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Procedures in the Emergency Department (35.3)

Procedures in the Emergency Department (35.3) - Policies, Clinical, UWHC Clinical, Department Specific, Emergency Department

35.3


EMERGENCY DEPARTMENT PATIENT CARE POLICY & PROCEDURE





Effective Date:
7/30/2014


X Other: Emergency
Department

Policy #: _35.3_____

X Original
Revision

Page
1
of 3

Title: Procedures in the Emergency
Department

I. PURPOSE

To assure a consistent process for determining the appropriateness of a procedure occurring
in the Emergency Department (ED), with specific attention to the safety and well-being of
the individual patient requiring the procedure as well as the safety and well-being of all other
ED patients.

II. POLICY

A. The nature of some procedures as well as the required time investment make some
procedures inappropriate for the ED, as they negatively impact patient safety and
throughput. Because the ED is prone to overcrowding and can be an unpredictable
environment, the well-being of all patients must be considered when considering
appropriateness of diverting ED resources for specified procedures. The following
circumstances would make the ED not appropriate for a procedure.
1. ED census and acuity- ED is overcrowded and/or the ED census or acuity
prevents Nursing or the ED attending physician from safely assisting,
monitoring or providing sedation for the procedure
2. ED nurse staffing- ED nurse staffing does not allow for a dedicated nurse to
address the required pre-procedural, procedural and post-procedural care of the
patient
3. ED physician staffing- ED physician staffing does not allow for the presence of
a qualified physician during the pre-, intra- and post-sedation phases
4. Duration of the procedure- Duration of the procedure is expected to exceed 45
minutes
5. Type of procedure- The type of procedure and the performance of that
procedure in the ED setting could have a negative impact on the patient
emotionally, physically or psychologically (see Appendix A)
B. If performance of the procedure in the ED has been denied, the consulting resident and/
or attending physician may perform the procedure on the inpatient unit or in the operating
room.















III. PROCEDURE

A. The ED Administrative Attending Physician, the ED Care Team Leader (CTL), and the
treating ED Physician will evaluate the factors listed above before approving a procedure
in the ED.
B. The ED Administrative Attending will notify the consulting resident and/ or attending
physician of the appropriateness of the procedure for the ED setting. If there are any
concerns, the ED Clinical Services Chief and/or the Department of Emergency Medicine
Chair and the ED Director should be contacted for resolution.

1. If the procedure is approved, the ED Administrative Attending Physician, ED
CTL and the physician performing the procedure will agree upon a time for the
start of the procedure. This ensures all resources are available at the appropriate
time and promotes patient safety.
2. If the procedure is denied, the ED Administrative Attending MD will assist the
consulting resident with making other arrangements for the procedure.
a. The admission of the patient will not be delayed while these arrangements
are being made.


IV. UWHC CROSS REFERENCE

A. UWHC Hospital Administrative Policy 8.38, Adult Sedation Policy
B. UWHC Hospital Administrative Policy 8.56, Pediatric Sedation Policy
C. UWHC Hospital Administrative Policy 8.34, Performance of Procedures and Sedation in
the Clinics and Ambulatory Settings












Effective Date:


Administrative Manual

X Other: Emergency
Department

Policy #: ______

X Original
Revision

Page
2
of 3

Title: Procedures in the Emergency
Department




Effective Date:


Administrative Manual

X Other: Emergency
Department

Policy #: ______









V. REVIEWED BY

Director, Emergency Services
Nurse Manager, Emergency Department
Chair, Department of Emergency Medicine
Clinical Medical Director, Department of Emergency Medicine
Director, Pediatric Emergency Medicine

SIGNED BY

_______________________________ ______________________________
Nurse Manager, Emergency Department Clinical Medical Director, DEM


_______________________ _______________________________________
Date Director, Pediatric Emergency Medicine




















Appendix A- List of procedures*


The following list of approved procedures may be denied on a case by case basis based on ED census
and acuity and the required staffing resources to safely perform the procedure.

X Original
Revision

Page
3
of 3

Title: Procedures in the Emergency
Department


*This list is not considered to be a complete list.

Approved Procedures (expected duration < 45 minutes)
ξ simple laceration repair
ξ single, uncomplicated digit amputation
ξ simple fracture or dislocation reduction
ξ foreign body removal ear, nose, digit



Denied Procedures (expected duration > 45 minutes or inappropriate type)
ξ multiple, complicated digit amputations
ξ repeat failed reduction attempts
ξ complex or lengthy laceration repairs
ξ most procedures involving genitalia (i.e. suturing, foreign body)
ξ complex burn debridement
ξ pain control and/or patient cooperation cannot be achieved with procedural sedation
ξ joint irrigation
ξ blood transfusions as primary reason for ED visit
ξ esophageal foreign body with h/o varices