Hospitals learn to deal with growing number of very obese patients

From CNN:

Going to the hospital is rarely fun. If you weigh over 300 pounds like Beth Henk, it can be embarrassing.

"I've flipped an exam table -- I sat on the end of it and it just flipped up," said Henk, whose weight peaked at 745. When her son was born three years ago, "I had to sit in the hospital bed the whole time -- the hospital's rocker wouldn't fit my butt."

Today Henk helps Barnes-Jewish Hospital in St. Louis find better ways to deal with the growing number of very obese patients, an issue for many U.S. hospitals. Barnes-Jewish is replacing beds and wheelchairs with bigger models, widening doorways, buying larger CT scan machines, even replacing slippers and gowns.

Last year, patient care director Colleen Becker decided to check the numbers. She looked at a daily hospital census -- about one-third of the 900 patients weighed 350 pounds or more.

Mumps Outbreak in Iowa: "Epidemic"

From AOL:

A mumps epidemic is sweeping across Iowa in the nation's biggest outbreak in at least 17 years, baffling health officials and worrying parents.

As of Thursday, 245 confirmed, probable or suspected cases of mumps had been reported to the Iowa Department of Public Health since mid-January.

The federal Centers for Disease Control and Prevention said it is the nation's only outbreak, which the CDC defines as five or more cases in a concentrated area.

"We are calling this an epidemic," said Iowa state epidemiologist Dr. Patricia Quinlisk, explaining that mumps has spread to more than one-third of the state and does not appear to be confined to certain age groups or other sectors of the population.

EZ-IO Enhancement

From Medgadget:

A press release for Vidacare Corporation states that the company has equipped its intraosseous vascular access system EZ-IO® with lithium-powered driver to replace the alkaline battery-powered drivers used previously.

The new EZ-IO Power Driver addresses the single biggest concern associated with using a battery-operated device in an emergency situation: the condition and reliability of the batteries. By using a lithium ion power supply, emergency personnel can complete 500 to 750 EZ-IO insertions--more than 10 times the insertions they could make using alkaline batteries. Additional attributes of the lithium battery upgrade include an increased shelf life to 15 years, a 10 percent increase in torque over alkaline batteries, decreased battery weight and elimination of the linear decline in battery performance associated with alkaline batteries. Vidacare anticipates that the user should not have to change the lithium batteries over the life of the product, thereby making it a hassle-free battery-powered device.

Australian EMS Technology

From ARNnet:

Victoria's Metropolitan Ambulance Service has issued its paramedic teams with fully ruggedized Panasonic CF-18 Toughbook laptops for use across its entire fleet of 160 ambulances.

The Toughbooks will be used primarily in tablet PC form and will run a software program called Vacis (Victorian Ambulance Clinical Information System), which the ambulance service designed and developed to assist paramedics by simplifying the process of capturing patient data for further analysis and reporting.

The Toughbooks will also hold information to help paramedics whilst they work including clinical practice guidelines, animated work instructions, training materials and the eMIMS electronic drug database.

Now, paramedics using Vacis provide the hospital with a paper copy of the patient care record, which is printed in the ambulance or at the hospital using the 802.11 wireless and Bluetooth features of the Toughbook. A future enhancement to Vacis will enable the patient care information to be wirelessly transferred direct to the hospital emergency department's information system.

Hospitals Train Staff with iPods

From the BBC:

Two hospitals in Glasgow are using iPod music players to train staff.
The gadgets give new recruits an "audio induction" to the workplace, which is followed by a computer-based test.

Hopital managers at NHS Greater Glasgow say the iPod tours can be used to train staff on issues like superbugs, moving patients and coping with violence.

The iPods are being used in operating theatres at Glasgow Royal Infirmary and in the labour ward and neonatal unit at the Princess Royal Maternity Hospital.

They are also being introduced at the Western Infirmary's Accident and Emergency department.

Most ER Patients Are Insured, Study Says

From the LA Times, referencing a study by ACEP:

Challenging a common notion that uninsured patients are clogging hospital emergency rooms, a new study has found that the vast majority of adults who turn up there frequently have health insurance and regular doctors.

The finding suggests that expanding health coverage will not by itself significantly help emergency rooms cope with demands that include patients seeking care for routine problems such as colds or sinus infections, experts said.

The uninsured account for just 15% of emergency-room visits, according to the study to be published today by the American College of Emergency Physicians. The nonprofit organization advocates for the interests of emergency-room doctors and supports medical research.

Emergency rooms are crowded because they fill up with patients who cannot get in to see their own doctor or are waiting for regular hospital beds, experts said.

"We've cut hospital budgets so much, the only way they can be efficient is by operating as close to capacity as possible, like airlines," said Sandra Schneider, head of the emergency medicine department at the University of Rochester in New York.

The study confirms earlier findings that have begun to change scholarly thinking about the cause of emergency room crowding.

Healthcare providers assumed until recently that uninsured patients were the primary cause of crowding, said Diane Jacobsen, a director at the Institute for Healthcare Improvement in Cambridge, Mass., who did not participate in the study. Most doctors are free to turn away patients who cannot pay, but emergency-room doctors must see everyone.

Over the years, however, research has indicated that the problem is broader and more complex. "We often focus on the ER as the problem, when the ER is a symptom of the problem," Jacobsen said.

Course Educates Docs on Malpractice Issues

From the Seattle Post-Intelligencer via Symtym

Except for a crop of gray hair, the enrollees in Sean Byrne's malpractice course at the University of Richmond Law School look like normal students. They sip Starbucks coffee and tap out notes on their laptop keyboards. And with lumpy hair and bleary eyes, a few looked like they rolled out of bed after a few hours of sleep.

But instead of suffering the effects of late-night study, some of them might have come off a long night at a hospital. That is because more than half the students are physicians, many of them in obstetrics or other specialties at high risk for malpractice lawsuits. Some have been sued; others say it's only a matter of time.

"I'm shocked at what is part of my life that nobody ever taught me about," said Dr. Shannon Weatherford, an obstetrician in Richmond who is taking the Saturdays-only class. "Four years of medical school and four years of residency, and there's nothing about the business of medicine and the legal aspects. This is just a single, terrific opportunity to get educated on something I should know about."

Much of the interest in the course was sparked by soaring premiums and growing insurance losses from malpractice claims that have led to calls for tort reform (though some critics have accused insurers of overstating these losses).

Fewer physicians offer free care

From CNN:

The percentage of physicians who provide free care to the poor has dropped over the past decade, signaling a growing problem for the uninsured, a survey suggests.

About three-quarters of physicians provided charity care in the mid-1990s, compared with about two-thirds now, according to a study released Thursday by the Center for Studying Health System Change.

The numbers have declined across all major specialties. The highest rate of free care, 78.8 percent, comes from surgeons, perhaps because many of these doctors treat uninsured patients in emergency rooms.

Just over 60 percent of pediatricians provided free care, the lowest rate among the specialties. That could be because children are more likely than adults to have insurance coverage.

"With fewer physicians providing charity care, it's going to drive more uninsured people to seek care in hospitals emergency rooms," Cunningham said. "Care in emergency rooms is more costly, it's less efficient."

Detonator on the Cot...

From 14WFIE (Evansville, IN) , emphasis added:

Three employees of the Crane Naval Surface Warfare Center were hurt Tuesday when detonators they were unpacking detonated prematurely.

Base officials said the employees were treated initially at Crane's medical facility and were reported to be in stable condition. Local news reports said at least two employees were transferred to a Bloomington hospital. The injured workers' names and conditions were not immediately available.

When a fragment of a detonator was discovered on a cot used to transport one of the injured workers into the hospital, it prompted a partial evacuation of the emergency room out of fear it could lead to further injury. Crane is about 30 miles southwest of Bloomington.

Waist packs track ER patients

From Boston.com, via Symtym:

Emergency room doctors and nurses at Brigham and Women's Hospital are getting some high-tech help watching vital signs and rapidly locating patients in the waiting room.

Under a trial funded by a $3.1 million grant from the National Institutes of Health, the hospital will today begin distributing 10 waist packs to patients that contain sensors, transmitters, and tracking gear. The packs will allow medical staff to constantly monitor patients' heart rates and blood-oxygen levels while they await treatment.

If a patient needs immediate attention -- or collapses in the vicinity of the emergency room -- an ultrasound tracking beacon will instantly give caregivers the patient's exact location. If successful, the units could be commercialized to be used to help handle large numbers of patients in major disasters.

''We wanted some way to monitor patients and track where they were," said Dr. Thomas Stair, a Brigham and Women's emergency physician coordinating the project.

Patients' vital signs will be picked up by a three-lead electrocardiogram and a finger sensor and fed into a personal digital assistant (PDA), then transmitted to a server that will display the information for nurses to monitor.

An ultrasound transmitter will send location information to receivers in the walls of the emergency room, halls, and restrooms. Ultrasound receivers transmit the signals to a computer that stores information about a patient's movements, according to a program written by MIT scientists.

''This system will tell us heart rhythm, oxygen saturation, and where they are so we can respond better to codes," Stair said.

Fire Marshal Cites WakeMed For Overcrowding

From NBC17.com (Raleigh, NC)

The Raleigh fire marshal issued WakeMed on New Bern Avenue a citation last week because hospital beds were crowding the hallways in the emergency room.

Over the last two weeks, the hospital has been operating at 120 percent capacity.

"At one point last week, we got to the point where we were going to have to early discharge the moms of newborns and let them stay in a hotel," said Debbie Laughery, a WakeMed spokeswoman.

At another point, the hospital's emergency room became so overcrowded that patients were placed on beds and put in the hallway. Someone called the fire marshal, who came down and hit the hospital with a citation.

"We were doing everything in our power to provide the absolute best care possible under really, really busy, busy times," Laughery said.

Doctors are fallible, just like the rest of us

From the Concord (NH) Monitor:

My mother-in-law died 11 years ago. But the recent death of John Arsenault brought it back to me again. The hospital staff sent Arsenault by cab from the emergency room to a local homeless shelter. Six hours later, the shelter staff, concerned by his inability to sit or stand, called an ambulance to take him back to the hospital, where he died.

I can imagine the shock and anger of his family on learning of his death. I still remember the look on my husband's face when at last he arrived home from the hospital that long ago Sunday. He was pale with grief and misery. But beneath his sadness lay a quiet fury aimed at the emergency room doctor.

Successful CPR Save in Canton, IL

From the Canton Daily Ledger:

During the 12 minutes it took for emergency services to arrive, the dispatcher talked Curtis through CPR and helped him try to save his mother’s life. Curtis doesn’t remember getting tired throughout the ordeal.

Rescue personnel took over for Curtis. They immediately loaded her into an ambulance and took off for Graham Hospital in Canton. One of the members of Buckheart Rescue Squad stayed with the children until someone could come get them.

Robot Nurse's Aide

Had to post it, simply because the picture's so cool...
From Medgadget:

Japanese-led research team said it had made a seeing, hearing and smelling robot that can carry human beings and is aimed at helping care for the country's growing number of elderly.

Croup and Humidity

From Forbes:

A time-honored treatment to ease the seal-like bark of croup is to bring your child into a steamy bathroom or run a cool-mist vaporizer in her room until symptoms subside.

However, a new study suggests that these measures probably won't have much effect on croup symptoms.

"The use of humidity failed to show any improvement in croup symptoms," said the study's lead author, Dr. Dennis Scolnik, an associate professor at the Hospital for Sick Children and the University of Toronto in Canada.

Results of the study appear in the March 15 issue of the Journal of the American Medical Association.

Croup, which is the swelling of the tissues around the voice box, is actually a response to a viral or bacterial infection rather than a distinct illness. Croup is characterized by a cough that often sounds like the bark of a seal. Sometimes, the inflammation can get so bad that it obstructs the airway.

Croup caused by viruses is one of the most common causes of upper airway blockage in youngsters, affecting as many as 5 percent of children under 6 years old, according to the study.

The idea behind the use of humidity is that the moisture would soothe the irritated airway and thin mucous secretions, making breathing easier. However, Scolnik said there's no good scientific evidence available to support the use of humidity.

Medicaid and ER's in Missouri

From the Kansas City Star:

Medicaid cuts enacted last year have led some low-income Missourians to reduce their spending on food and utilities to pay for their health care, according to a survey released Tuesday.

The report suggests the state should monitor the effects of the Medicaid cuts on people and on government, including whether the cuts lead to greater use of emergency rooms. When asked how they planned to get health care, 46 percent of the survey respondents affected by the Medicaid cuts said they planned to go to a hospital emergency room.

ER Medicaid Boost in NY

From WCAX.com:

Hospitals may be getting more money for emergency care for the poor.

For the first time in 15 years, both the Republican-led Senate and Democratic-controlled Assembly have raised the per-visit rate.

The current rate for Medicaid patients is 95 dollars. The proposed rate would be 150 dollars.

Lawmakers estimate the rate increase would cost 23 (m) million dollars.

Hospital advocacy groups say raising the rate will free up money to improve care in other areas.

The cost of an emergency room visit is now estimated at 400 dollars.

Emergency rooms are often used by the uninsured and poor for a range of medical care.

EMS Week May 14-20

From ACEP:

The American College of Emergency Physicians (ACEP) today announced the 33rd annual Emergency Medical Services (EMS) Week will be celebrated throughout the nation May 14-20, 2006. The event brings together local communities and medical personnel to publicize safety and honor the dedication of those who provide the day-to-day lifesaving services of the medical “front line.”

National EMS Week will feature hundreds of grassroots activities coast-to-coast that will be planned around this year’s theme, “EMS: Serving on Health Care’s Front Line,” which underscores the commitment and dedication of the 750,000 EMS providers who serve their communities.

"As this year’s theme emphasizes, the brave men and women who serve as EMS providers are often first on the scene of a disaster, a motor vehicle crash or other event that may place them in a hazardous environment," said Dr. Frederick Blum, president of ACEP. "It’s important that we take the time to honor these front line medical responders for often going above and beyond the call of duty to save lives, while risking their own."

Resuscitation Outcomes Consortium (ROC) Hypertonic Saline with Dextran

From JEMS (the University of Iowa is part of this study):

The ROC consists of 10 resuscitation centers and one coordinating center. It's working on collaborative prehospital and early hospital clinical trials looking for instances of cardiopulmonary arrest and life-threatening trauma. Sponsors for this initiative include the National Heart, Lung and Blood Institute, the U.S. Department of Defense, the Canadian Institutes of Health Research, and other institutes within the National Institutes of Health.

In the fall of 2005, randomized control trials began to study clinical outcome in trauma patients in hypovolemic shock (BP 90) and severe brain injury (GCS 8). Patients have been randomized into three treatment groups:

1. 250 cc normal saline (0.9%);
2. 250 cc hypertonic saline (7.5%); and
3. 7.5% hypertonic saline with dextran (HSD, a synthetic colloid volume expander).

The inclusion criteria for the hypovolemic shock group are blunt or penetrating trauma, prehospital SBP 90 (about 30% loss of volume) and age 15 years (or weight > 50 kg if age is unknown).

Inclusion criteria for the traumatic brain injury group are blunt trauma, prehospital GCS 8 and prehospital SBP > 90 and age > 15 years or weight > 50 kg. Any patients who have both a GCS 8 and SBP 90 will be counted in the hypovolemic shock group but will have neurological outcome assessments.

The exclusion criteria for both groups are known or suspected pregnancies; age < 15 or weight < 50 kg; ongoing prehospital CPR; receipt of more than 2,000 cc of crystalloid, colloid or blood products; severe hypothermia, drowning or hangings; burns > 20% of TBSA in adults or 10% in children; isolated penetrating head trauma; and inability to gain IV access in the field.

The primary outcome measures are survival to discharge for the hypovolemic shock patients, and neurological outcome in the brain-injured patients.

MDCalc

From Medgadget:

Well medbloggers, the time is here. Readers, meet MDCalc, The Clinical Calculator. MDCalc, meet the readers. MDCalc is a free website to help you do the medical calculation grunt work.

I got tired of wading through Google searches to find a calculator for all those medical calculations that you often have to use, but don’t use often enough to remember: the A-a O2 Gradient, the Calcium Correction in Hypoalbuminemia, the FENa, the MDRD. And countless others. (Easy ones, too, including the BMI and a patient age calculator.) I’m going for the Guiness Book of World Records, Most Medical Equations on One Website.

I’ve also included a number of scores and risk calculations, including the Framingham Cardiak Risk, the PORT Score/Community-Acquired Pneumonia Severity Scale Ranson’s Criteria for Pancreatitis and the Strep Pharyngitis Probability Score. Not to mention the TIMI Scores.

You can even download the equations to your PDA.

So please try out the site, and tell me what you like, what you don’t, and what I’m missing. Feedback is greatly appreciated! And if you feel like it’s worth a link, please link to it on your blog!

Plavix + Aspirin: Impairment rather than improvement?

From CNN.com:

Some people taking the blood thinner Plavix on top of aspirin to try to prevent heart attacks, as many doctors recommend, now have good reason to stop.

The drug combination not only didn't help most people in a newly released study, but it unexpectedly almost doubled the risk of death, heart attack or stroke for those with no clogged arteries but with worrisome conditions like high blood pressure and high cholesterol.

"They actually were harmed," said Dr. Eric Topol. "This was a trial to determine the boundaries of benefit, and it did. You don't use this drug for patients without coronary artery disease."

Anyphylaxis Underdiagnosed, Undertreated?

From Medpagetoday.com:

Life-threatening anaphylactic reactions to foods are under-diagnosed and under-treated, both in the community and in the emergency room, according to researchers here.

So found two studies -- from Massachusetts General Hospital in Boston and the Albany (N.Y.) Medical College -- that were reported at the American Academy of Allergy, Asthma, and Immunology meeting here.

"Anaphylaxis has for decades been considered a rare disease, even by physicians, even by other health care professionals," said F. Estelle R. Simons, M.D., of the University of Manitoba in Winnipeg, who is president of the American Academy of Allergy, Asthma and Immunology.

But in fact, the rate of anaphylaxis -- not just anaphylactic shock, but any type of acute, severe allergic reaction -- is likely much higher than published estimates, said Dr. Simons, because many episodes of anaphylaxis occur outside the emergency room.

"They experience anaphylaxis at home, at school, at camp, or on a plane or a bus or wherever they may happen to be," she said.

A consensus panel of the National Institute of Allergy and Infectious Diseases defined anaphylaxis as "acute onset of illness (within minutes to several hours) with involvement of the skin, mucosal tissue or both," following exposure to an allergenic substance, combined with one or more of the following: respiratory compromise, reduced blood pressure or associated symptoms of end-organ dysfunction, involvement of skin or mucosal tissues such as hives, and persistent gastrointestinal symptoms."

But even when anaphylaxis is recognized correctly in the emergency room, only about half of the patients receive epinephrine to treat it, although about a quarter of all such patients have symptoms serious enough to require hospitalization, reported researchers at Massachusetts General Hospital and Harvard Medical School.

Teamwork Saves a Young Man's Life in Marshall, MN

News from one of our affiliated facilities, in Marshall, MN. From the Independent:

As a member of the Marshall hospital board of directors, Mike Rich has been involved in improving the hospital’s high-tech abilities — making it faster for local doctors to share emergency information with doctors at other hospitals.

A month ago, Rich found out exactly how important the changes he’s pushed for have been: They saved his son’s life, he believes.

“The ER doc knew we had to get him out immediately,” Rich said.

Rich had been to the ER before Matthew’s accident. With Matthew, the ER situation was different because it had been just over a year since Avera Marshall switched to a on-staff ER doctor 24-hours-a-day, seven days a week.

The change from an on-call doctor to a doctor always in the ER was expensive-about $800,000 in a contract, Rich said.

But on Feb. 2 Rich knew it was worth every dollar.

“The doctor was really a super guy,” Arlene Rich said of Dr. Scott Goecke.

Quebec teen didn't die from kissing boy who ate peanut butter snack: coroner

From Canada.com:

A fifteen-year-old girl with a severe peanut allergy did not die from kissing her boyfriend after he ate a peanut butter snack, said local coroner Michel Miron.

The story made headlines around the world and Miron said he wants people to know that a peanut butter sandwich didn't cause the death of Christina Desforges last November.

Miron wouldn't reveal the cause of death in an interview with the Saguenay-Lac-St-Jean Le Quotidien newspaper because he hasn't yet submitted his final report to the provincial coroner's office. He also said he is waiting on some final test results to confirm the cause of death.

He wasn't available on Friday to comment further on the circumstances of the teen's death in this small city, about 250 kilometres north of Quebec City.

A reporter for Le Quotidien, the newspaper that first reported the story, said Friday it was the media that focused on peanut butter as the culprit after ambulance attendants, an emergency room doctor, and the girl's mother suggested it could be the cause due to her allergy.

"But no one at the scientific level was able to succeed quickly at confirming the cause (of her death)," said Louis Tremblay.

"The proof has now shown that's not what happened," he added.

Study shows few ERs are kid-friendly

From the Toledo Blade:

Your baby is hurt seriously in a car accident and rushed to the nearest emergency room. But once there, doctors can't find the right-sized intravenous line to deliver life-saving medication.

According to results of a nationwide survey of hospital emergency departments, that scenario may occur far more often than the public realizes.

Researchers for the federal Centers for Disease Control and Prevention conducted the survey to gauge how prepared hospital emergency departments are in taking care of children. Some of the findings are startling.

For example, less than 6 percent of hospitals had an adequate range of sizes for pediatric medical equipment, ranging from tiny needles for infants to larger tubes for teenagers.

"Only 5.5 percent of them had everything. That was shocking. I thought there would be more than that," said Kimberly Middleton, lead author of the CDC report that was released this week. Nearly 5,000 hospitals were surveyed - nearly every hospital in the country - and 86 percent responded.

Hospital Study Shows Money Lost on Care

From the LA Times (via Symtym):

Half of the hospitals in a six-county region including Los Angeles lost money on patient care in 2004, according to a report to be released today.

Of 212 hospitals in the region that year, the latest for which figures are available, 107 spent more treating patients than they were able to collect for that care, according to the report by the Los Angeles County Economic Development Corp.

State-mandated nurse-staffing ratios, high property taxes and high numbers of uninsured patients make it "very hard to do business in Southern California," said David Langness, a spokesman for Tenet Healthcare Corp., which operates 12 hospitals in the region, down from 28 hospitals three years ago.

The Hospital Assn. of Southern California commissioned the report, the first of its kind, to gauge the role hospitals play in the region's economy.

The association highlighted the finding that hospitals and related services contributed $85.5 billion worth of wages, purchases and taxes — about 12% of all goods and services produced locally.

Advocacy group registers its first success in defending doctors

From Bizjournals.com

Doctor's Advocate, established last year to help Pennsylvania physicians fight frivolous malpractice lawsuits, scored its first victory this month.
The Pottstown-based organization said it succeeded in getting Dr. Lynne Coslett-Charlton, an obstetrician/gynecologist from Wilkes- Barre, released from a lawsuit filed in December 2004.

In October, Coslett-Charlton sought the help of Doctor's Advocate, which brought in an outside law firm -- Frey, Petrakis, Deeb, Blum & Briggs of Philadelphia -- to help review the case.

In the incident that took place in 2004, Coslett-Charlton met with a woman late in her pregnancy for the first and only time. After an examination revealed serious complications, she sent the patient directly to the hospital. The doctors at the hospital took over treatment. The patient later sued several doctors, including Coslett-Charlton, for malpractice.

After reviewing the lawsuit, Doctor's Advocate demanded that the plaintiff's attorney drop Coslett-Charlton from the lawsuit under threat of a countersuit. The lawsuit against Coslett-Charlton was dropped this month.

"I was upset after being named in the lawsuit because I knew that I was not guilty of malpractice," Coslett-Charlton said in a statement. "My case dragged on for over a year. Doctor's Advocate got it dropped in seven weeks."

Doctor's Advocate, launched in August, was founded by Robert B. Surrick, a retired trial lawyer, and Dr. Elliot Menkowitz, an orthopedic surgeon who lives in Pottstown.