Managing Risk Factors in the Emergency Department

Abstract

This chapter aims to provide a comprehensive guide for healthcare professionals on addressing and managing key risk factors associated with chronic and acute illnesses in emergency care settings. The emergency department often serves as a critical juncture where timely identification of risk factors can significantly influence patient outcomes. The scope of the chapter includes commonly encountered risk factors such as hypertension, diabetes, smoking, alcoholism, and obesity. It offers insights into rapid assessment tools like risk scales and quick lab tests that are practical for an emergency setting. Additionally, the chapter will explore evidence-based interventions for immediate stabilization and risk factor management, emphasizing the need for interdisciplinary coordination. Effective communication strategies for healthcare providers to use with both colleagues and patients will also be discussed. The chapter concludes with recommendations for implementing up-to-date protocols and emphasizes the need for ongoing professional training.

1. Introduction

The environment of the emergency department (ED) is uniquely dynamic and unpredictable, which inherently carries high risks. During a shift, ED personnel may face a wide range of situations, ranging from common cold cases to critical situations of trauma or cardiac arrest demanding intensive resuscitation efforts. In this context, agile decision-making is necessary, understood as the ability to make informed and timely decisions in an environment where every second counts. This highlights the need for speed, efficiency, and accuracy in the assessment, diagnosis, and treatment of patients [1].

Proper management of clinical risk factors is essential in this setting, especially due to the often-overwhelming flow of patients. This management involves the identification, evaluation, and control of risks associated with medical care in the ED, including the risks of infections, medication errors, and other complications that may arise. Effective management of these risks can not only make a significant difference in the clinical evolution of patients, aiding in avoiding major complications and promoting a quicker recovery, but can also result in a notable reduction of costs associated with medical care. Complications arising from poor management of risk factors can generate a considerable economic burden due to extended hospitalizations, additional treatments, and additional resources needed to address these complications. Therefore, adequate risk management is essential not only from a clinical perspective but also an economic one, contributing to the optimization of available resources and the sustainability of the healthcare system [2].

Various researchers have highlighted methodologies in risk management in emergency medicine. A palpable example is the early identification of sepsis, a critical condition that can be fatal if not treated promptly. The implementation of sepsis protocols, such as the rapid administration of antibiotics and fluids, is essential in these cases [3]. Additionally, effective management of patients with chronic diseases, such as diabetes or heart disease, is crucial to avoid complications arising from hyperglycemic or hypoglycemic crises, where early intervention can prevent severe complications and improve outcomes [4, 5].

In the ED, every decision and action have immediate and long-term implications on the patient’s health. The identification and adequate management of risk factors, such as pre-existing chronic diseases or acute symptoms, are essential to provide effective and safe care [2]. The management of these factors goes beyond the treatment of the presented conditions; it includes the anticipation and mitigation of possible complications. Effective risk management requires a systematic approach that allows for accurate documentation and treatment of the patient, minimizing unexpected errors and thus improving patient outcomes in this critical environment [6].

The dynamics in this Department are unique, with a fast pace and crucial decisions made within a very short span. Each patient entering the doors represents a set of risks that need to be evaluated and managed effectively to ensure appropriate and timely treatment. Interaction with the patient in the ED is a critical opportunity to identify and address risk factors that could adversely affect their health, both in the short and long term. A proactive approach to risk management can facilitate a smooth transition of the patient towards a complete recovery and reduce the likelihood of readmissions. For instance, effective communication between ED personnel and the patient, along with proper follow-up upon discharge, can help manage risks more effectively and improve patient satisfaction [7]. This communication can include clear explanations of diagnoses, treatments, and steps to follow discharge, as well as establishing an open channel of communication for any queries or concerns that may arise later.

2. Risk factors in the emergency department

2.1 Patient inherent risk factors

In the emergency department, effectively managing patient-specific risk factors is key to providing personalized medical care and forecasting clinical outcomes. These factors encompass a broad spectrum, including preexisting health conditions and psychosocial attributes, each playing a significant role in patient assessment and treatment strategies.

At the outset of discussing risk factors in the ED, it’s beneficial to refer to Table 1, which provides a concise overview of common risk factors encountered in this setting. Chronic illnesses such as diabetes and heart disease are particularly impactful in emergency settings. For instance, a diabetic patient may present with a life-threatening hyperglycemic crisis, necessitating immediate intervention and careful ongoing glucose monitoring. Understanding a patient’s comprehensive medical history, including previous surgeries, allergies, and current medications, is vital to prevent adverse drug interactions and to fully grasp their health status. For example, a patient with a history of allergic reactions to certain antibiotics will require alternative treatment options.

Risk Factor	Prevalence	Warning Signs	Initial Management Strategies
Hypertension	Very common	Elevated blood pressure, headache	Blood pressure measurement, administration of antihypertensives
Diabetes	Common	High/low blood sugar levels, excessive thirst, fatigue	Glucose monitoring, administration of insulin or hypoglycemics
Heart Diseases	Common	Chest pain, shortness of breath, fatigue	ECG, administration of heart medications, oxygen
Trauma	Variable	Visible injuries, pain, bleeding	Stabilization, pain management, blood loss prevention
Acute Infections	Common	Fever, chills, signs of infection	Cultures, antibiotics, fluid support
Pulmonary Disease	Moderately common	Cough, difficulty breathing, wheezing	Pulse oximetry, bronchodilators, steroids

Table 1.

Common risk factors in the emergency department.

ECG: Electrocardiogram; BP: blood pressure.

Age-specific considerations are also crucial. Pediatric patients may present with symptoms that differ significantly from adults, like fever in a child potentially indicating a more severe infection. Similarly, elderly patients often have multiple comorbidities, making them more susceptible to adverse reactions from standard emergency treatments.

Psychosocial and behavioral elements play a pivotal role in medical management. A patient experiencing high stress or anxiety levels, for instance, might exhibit heightened pain sensitivity or have a panic attack, mimicking more serious conditions like myocardial infarction. Substance use can further complicate diagnosis and treatment, as in the case of an intoxicated patient who might require a different approach to pain management or may not accurately report symptoms.

Finally, individual physiological responses and genetic predispositions are key considerations. A patient with a genetic predisposition to clotting disorders, for example, might require a different approach to managing a suspected deep vein thrombosis. Such personalized health variations call for tailored diagnostic and treatment strategies to ensure effective and compassionate care in the ED.

2.2 Environmental risk factors

In the emergency department, environmental factors play a critical role in determining the quality and effectiveness of medical care. A primary challenge is managing patient overload, which often leads to extended waiting times and can delay urgent treatments. This issue not only tests the staff’s ability to manage patient flow efficiently but also impacts the timeliness of care delivery.

The availability of key resources, such as essential medications and medical equipment, directly affects treatment capabilities. Limited resources can constrain treatment options, leading to delays in care provision. Equally important is the staffing level in the ED. Both the number of staff and their level of training are crucial; shortages or lack of adequate training can compromise the quality of care provided.

The physical layout and infrastructure of the ED also significantly influence care delivery. An effectively designed ED can enhance workflow, increase efficiency, and improve patient safety. Conversely, poor design may impede effective care delivery and compromise safety. Additionally, the work environment in the ED, often marked by high stress and chaos, can affect both staff decision-making abilities and their capacity to focus on patient-centered care.

Effective health information systems are essential for ensuring efficient communication and coordination of patient care. These systems facilitate the sharing of critical patient information among healthcare professionals, aiding in more informed decision-making.

Lastly, strict adherence to safety protocols and infection prevention measures is paramount in maintaining a safe environment for both patients and staff. For example, during the COVID-19 pandemic, EDs that implemented rigorous infection control measures, such as separate triage areas for suspected cases, effectively minimized cross-infection risks.

2.3 Clinical risk factors

In emergency medicine, effective decision-making and treatment hinge on recognizing and managing clinical risk factors. These include the presentation of acute symptoms and potential complications during medical care. For instance, symptoms like chest pain or breathing difficulties demand immediate assessment as they may signal life-threatening conditions. A prompt and accurate diagnosis is essential to prevent inappropriate treatments and mitigate the risk of adverse outcomes.

In the emergency department, treatment complications such as adverse drug reactions or problems arising from invasive procedures can significantly elevate clinical risks. A case in point is the management of a heart attack, stroke, or sepsis, where rapid and accurate intervention is critical. Such situations underscore the importance of vigilant monitoring and strict adherence to established medical protocols. Moreover, coordinating with various medical specialties is key in providing comprehensive and effective treatment.

Additionally, managing the risk of infectious disease transmission is a paramount concern in the ED. Implementing strict infection control measures, including proper isolation procedures, is crucial in preventing the spread of infections to both patients and healthcare staff. This aspect was particularly highlighted during the COVID-19 pandemic, where EDs worldwide adapted their protocols to manage the heightened risk of virus transmission.

Overall, managing clinical risk factors in the ED is a dynamic and critical aspect of emergency medical care, essential for ensuring patient safety and achieving optimal clinical outcomes.

2.4 Communication risk factors

Effective communication in the emergency department (ED) is crucial for delivering high-quality care. Miscommunication can lead to incorrect clinical decisions or treatment delays, especially during critical times such as shift changes or patient transfers.

For instance, consider a scenario where a patient’s allergy information is inaccurately communicated during a shift change, leading to an avoidable adverse reaction. This highlights the importance of clear, concise, and accurate information transfer among healthcare professionals.

Communicating with patients and their families is equally important. Providing clear explanations about diagnoses, treatment options, and care plans is vital for informed consent and treatment adherence. Effective communication in these areas not only aids in medical decision-making but also helps alleviate patient and family anxiety, boosting overall satisfaction.

Handling sensitive situations, such as delivering difficult news or discussing end-of-life care, requires empathy, respect, and clear communication. This aspect of communication is critical for maintaining trust and providing compassionate care.

Developing communication skills among ED staff is therefore essential. Regular training sessions, role-playing scenarios, and feedback mechanisms can help staff enhance these skills. Additionally, implementing clear communication guidelines and utilizing efficient health information systems can play a significant role in mitigating communication-related risks. For example, electronic health records that are easily accessible and updateable can ensure that critical patient information is accurately recorded and shared.

2.5 Systemic risk factors

Structural and organizational elements play a pivotal role in the quality and safety of emergency care. These elements include the implementation of evidence-based protocols and effective coordination among various medical services. The absence of standardized protocols can lead to variability in patient care, compromising both quality and safety. Consistently applied, evidence-based protocols ensure that staff across the board manage emergencies effectively, adhering to the best current practices.

One case illustrating the importance of protocol standardization involved a large urban ED that implemented a new stroke protocol. This protocol streamlined the process for identifying stroke symptoms, expedited imaging, and facilitated faster treatment decisions. As a result, the department saw a notable reduction in door-to-treatment times for stroke patients.

Effective coordination within the ED and with other hospital units is another critical factor. Poor coordination can lead to delayed treatments and negatively affect patient outcomes. An example of improved coordination can be seen in a regional hospital where the introduction of an integrated patient transfer system reduced wait times and improved patient flow, directly impacting the quality of care and patient satisfaction.

The integration of health information systems is essential for systemic risk management. These systems improve communication among healthcare professionals, ensure the accuracy of patient records, and enhance the efficiency of workflows. They provide quick, reliable access to patient information, crucial for making informed decisions in high-pressure situations. For instance, an ED adopted an advanced electronic health record system, which led to improved patient tracking, reduced medication errors, and enhanced overall treatment efficiency.

Adapting rapidly to the evolving needs of the ED, particularly during public health crises or disasters, is vital for efficient and safe care delivery. An example of this adaptability was seen during a recent pandemic when an ED quickly expanded its capacity and implemented new infection control protocols, effectively managing the surge in patient volume while maintaining safety standards.

3. Methodologies and tools for risk Management in the emergency department

In the emergency department, where situations change rapidly and unpredictably, the implementation of robust risk management methodologies and tools is critical. These strategies enable swift and precise patient assessments and foster effective responses to critical conditions. This section examines widely used methodologies and cutting-edge tools that bolster effective risk management and how their implementation can elevate patient outcomes and enhance operational efficiency.

3.1 Risk assessment methodologies

3.1.1 Triage systems

Triage systems like the Emergency Severity Index (ESI), Figure 1, are pivotal in assessing patient acuity and determining treatment priorities. These systems aid in categorizing patients based on the severity of their conditions, ensuring that those in most need receive immediate care. Recent studies, such as the one featured in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, highlight how the implementation of such triage systems has led to improved patient outcomes in specific emergency situations like trauma, stroke, sepsis, and acute coronary syndrome. These findings underline the crucial role of triage systems in not only streamlining patient flow but also in significantly enhancing the quality of care and patient safety in emergency settings [9].

Figure 1.

Standard emergency severity index triage algorithm for adults [8]. HR, heart rate; RR, respiratory rate; SpO2, oxygen saturation.

3.1.2 Clinical decision rules

Tools like the Ottawa Ankle Rules or the HEART Score for chest pain evaluation guide clinicians in making evidence-based decisions, thereby reducing unnecessary diagnostics while ensuring patient safety. These decision rules, as part of systematic approaches to assessment and risk management, have been instrumental in the effective identification and management of clinical deterioration in the ED. The same study emphasizes that systematic methods following initial triage assessments have emerged over the last decade, significantly contributing to the recognition of deteriorating patients and establishing standards for expected responses [10]. This systematic approach to risk assessment and management aligns with the global priority of enhancing patient safety in emergency care.

By integrating these methodologies and utilizing data from extensive studies, the ED can significantly improve its capability to manage risks, leading to better patient outcomes and heightened operational efficiency. These strategies are not only vital for addressing immediate patient needs but also play a crucial role in fortifying a more structured and reliable emergency care system.

3.2 Data-driven tools

3.2.1 Predictive analytics

Utilizing data analytics to forecast patterns in patient influx, identify high-risk cases, and predict resource needs. For instance, analyzing historical data to predict peak times helps in resource allocation, thus reducing wait times and improving patient throughput.

3.2.2 Electronic health records (EHR)

EHR systems play a vital role in centralizing patient information, enhancing provider communication, and allowing swift access to crucial patient data. These systems improve documentation, facilitate better care coordination, and support decision-making.

3.3 Technology-enhanced tools

3.3.1 Telemedicine

Platforms for telemedicine can speed up consultations with specialists, particularly valuable in remote or understaffed EDs. They broaden patient access to expert care and are pivotal in managing intricate cases, as evidenced by their rising use during the COVID-19 pandemic.

3.3.2 Mobile health applications

Apps assisting in symptom evaluation and preliminary diagnosis can expedite the triage process. They empower patients to manage their health effectively and reduce the burden on ED resources.

3.4 Quality improvement tools

3.4.1 Root cause analysis (RCA)

Performing RCA following adverse events or near misses is vital. This method identifies deep-rooted issues in procedures or systems, paving the way for strategic improvements. It’s a cornerstone of continuous quality improvement initiatives.

3.4.2 Simulation training

Conducting regular simulation drills for various emergency scenarios equips staff to handle a wide range of clinical situations. This training enhances response abilities, minimizes error rates, and fosters team coordination.

3.5 Communication and coordination tools

3.5.1 Centralized communication systems

Implementing systems like radio-frequency identification (RFID) for patient tracking and integrated communication platforms enables seamless coordination among various ED departments. This integration plays a crucial role in optimizing patient flow and resource utilization.

3.5.2 Standardized handoff protocols

Establishing consistent protocols for patient handoffs is key to minimizing information loss and ensuring continuity of care. These protocols are especially important during shift changes or when transferring patients between departments.

By embracing these methodologies and tools, the ED can markedly improve its risk management capabilities, leading to superior patient care and greater operational efficiency. These approaches not only address the immediate needs of patients but also contribute to building a more structured and dependable emergency care system.

Table 2 Comparative Table of Risk Management Methodologies and Tools in the emergency department provides a comprehensive overview, allowing readers to compare the various methodologies and tools discussed, highlighting their respective advantages, limitations, and ideal contexts for use. This comparative perspective aids in understanding the practical applications and potential impact of each tool and methodology within the dynamic environment of the ED.

Methodology/Tool	Advantages	Limitations	Ideal Use Context
Emergency severity index (ESI)	Enables quick patient triage based on severity.	Requires specific training for implementation.	High-volume EDs to prioritize critical cases.
Manchester Triage System	Standardizes patient assessment in urgent situations.	Less effective in extremely high patient volumes.	EDs with staff trained in the UK triage system.
Clinical Decision Tools (e.g., Ottawa Ankle Rules)	Reduces need for unnecessary diagnostic tests.	Specific to certain conditions; not applicable in all scenarios.	EDs for evaluating specific injuries, reducing X-ray burden.
Predictive Analytics (Data Analytics)	Predicts patient influx trends and resource needs.	Requires extensive and accurate historical data.	Large EDs with robust data collection systems.
Telemedicine	Improves access to specialists, reduces waiting times.	Depends on adequate technology and connectivity.	Remote EDs or those lacking onsite specialists.
Simulation Training	Enhances staff skills in realistic emergency scenarios.	Requires resources and time for simulations.	EDs looking to improve preparedness and response in critical situations.

Table 2.

Comparative table of risk management methodologies and tools in the emergency department.

ED: Emergency Department; ESI: Emergency Severity Index.

4. Challenges and limitations in implementing risk management tools and strategies

In the emergency department, effective implementation of risk management tools and strategies is crucial for enhancing patient care and operational efficiency. However, challenges such as resistance to change, technological limitations, training gaps, and regulatory and data security obstacles can complicate this process. In Figure 2, the process of implementing new technologies in the emergency department is outlined. It is essential to navigate through various stages: needs assessment, technology selection, planning, acquisition, staff training, implementation, and ongoing monitoring. This structured approach helps address the challenges and limitations mentioned.

Figure 2.

Process of implementing new technologies in the Emergency Department.

One of the biggest challenges is resistance to change within the ED staff. The introduction of new methodologies and tools may be met with skepticism and reluctance, particularly from those accustomed to traditional practices. This resistance often stems from comfort with existing processes and doubts about the effectiveness of new methods. For example, at Massachusetts General Hospital, resistance to a new triage system was overcome through detailed training programs and feedback sessions that demonstrated tangible benefits of the system, such as reduced wait times and better patient classification. This change management approach emphasizes the importance of clearly communicating benefits and involving staff in the implementation process.

Technological limitations also present a significant barrier in some EDs, especially in rural or less developed areas. Limited access to high-speed internet, outdated hardware, or lack of system integration capabilities can hinder the effective implementation of tools like telemedicine or data analytics systems. Furthermore, staff may lack the necessary technical skills to fully utilize these tools, leading to underutilization or incorrect application. The experience of the University of Pittsburgh Medical Center illustrates how investment in advanced technological infrastructure and specific training in digital tools can significantly improve efficiency in the ED. They implemented an advanced electronic health record system and provided intensive training to staff, resulting in notable improvements in patient management and data accuracy.

Another area of focus is innovation in technology and processes. A prominent example is the use of telemedicine in the ED at Stanford Hospital, which has enabled rapid consultations with specialists and improved patient care in rural areas. This technological innovation has proven to be an effective tool for overcoming geographical and resource barriers.

Training and education gaps are crucial factors for the successful implementation of risk management tools. Without proper training, staff may not fully exploit the potential of these systems or could misuse them, leading to ineffective or suboptimal patient care. Continuous education and training are essential to ensure that ED staff are competent and confident in effectively utilizing these advanced tools.

Navigating the complex landscape of healthcare regulations and compliance requirements presents another challenge in integrating new risk management strategies. Ensuring that these tools and methodologies align with the latest legal and regulatory standards is critical but often complex, particularly with the rapidly changing nature of healthcare practices and technology.

With the growing reliance on digital tools and electronic health records, concerns about data security and patient privacy have become increasingly important. Ensuring the confidentiality and integrity of patient data while using advanced risk management tools is a major challenge that requires robust security protocols and constant vigilance.

To address these challenges, a comprehensive approach is necessary. This includes securing appropriate funding, fostering a culture receptive to innovation, providing thorough training and support, ensuring adequate technological infrastructure, and adhering to regulatory and data security standards. Addressing these issues is vital for the effective implementation of risk management tools and strategies, ultimately leading to improved patient outcomes and more efficient emergency care.

The growing incidence of overcrowding in EDs presents another crucial challenge. A study cited in the “Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine” indicates that, over the past two decades, overcrowding in EDs has become an increasingly common global phenomenon. This overcrowding poses significant challenges as EDs must continue to provide care during periods of high demand and respond to both predictable changes (such as seasonal demand increases) and unexpected changes (such as unforeseen events and varying demand). Overcrowding hampers the ability of ED staff to provide timely, safe, and quality care, extending the time patients spend in the ED and threatening patient outcomes.

This overcrowding phenomenon underscores the importance of effective risk management in EDs, which should address not only the implementation of advanced tools and strategies but also consider how to optimally manage available resources during times of high demand. Challenges include not only technological and budgetary limitations but also the need for operational strategies that can quickly adapt to patient volume changes. Training staff in overcrowding management methods, along with implementing health information systems to improve communication and coordination, are key aspects of addressing this challenge. Furthermore, developing a culture that promotes adaptability and efficiency in managing patients during high-demand situations is essential for improving patient outcomes and maintaining the quality of care in the ED.

Finally, leadership plays a critical role in the successful implementation of new tools and strategies in the ED. Leaders must not only advocate for the adoption of innovations, but also ensure that staff are properly trained and supported during transition periods. The experience at Johns Hopkins Hospital’s ED demonstrates how effective leadership, through the promotion of a culture of innovation and continuous learning, has led to significant improvements in risk management and patient outcomes.

5. Opportunities for enhancing risk Management in the emergency department

The dynamic and challenging environment presents numerous opportunities for enhancing risk management, improving patient care, and operational efficiency. These opportunities span from adopting advanced technologies to developing comprehensive training programs and embracing proactive change management practices.

The integration of emerging technologies like artificial intelligence (AI), virtual reality, and robotics offers transformative potential in the ED. AI systems, for instance, have been implemented in some hospitals to analyze patient data and predict potential deteriorations, thereby aiding in timely interventions. Virtual reality is increasingly being used for training purposes, providing realistic simulations that enhance the decision-making skills of ED staff. Robotics, though in its nascent stages, has begun to show potential in automating routine tasks, allowing staff to focus more on patient care.

Investing in advanced training and education programs is another key opportunity. These programs not only improve technical competencies but also foster adaptability and critical thinking. For example, Johns Hopkins Hospital has developed simulation-based training programs that prepare staff for complex and rapidly changing scenarios, enhancing their ability to manage various emergencies effectively. Additionally, workshops focusing on communication skills are becoming integral, as they are crucial in ensuring clear and effective interactions among staff and with patients.

Proactive change management practices are essential to leverage these opportunities effectively. Developing a culture that embraces change and innovation is critical. Effective leadership plays a vital role in this aspect, encouraging staff participation in decision-making processes and being open to experimenting with and learning from new approaches. A notable example is the Mayo Clinic, where leadership has consistently promoted a culture of innovation, leading to significant improvements in risk management and patient outcomes.

Collaborations and strategic partnerships have also proven beneficial. Partnerships between EDs and academic institutions, technology companies, and other healthcare organizations have led to knowledge exchange, resource access, and the development of innovative solutions in risk management. A case in point is the collaboration between Massachusetts General Hospital and a tech company to develop a predictive analytics tool that significantly improved patient triage and resource allocation in their ED.

Looking forward, the continuous improvement approach, where practices and processes are regularly reviewed and adjusted, will likely lead to significant advancements in the ED. Regular evaluations of implemented strategies and incorporating feedback from staff and patients are crucial for ongoing improvement. The future trends in risk management in the ED might include more personalized patient care approaches, enhanced use of data analytics for predictive modeling, and further integration of technology in everyday clinical practice.

The opportunities for enhancing risk management in the ED are abundant and varied. By leveraging technological innovations, focusing on advanced training and education, adopting proactive change management practices, establishing strategic collaborations, and committing to continuous improvement, EDs can significantly optimize patient care and operational efficiency. These opportunities not only benefit the patients but also empower the ED staff, contributing to a more dynamic, responsive, and rewarding work environment.

6. Conclusion

This chapter has thoroughly explored the critical aspects of risk management in the emergency department, covering everything from the identification of risk factors to the implementation of effective methodologies and tools, as well as the challenges and opportunities present in this dynamic environment. We have seen how technological innovation, advanced training, proactive change management practices, and strategic collaborations can significantly transform risk management in the ED. Looking forward, continuous adaptation and commitment to improvement are essential for evolving and consistently enhancing patient care and operational efficiency in EDs. This chapter provides a solid foundation for understanding and addressing these vital aspects, empowering healthcare professionals to effectively tackle challenges and seize opportunities in emergency care risk management.

Conflict of interest

The authors declare no conflict of interest.

Appendices and nomenclature

ED	emergency department
ECG	electrocardiogram
BP	blood pressure
ESI	emergency severity index
HR	heart rate
RR	respiratory rate
SpO2	oxygen saturation
EHR	electronic health records
RCA	root cause analysis
RFID	radio-frequency identification