal applications, plus this need for bloodless field, seriously limits their potential.
- The involvement of the commonly used blood thinner, Plavix, has a very distinct impact on what would otherwise be minor bleeding. Minor epistaxis, for example, can require an ER or urgent care visit if the patient is on Plavix.
- Digital imaging (x-ray) has a very direct, positive impact on patient care. The ability to obtain a computerized image rapidly that can be readily transmitted from Radiology to the patient record accessible by the ER doc shortens the gap between the x-ray order and the doc’s ability to make a clinical decision based on the results. This improves time and improves the efficiency of the visit as well as the usefulness of the patient record. Imaging difference in quality compared to film is probably relatively insignificant.
- Healthcare, despite many advances, remains fairly inefficient, even in the best facilities. The need for coordination across multiple departments (even between triage and ER units), with patient records, and the lack of point-of-care imaging causes delays in patient care, tying up beds and delaying the clinical decision-making of ER docs. Electronic patient records that are accessible across different points of care (doc offices, ER, etc) would speed care and reduce complications (e.g., patient record always reflecting the most current presciptions and their dosage).
- Peer review of new technology is a necessary check and balance against unproven developments, but still delays the adoption of potentially important new options available to the clinician. Manufacturers have a significant hurdle in penetrating the mainstream, routine use of new technologies, but can minimize this in having a highly focused effort on delivering technology with value that clinicians can readily appreciate for its ability to improve clnical outcome, save time or otherwise improve patient care and the ability with which clinicians can deliver it.
- Mission Hospital in Mission Viejo, CA, has an excellent level of service
I appreciate any feedback others have on heealthcare experience, especially as it may be driven or influenced by technology.