Top ER Protocols

Emergency room protocols are generally based on patients' conditions when they appear at the ER. In cases of mass injuries, such as a bus accident, explosion, multi-car pileup or other serious event, an ER accepting patients will usually set up a triage to evaluate patients as they arrive, sending the most seriously injured to the head of the line. Under more ordinary circumstances, hospital-established ERs have protocols for a variety of medical conditions; every hospital establishes its own emergency protocols. Among the most serious conditions are strokes, coronary heart disease and traumatic injury, such as internal injuries, gunshot wounds, broken bones, profuse bleeds and head injuries.

ER Condition Protocols

• Emergency protocols assist ER personnel in evaluating and treating patients.

  The University of Cincinnati's Emergency Medicine Department developed protocol guidelines to assist ER personnel evaluate incoming patients. Working on the premise that an ER cannot anticipate the daily flow of patients, it can predict the quality of patient care provided by ER doctors, the university physicians established guidelines for 20 frequently encountered conditions. Such medical problems as strokes, diabetes, asthma, pneumonia, heart attacks and other circumstances are covered. Similarly, Maine Health in Portland created a series of emergency protocol websites for ER personnel to consult to ensure consistent diagnosis and treatment of commonly encountered conditions.

ER Evaluation Protocols

• Doctors and nurses working together to triage patients can speed up ER wait time.

  At the Missouri Baptist Medical Center in St. Louis, a doctor is on the triage team 16 hours a day. Now a physician and a triage nurse work side-by-side evaluating patients. This protocol has resulted in a decrease in waiting time, and often, the triage doctor is the only physician the patient needs to see. Additionally, the ER has an electronic medical record for each patient in which all the doctors can enter vital information along with the proscribed treatment or needed tests or drugs, as well as nursing staff alerts. These protocols have resulted in improved patient care.

Rapid Intervention Protocols

• Improved technologies and rapid intervention are making ERs more responsive.

  White Plains Hospital in New York has established a series of new protocols that include a resuscitation area for critical cardiac patients, as well as emergency angioplasty and hypothermia treatment for heart attack vicitms; fast response for individuals presenting symptoms of a stroke; an increased number of beds for emergency patients; X-ray equipment in the ER and negative pressure rooms to handle patients with infectious diseases. Parkland Memorial Hospital in Dallas initiated a Rapid Disposition Unit that now has nurses and paramedics consulting with ER patients as soon as they arrive there by keeping the ER staff better aware of patients waiting for treatment. The hospital added 20 nurses and paramedics to accommodate the change, which made an immediate difference. Adding to the ER's efficiency is a re-purposed clinic that now sees non-emergency patients.