Wednesday, May 31, 2006

Air Medical Crash

From AOL:

WASHINGTON (May 31) - A medical helicopter crashed on its way to Washington Hospital Center, killing the patient and injuring three crew members.

The patient, Steven Gaston, was being transported from another hospital about 10 miles away and died in emergency surgery late Tuesday after the crash, Washington Hospital Center spokesman LeRoy Tillman said.

The pilot, nurse and paramedic were listed in serious but stable condition with broken bones and tissue injuries, said Dr. Janis Orlowski, the hospital's chief medical officer.

The chopper crashed in clear conditions less than a mile from the hospital on a hilly area of a golf course at the U.S. Soldiers and Airmen's Home.

One witness said he saw the low-flying helicopter and heard it hit a tree about 500 yards from the golf course clubhouse.

"It was lumbering," said Billy Bartlett, who works at the golf course's pro shop. "You knew something wasn't right."

The National Transportation Safety Board and Federal Aviation Administration were investigating.

Tuesday, May 30, 2006

Top 10 Drugs Prescribed by Emergency Physicians in 2005

From "Vital Signs" in ACEP News
Source: Verispan

Zithromax Z-Pak: 961 million
Levaquin: 662 million
Zithromax suspension: 354 million
Zithromax: 310 million
Lipitor: 308 million
Norvasc: 197 million
Ambien: 191 million
Skelaxin: 189 million
Prevacid: 186 million
Toprol XL: 183 million

Physicians' on-call system may have to go through changes or die

From Columbus (OH) Business First, via Symtym:

The Ohio Hospital Association says shrinking reimbursements from insurers, Medicare and Medicaid, increasing malpractice insurance premiums and other factors are combining to discourage physicians from taking on-call assignments.

Physicians serving on-call at hospitals generally don't earn income unless they are actually called into service and the patient or their insurance carrier pays.

An ever-growing number of patients without health insurance showing up in emergency rooms, as well, means physicians treating those patients most likely will not be paid.

Consequently, physicians are increasingly either declining to serve on call at hospitals or attempting to find compensation for being on call, a service traditionally rendered as a courtesy to hospitals at which they hold privileges.

As a result, some in the health-care industry fear that patients will soon face sharp increases in already skyrocketing costs for care - or may end up with limited access to critical specialist care in emergency rooms around the country.

"Doctors are saying, 'if I spend 12 or 24 hours on call, I'd like a certain amount of money because that's impinging on other things - my life, my ability to generate other revenues in practice,' " says Reed Fraley, senior vice president of the Ohio Hospitals Association.

Monday, May 29, 2006

Iowa governor signs malpractice bill

From the Des Moines Register:

Legislation offering a solution to the problem of costly medical malpractice insurance was signed into law Wednesday by (Iowa) Gov. Tom Vilsack.

Under House File 2716, approved by the Legislature late last month, doctors and other licensed professionals will be allowed to apologize for botched procedures and not face those admissions as proof of wrongdoing in court.

Supporters of the legislation say it will permit some patients to get closure from their doctor without having to go to court. They hope that will cut down on medical malpractice lawsuits and help hold down malpractice insurance premiums.

Standards, costs keep docs from digital age


Dr. Brian Zell was an early adopter of electronic health records when he switched his suburban Philadelphia practice to a computerized system five years ago -- but he still uses reams of paper.

Most experts agree that electronic records reduce medical mistakes and cut costs by avoiding duplication, but there is no standardized way to share digital information with other doctors, hospitals or insurers.

At Zell's office in Marlton, New Jersey, doctors and office staff use 13 computers to manage notes on patient care as well as keep insurance and payment records. But they still use paper for referrals, faxing forms and other tasks.

"Until there's a standard technology ... it makes it very difficult for my practice to leap forward," said Zell, an orthopedic surgeon who shares a 10,000-patient practice.

A group of companies hopes to have a prototype of a national health network ready later this year, but there is still a debate over whether doctors need incentives to digitize their practices.

Doc gives patient blood during surgery


A heart surgeon had to take a break from a mercy-mission operation in El Salvador so he could donate his own rare-type blood for his 8-year-old patient.

Dr. Samuel Weinstein said he had his blood drawn, ate a Pop-Tart, returned to the operating table and watched as his blood helped the boy survive the complex surgery.

"It was a little bit surreal," Weinstein said by phone from the Children's Hospital at Montefiore Medical Center in New York, where he is chief of pediatric cardio-thoracic surgery

Sunday, May 28, 2006

"Doctors' Lingo That Leaves You Speechless"

From the Hartford Courant:

It's impolite to speak in a foreign language in front of people who don't know it. For many of us in the medical profession, though, the switch to medicalese just happens, the way French comes back when two Parisian expatriates meet. At lunch with friends, another of whom is a doctor:

Guest: What's with bleeding people? Do you guys ever bleed anyone anymore?

Doctor: Yes. There's a condition called hemochromatosis where bleeding is actually the treatment.

Me: Or CHF. [Congestive heart failure - a type of fluid overload.]

Doc: Ah, just give 'em Lasix. [A "water pill" in IV form.]

Me: What if they're in renal failure? [What if their kidneys aren't working, and they can't make urine?]

Doc: Just dialyze 'em. [Hemodialysis, that is.]

Me: What if the renal fellow doesn't show? Phlebotomize! (Looking around at other guests) Um...Never mind.

At a patient's bedside (as when the expat is back in France, talking to a puzzled tourist): "Your EKG was negative, and your clinical picture and elevated BNP really suggest that your dyspnea was due to CHF - we're diuresing you and giving you antihypertensives."

At least we're not phlebotomizing.

Friday, May 26, 2006

New ACEP CME: Treatment of TASER Injuries

An article associated with Continuing Medical Education (CME)on the American College of Emergency Physician's (ACEP) website:

Focus On: Management of TASER Injuries

Tuesday, May 23, 2006

Specialists Paid to Aid the Uninsured

From the Palm Beach (FL) Post:

In an effort to alleviate the shortage of medical specialists handling emergency cases, JFK Medical Center in Atlantis has started paying doctors for treating uninsured emergency patients.

JFK is setting aside at least $800,000 a year to pay physicians under the program that started last month, said Dr. Ross Stone, an orthopedic surgeon and president of the JFK medical staff.

This gives us an incentive to cover the ER where otherwise we would lose money on indigent patients," he said.

While many South Florida hospitals have recently started paying hard-to-find specialists such as neurosurgeons and hand surgeons a daily stipend for being on call for emergencies, JFK is believed to be the first to directly reimburse doctors for treating uninsured emergency patients. JFK is owned by HCA Inc. (NYSE: HCA; $43.44), the largest hospital chain in the country.

JFK doctors are paid only if uninsured patients don't qualify for Medicaid, the Health Care District of Palm Beach County's Coordinated Care program or other government insurance programs. The doctors are paid a rate based on how much the federal Medicare program pays for the service.

Some doctors say the JFK reimbursement program is fairer than paying physicians a daily stipend for being on call. That's because a doctor who treats a patient with health insurance under that system gets to "double dip" — receive a payment from both the hospital and the patient.

Monday, May 22, 2006

QuickStats: Most Common Diagnoses in Patients Transported by Ambulance to Emergency Departments, by Primary Diagnosis Group

From the CDC, via GruntDoc

During 2003, approximately 16 million ambulance transports were made to emergency departments (30 per minute); 37% of patients transported were admitted to hospitals.

Chest pain
Contusion with intact skin
Nonischemic heart disease
Sprains and strains of the neck and back
Syncope and collapse
Abdominal pain
Drug dependence and non-dependent abuse of drugs
Fractures, excluding lower limb

Friday, May 19, 2006

More info on MIT's SMART

From Medgadget:

After two and a half years of development, the SMART team plans to test its prototype system on actual emergency patients at the Brigham this summer. Each monitored patient would get a fanny pack containing a "pocket PC" from Hewlett-Packard (the iPaq h5500), says Dorothy Curtis, research scientist in computer science and artificial intelligence at MIT.

The device receives data from a blood oxygen sensor on the patient's finger and three electrocardiogram sensors on the chest, then transmits the data via Wi-Fi back to a nurse's station for monitoring. Software at the station issues an alert if a patient's condition changes, Curtis says. The iPaq itself runs in "dark" mode, meaning it doesn't emit beeps or flashes, which might startle the patient.

Also in the fanny pack is a transponder from Sonitor Technologies of Oslo, Norway, that allows the patient to be tracked with ultrasound. The researchers chose not to use radio-frequency tracking transponders primarily because they did not want the tracking signals to travel through walls. With a Sonitor sensor in each room, though, staff immediately know what room a patient is in, Curtis says. "We can't tell what chair you're in, but we can tell if you are in the waiting room versus the restroom or offsite, and that's what we need," Curtis says.

Thursday, May 18, 2006

DNR Tattoo

From GruntDoc:

This is a photo of a tattoo that Mary Wohlford, 80, has emblazoned on her chest. Wohlford, of Decorah, Iowa, got the ink in February to hopefully eliminate the possibility of any Terri Schiavo-esque controversy about her medical wishes should she become unable to communicate them directly. From the Des Moines Register (photo by Mary Chind)

If all else fails, if family members can't find her living will or can't face the responsibility of ending life-sustaining measures, she said, then doctors will know her wishes by simply reading the tiny words that are tattooed over her sternum.

Lack of volunteers threatens rural ambulances


In the past year, three ambulance services have shuttered in a state where about 90 percent of EMTs are volunteers, said Tim Meyer, director of the state Division of Emergency Services.

About one-third of the state's 141 ambulance services are at risk of the same fate, he said. EMTs and officials worry the shortage could hurt the quality of health care, forcing people to wait longer before an ambulance arrives.

"Science will tell you the longer you have to wait when you're having an acute event, the less likely you'll have a positive outcome," Meyer said.

North Dakota is not alone. Volunteer shortages are found in most states, said Jerry Johnston, president-elect of the National Association of EMTs.

"There's been some ... debate about what the issue is with volunteerism," Johnston said. "But a lot of it has to do with the generation of people right now."

Earlier generations had strong feelings of volunteerism and being part of a bigger world, said Mark Haugen, past president of the North Dakota Emergency Medical Services Association.

"We need to rekindle that spirit," Haugen said.

Monday, May 15, 2006

"CardioCerebral Resuscitation"

From MedPage Today:

When performed by EMS personnel, a new approach to cardiopulmonary resuscitation (CPR) substantially improves the survival rate for most patients with out-of-hospital cardiac arrest, according to researchers.

The new approach, dubbed cardiocerebral resuscitation (CCR), emphasizes fast, forceful chest compressions to get blood moving through the body over airway management, said Michael J. Kellum, M.D., of the University of Arizona College of Medicine here.

Compared with standard CPR, the new approach nearly tripled survival rates during a one-year study, Dr. Kellum and colleagues reported online in the American Journal of Medicine.

The Wisconsin Emergency Medical Services Bureau teamed with the University of Arizona researchers to test the new protocol in two Wisconsin counties during 2004 and 2005.

During the previous three-year control period, when standard CPR was used, there were 92 adult patients with witnessed cardiac arrests and an initially "shockable" rhythm. Eighteen of these patients (20%) survived, and 14 (15%) survived neurologically intact.

After the CCR protocol was initiated, there were 33 such patients. Nineteen (57%) survived, and 16 (48%) survived neurologically intact. The differences in both total survival and neurologically normal survival were statistically significant (P=0.001).

With CCR, first responders skip the first steps of the standard protocol: intubating the patient for ventilation and delivering a shock using a defibrillator. While still attaching the victim to a defibrillator, they do not wait for the device to analyze the patient's heart rhythm, but start fast, forceful chest compressions.

"ERs Physicians Give Short Shrift to Out-of-Control Pain"

From MedPage Today:

Patients who go to emergency rooms for out-of-control pain perceive that the treatment they are offered lacks dignity, satisfaction, and effectiveness.

That became evident on the basis of a series of studied reported at the American Pain Society meeting here. The papers described the frustration and dissatisfaction and patients. Instead of obtaining relief, they are rebuffed, disbelieved, or made to wait hours to see a doctor and are sometimes sent away without treatment.

"Much remains to be done in this area," said Knox Todd, M.D., director of the Pain and Emergency Medicine Institute at Beth Israel Medical Center in New York.

He found in a study that included 842 patients arriving at ERs in hospitals across the United States and Canada that:

Patients with pain often have pain score in the moderate to intense levels when presenting to the emergency department—yet it is uncommon that the clinical staff will reassess those pain levels during the hospital stay.

Of the 842 patients, medical records note a pain assessment in 83% of cases—but a second pain assessment occurred in only 31% of cases and just 14% had three assessments.

Analgesics are underutilized. Only 61% of the patients who were surveyed by emergency room personnel—doctors or nurses who contacted the patients to record their experiences—were given analgesics.

Delays to treatment are common. The mean ER wait was 90 minutes.

2005 American Heart Association ECC Guidelines

An excellent overview of the BLS, PALS and ACLS Guidelines changes from JEMS.

What Ethical Issues Face Emergency Physicians? Make Your Voice Heard!

The American College of Emergency Physicians is conducting a survey on ethical issues faced by emergency physicians:

"The ACEP Ethics Committee is conducting a survey of ACEP members to identify important ethical issues and to help guide ACEP in serving member needs.

Please participate by completing a brief research survey about ethical issues in emergency medicine. The survey will take only a few short minutes, and the results will be kept anonymous and confidential."

"Emotion's Defibrillator"

From Medgadget:
"We've spent far too much time covering how bio-sensors will monitor blood sugar, prevent falls, warn of heart attacks, and more. Why not focus on using bio-sensors against humanity?

That seems to be the premise behind Tobias Grewenig's new installation, Emotion's Defibrillator. Well, ok, fine, the artist says it's about the media's affect on our physiology:

The user of the installation, wearing an oxygen mask and a pincer on his left forefinger that will measure his/her pulse, puts his head into a big sphere. By placing the hands on two metalic spheres, the equipment is set in motion. First, bio data such as respiration, pulse and skin resistance are measured by the sensors and sent to the software to define the starting parameters. There are various sources of audio and a screen within the sphere. In relation to the data picked up from the body, the audio resonates, tiny electric shocks are delivered via the metallic spheres while the screen shows a flickering image of the user which is being interrupted by "subliminals". When the user takes the hands off the spheres, the installation stops.

Grewenig says that it's fascinating to observe how the electronic equipment, although basically off-the-shelf material, starts frightening its user and turns into something profoundly unpredictable. This already happens when the sensoric input is roughly at the level of everyday city-life. (Well, plus electric shocks, that is."

Friday, May 12, 2006

Senate Rejects Award Limits in Malpractice

From the NY Times

The Senate on Monday once again rebuffed a Republican effort to limit jury awards in medical malpractice cases, taking the issue — a high priority for both President Bush and the majority leader, Senator Bill Frist — off the agenda for this year.

In back-to-back votes, Republicans fell far short of the 60 senators necessary to proceed on two malpractice-related measures. The first would have capped jury awards in all lawsuits against doctors and health care institutions; the second would have applied caps only to cases involving obstetricians, who have been especially hard-hit by malpractice rates.

Tuesday, May 09, 2006


A tip from Medgadget, here's an excerpt from the Lumitex website:

The VeinViewer™ Imaging System utilizes near infrared light and patented technologies to illuminate subcutaneous vasculature by imaging their location on the surface of the skin. Hailed by TIME Magazine as one of the year's "Coolest Inventions," VeinViewer™ is a mobile biomedical device consisting of the following four components:

Infrared light source - The light source emits a harmless, near-infrared light reflected back to the surface from the tissue surrounding the vein, while no light is reflected back from the blood inside the vessel.

Digital video camera - The digital video camera captures the near-infrared light reflected back from the patient.

Image processing unit - The microprocessor adds contrast and projects this image back on the skin in their actual location.

Digital image projector - Using Texas Instruments Digital Light Processing™ technology, the projector displays these real-time images of the vasculature onto the surface of the skin.

Google Health Debuts This Week?

From Medgadget:

Fueled by a post by Kevin Maney at his blog at the USA Today, rumors of an impending release of Google Health are growing.

SearchEngineWatch focuses on the role of Adam Bosworth, whose title at Google is "Architect, Google Health". Bosworth wrote the old Quattro spreadsheet program, and has a bachelor's degree in History ... so it seems natural he should develop a database of medical histories.

But what about the rumors that Google Health will grade doctors and hospitals? Enroll patients in clinical trials? Diagnose your rash and suggest the right therapy? Stent your occluded coronary vessels?

If Google Health does launch this week, count on to bring you the lastest analysis and opinion on this important development. We usually balance our gadget reporting with our day jobs as physicians -- but if Google Health lives up to the hype, well, we might not have our day jobs in the future...

Monday, May 08, 2006

Location of Cardiac Arrests in the Public Access Defibrillation Trial

From Prehospital Emergency Care via EmergencyMDLinx:

Background. The Public Access Defibrillation (PAD) Trial found an overall doubling in the number of out-of-hospital cardiac arrest (CA) survivors when a lay responder team was equipped with an automated external defibrillator (AED), compared with cardiopulmonary resuscitation (CPR) alone. Objectives. To describe the types of facilities that participated in the trial and to report the incidence of CA and survival in these different types of facilities.

Conclusions. During the PAD Trial, the exposure-adjusted rate of treatable CA was highest in fitness centers and golf courses, but the incidence per facility was low to moderate. Survival from treatable cardiac arrest was highest in recreational complexes, public transportation facilities, and fitness centers.

A leap in faith: the impact of removing the surgeon from the level II trauma response

from the Journal of Pediatric Surgery, via EmergencyMDLinx:

Limitation of resident work hours has created the need to explore alternatives to surgeon presence during initial assessment and resuscitation for selected life-threatening injuries in children. We recently eliminated the requirement for surgeon presence during Level II alerts. The purpose of this study was to evaluate the impact of this change on patient care.

When ED physicians replaced PS for Level II alerts, trauma room length of stay was increased, but use of abdominal imaging was decreased with no differences in rate of missed injury or mortality. Emergency Department physicians can safely replace PS during Level II alerts. These findings may be useful to institutions experiencing surgical workforce limitations for trauma alerts.

Saturday, May 06, 2006

Study: It really does hurt to wait


Anyone who's ever taken a preschooler to the doctor knows they often cry more before the shot than afterward.

Now researchers using brain scans to unravel the biology of dread have an explanation: For some people, anticipating pain is truly as bad as experiencing it.

How bad? Among people who volunteered to receive electric shocks, almost a third opted for a stronger zap if they could just get it over with, instead of having to wait.

More importantly, the research found that how much attention the brain pays to expected pain determines whether someone is an "extreme dreader" -- suggesting that simple diversions could alleviate the misery.

The research, published in the journal Science, is part of a burgeoning new field called neuroeconomics that uses brain imaging to try to understand how people make choices. Until now, most of that work has focused on reward, the things people will do for positive outcomes.

Friday, May 05, 2006

"Wireless in the ER Waiting Room"

From the MIT Technology Review:

Here's a scenario: You find yourself sitting in a local emergency room, or standing in the admitting line of an emergency clinic. But instead of just cooling your heels (and having a cardboard tag tied around your neck, as Gulf Coast clinics did after Katrina), you've been given a fanny pack containing a pocket-sized computer and ultrasound transponder. And wires come out of it, leading to a sensor on your finger and some more on your chest. Now, if something happens -- say, you quietly go into a cardiac arrest -- the doctors will know and can come running.

At least that's the vision of researchers at Brigham & Women's Hospital in Boston, who are collaborating with colleagues from Harvard Medical School and MIT to test what they're calling "Scalable Medical Alert and Response Technology" (SMART).

"In every disaster there is real lag time in keeping track of where the patients are," says Tom Stair, a staff physician at the Brigham hospital. "You have to move one person out as a sicker person comes in, and later you're asking, 'Did she go to x-ray?'"

It's a good idea to track emergency patients even under normal conditions, Stair says. "We've had them wander out of the ER waiting room and collapse in the bathroom, and not be found until it's too late."

After two and a half years of development, the SMART team plans to test its prototype system on actual emergency patients at the Brigham this summer. Each monitored patient would get a fanny pack containing a "pocket PC" from Hewlett-Packard (the iPaq h5500), says Dorothy Curtis, research scientist in computer science and artificial intelligence at MIT.

The device receives data from a blood oxygen sensor on the patient's finger and three electrocardiogram sensors on the chest, then transmits the data via Wi-Fi back to a nurse's station for monitoring. Software at the station issues an alert if a patient's condition changes, Curtis says. The iPaq itself runs in "dark" mode, meaning it doesn't emit beeps or flashes, which might startle the patient.

Also in the fanny pack is a transponder from Sonitor Technologies of Oslo, Norway, that allows the patient to be tracked with ultrasound. The researchers chose not to use radio-frequency tracking transponders primarily because they did not want the tracking signals to travel through walls. With a Sonitor sensor in each room, though, staff immediately know what room a patient is in, Curtis says. "We can't tell what chair you're in, but we can tell if you are in the waiting room versus the restroom or offsite, and that's what we need," Curtis says.

"Bay Area doctor arrested trying to assist critically injured daughter"


Dr. Karl Swanson, an anesthesiologist, with experience treating patients in the emergency room rushed to the scene. His only concern: getting to his daughter and doing what he could to help.

Dr. Karl Swanson, Crash Victim’s Father:
“Because he said she was critical and things didn’t look good… I thought it meant she was dying. I kind of went into the mode of I have to save my daughter’s life.”

Swanson found his 18 year old daughter Krystyna is the back of an ambulance, but when he tried to get inside, was told he had to leave by a State Trooper and Pasco County EMT.

Dr. Karl Swanson, Crash Victim’s Father:
“As soon as I got in there he was basically telling me to get out. I was saying this is my daughter here… and trying to get him to let me stay.”

But according to the Florida Highway Patrol Dr. Swanson became combative, allegedly pushing an E-M-T and state trooper, forcing the paramedics to stop their treatment. Swanson says he never touched anyone and that the trooper was simply trying to take a blood sample to test for DUI before the eighteen year old was flown to the hospital. Dr. Swanson was later arrested, and taken to the Pasco County Jail.

ED Billing Company Employee Allegedly Steals Credit Card Information


A brother and sister were arrested Thursday, accused of robbing dozens of emergency room patients, KIRO 7 Eyewitness News reported.

According to the Seattle times, Lennie and Yvon Hennings stole tens of thousands of dollars by using patients' credit card information.

Authorities allege that Yvon used her job at Med Data, a Seattle company that provides billing services for emergency room doctors, to steal the information. She then passed the information to her brother Lennie, who used it to buy gift certificates online, prosecutors said.

Prosecutors said Yvon took more than 30 credit card numbers and other personal information from patients being billed for emergency room care at Stevens Hospital in Edmonds.

Wednesday, May 03, 2006

Mandatory Reporter / News Investigation

Interesting insight into the way an investigative reporter views a mandaory reporter, from the Denver Channel:

DENVER -- When children are brought to an emergency room, doctors must report certain injuries to police and social services. The laws are there to protect kids from possible child abuse.

But 7NEWS Investigator Tony Kovaleski uncovered a case in which some doctors made a big mistake.

In October, a first-time mom took her 3-month-old son, Tyler, to the emergency room, expecting to get help. She didn't expect to find herself in the center of an investigation into child abuse.

Medical copters refuse to fly meth victims


You’re at home when the lights go out. You smell gas. You won't pull out your lighter to see, would you?

Now you have an idea why StatCare is taking no chances--because possible meth victims and choppers don't mix.

Virtually every day, one of StatCare's three choppers is in the air -- an injured man in Kentucky, a burned baby in Tennessee, a sick mother in Ohio. If they need the specialized help of Louisville’s hospitals, StatCare stands ready.

But all bets are off when it comes to airlifting suspected meth victims, whose clothes may be saturated with toxic and flammable fumes.

This past weekend's house explosion in Harrison County was an example, StatCare forced to back off taking them by air -- the burned victims were instead transported by ground and into a special plastic enclosed emergency room; the dangers posed by such possible meth contaminated too great.

By the way, regarding that Harrison County, Indiana house explosion: StatCare says it wasn't the only one that decided air transport would be too hazardous.

StatCare says authorities called a second air ambulance service. That service refused for the same reason.

Malpractice bill vetoed by governor

From AZ Central:

Gov. Janet Napolitano vetoed a bill Tuesday that aimed to make it more difficult for patients to collect damages in lawsuits against emergency-room personnel.

House Bill 2315 was one of four bills vetoed by Napolitano. Supporters of the measure said the threat of costly lawsuits has led to fewer doctors, especially specialists such as brain surgeons, working in emergency rooms. Opponents said the bill would have left the public at risk of not being able to receive compensation for injuries caused by negligence.

Napolitano wrote in her veto letter that there isn't any proof that the bill would have alleviated a shortage of emergency-room doctors. She also said five former Arizona Supreme Court justices wrote to her to express concern that the bill may have been unconstitutional.

The legislation would have raised the burden of proof necessary to win a lawsuit against emergency-room personnel from a preponderance of evidence to clear and convincing evidence, the highest standard in civil cases.

Doctors said that would encourage specialists to return to the ER by reducing their chances of losing a career-ending lawsuit. Opponents, led by trial attorneys, said the bill would hurt those least able to defend themselves while doing nothing to help the problems of overcrowded emergency rooms.

Press Ganey: "Gap Widens in Hospital Patient Satisfaction -- Hospitals Committed to Service Excellence Improve While Nationally, Satisfaction Declines

From a press release on

SOUTH BEND, Ind., May 3 /PRNewswire/ -- The gap in patient satisfaction
is widening between hospitals that deliver exemplary patient service and
those that provide lower levels of care. Press Ganey Associates Inc., which
measures health care satisfaction across thousands of health care delivery
organizations, captured the disquieting trend in its 2006 Health Care
Satisfaction Report, which includes data from more than 2.2 million
patients who had inpatient stays at nearly 1,600 U.S. hospitals.

According to Press Ganey data, hospitals, emergency departments,
physicians' offices and other health care facilities have shown significant
improvement over the past several years, directly opposite the trends in
health care at large. The hospitals with the greatest commitment to
improvement averaged a 2.7 mean score increase over the past year despite
the national decline in health care satisfaction.

"The American Consumer Satisfaction Index (ACSI) from the University of
Michigan has shown that consumers' satisfaction with health care has
decreased significantly over the past several years," says Melvin F. Hall,
Ph.D., president and chief executive officer of Press Ganey. "Hospitals
that partner with Press Ganey to continually measure and improve patient
satisfaction challenge that trend."

Press Ganey data confirms what many health care policy experts have
been saying about health care -- the landscape presents a lot of mediocrity
with pockets of excellence and very poor care. Patients receiving care at
health care facilities in the upper 90th percentile of Press Ganey's
database almost never report "very poor" or "poor" care while patients at
health care facilities in the 10th percentile report "very poor" or "poor"
care with far greater frequency.


An investigation on the Return on Investment (ROI) for the implementation of Computerized Physician Order Entry (CPOE), as reported by Gruntdoc:

Results: Between 1993 and 2002, the BWH spent $11.8 million to develop, implement, and operate CPOE. Over ten years, the system saved BWH $28.5 million for cumulative net savings of $16.7 million and net operating budget savings of $9.5 million given the institutional 80% prospective reimbursement rate. The CPOE system elements that resulted in the greatest cumulative savings were renal dosing guidance, nursing time utilization, specific drug guidance, and adverse drug event prevention. The CPOE system at BWH has resulted in substantial savings, including operating budget savings, to the institution over ten years.

Conclusion: Other hospitals may be able to save money and improve patient safety by investing in CPOE systems.

ACEP Renews Call for Emergency Medical Services Act During "Cover the Uninsured Week"

From the American College of Emergency Physicians:

ACEP is asking the public to visit and send messages to Congress to pass HR 3875, the Emergency Medical Services Act, to address the critical problems affecting their access to emergency care. The bill, introduced by Representatives Bart Gordon (D-TN) and Pete Sessions (R-TX) has three objectives:

1. Provide financial incentives to end the practice of "boarding" patients in emergency departments in order to expedite the movement of patients to inpatient beds. The practice of leaving or "boarding" admitted patients in emergency departments until an inpatient bed becomes available in the hospital is the cause of the gridlock in emergency departments, resulting in long waits for treatment and ambulance diversion to other hospitals.

2. Provide an alternate medical liability system for physicians who provide uncompensated care in an emergency department. The liability risk of caring for emergency patients is so great, it is deterring many medical specialists from being on-call to emergency departments and driving many emergency physicians out of practice.

3. Increase Medicare payments to physicians who provide care in emergency departments. The continuing decline in payments for emergency medical care reduces resources to care for more patients, decreases access to on-call medical specialists who lack financial incentive to be on-call to emergency departments and makes emergency medicine unattractive to medical students who are choosing a specialty.

Three-Fourths Of Emergency Department Directors Report Shortages Of Medical Specialists

From the American College of Emergency Physicians:

Three-fourths of emergency department medical directors responding to a survey reported inadequate on-call specialist coverage, compared with two-thirds in 2004, according to a new report released by the American College of Emergency Physicians (ACEP), in conjunction with researchers from Johns Hopkins University and funded by a grant from the Robert Wood Johnson Foundation.

The findings indicate that on-call coverage in the nation's emergency departments has deteriorated significantly since 2004. Both surveys were conducted to assess the effects and potential unintended consequences of changes made to the regulations governing the Emergency Medical Treatment and Labor Act (EMTALA). The changes include permitting specialists to be on-call at more than one hospital at the same time and limiting the amounts of call time.

"The availability of specialists has spiraled downward in just one year and confirms what was reported in the National Report Card on the State of Emergency Medicine, released in January by ACEP," said Frederick Blum, MD, President of ACEP. "These survey findings are evidence of further strain on an already frayed health care system, which coupled with the growing demands for emergency services, means patients could be at risk. If emergency departments can't handle the day-to-day emergencies, how will we ever be able to save lives and respond effectively to acts of terrorism and other disasters?"

The top five shortages were among the specialties of orthopedics; plastic surgery; neurosurgery; ear, nose and throat; and hand surgery. Seventy-three percent of emergency department directors reported problems with inadequate specialist coverage, compared with 67 percent in 2004. More specialists were negotiating for fewer on-call duty hours in 2005 - 42 percent compared with 18 percent in 2004. Forty-five percent of directors reported patients were leaving without being seen, compared with 29 percent in 2004. The percent of hospitals paying stipends to specialists, whether or not they see patients, more than quadrupled to 36 percent, compared with 8 percent in 2004.