Doctors, Federal Health Officials Search for Solutions to Emergency Room Crowding

From ABC News

On Friday, June 22, nearly a year after the Institute of Medicine issued three reports chronicling a rise in numbers of emergency patients and a decline in the number of emergency facilities nationwide, the House Committee on Oversight and Government Reform listened to testimony from five physicians in a hearing titled "The Government's Response to the Nation's Emergency Room Crisis."

Study: Iowa quickest in US on ER visits

From Yahoo News:

Iowans may want to think twice before complaining about long waits in the emergency room. According to a national study, Iowa is the quickest place in the country to get emergency medical attention — the average visit lasting two hours, 18 minutes.

The national average is three hours, 42 minutes, according to a study from Press Ganey Associates Inc., a South Bend, Ind.-based company that measures patient satisfaction.

The study, which was published this month, rated hospitals' performances last year. Nebraska rated second fastest in the nation at two hours, 26 minutes, followed by South Dakota (2:28), Vermont (2:32) and Wisconsin (2:34).

The longest average visits were in Arizona (4:57), Maryland (4:07), Utah (4:04), New York (3:58) and Florida (3:57).

Scott McIntyre, spokesman for the Iowa Hospital Association, said Iowa's rural landscape could be one reason why ER visits are shorter here.

"We have a lot of small hospitals that don't have a lot of emergency room traffic," he said. "The pressure on the ERs here is not comparable to ERs in, say, Los Angeles."

In addition, McIntyre said more Iowans have primary physicians, regular health care and insurance than people in other states, which leads to less time in the emergency room.

Update on Standard MM 4.10 in the Emergency Department (ED)

From the Joint Commission:

Effective April 6, 2007, the interim action was suspended for Standard MM.4.10, Element of Performance 1 that required a retrospective review of all medication orders in the Emergency Department (ED) by a pharmacist when a prospective review was not conducted. The interim action was implemented on January 1, 2007 for EDs in hospitals and critical access hospitals.

The decision to suspend the interim action was based on several concerns cited by the field, including the lack of prior hospital pharmacist involvement in the ED setting, the costs to hospitals of providing additional pharmacist manpower to support medication review of any type in the ED, and the frequent unavailability of pharmacists because of the long-standing pharmacist shortage.

The 1000 lb Ambulance

From Medgadget:

Obese folks living within the Calgary region of O'Canada now have access to an ambulance that is designed for patients up to 1000 lbs (450 kg) in weight. According to the article, obesity is not only a problem in Canada, but in the rest of North America as well.

The upgrades to the ambulance include a specially designed air mattress that is inflated beneath the patient, making transfer to a widened stretcher easier and safer. A remote lift system then gently raises the stretcher into the ambulance.

Physicians who talk about themselves cut into visit's valuable time

From MSNBC:

Too much personal talk by doctors can be bad medicine, according to a study published on Monday in which U.S. researchers sent actors posing as new patients to see doctors in secretly recorded visits.

Doctors often wasted time in what already may have been short visits and stifled the flow of information from patients by gabbing about themselves, their own health problems, their families and their political beliefs, the study found.

The doctors engaged in such "personal disclosures" in 34 percent of visits tracked by the researchers. The personal talk may have been well-intentioned — to deepen a doctor-patient relationship — but yielded little of value to patients and sometimes was counterproductive, the researchers said.

Standard of Care Remains a Moving Target in Medical Malpractice Cases

From MedPage Today:

Courts in 21 states adhere to a local or community standard of care in medical malpractice cases, slowing implementation of evidence-based, resource-based, nationwide standards.

So said Michelle Huckaby Lewis, M.D., J.D., of Johns Hopkins and Georgetown University, and colleagues in a commentary in the June 20 issue of the Journal of the American Medical Association.

The locality rule was a 19th century concept intended to protect rural physicians from being held to the same standards as physicians working in urban areas or at academic institutions, the authors said.

But, they note, modern communication has removed barriers to standardization -- no place is more than a phone call or a mouse click away from the latest evidence-based findings.

As a result, a rule originally intended as a protection now "imposes additional duties and legal risk on physicians. Not only must they remain aware of advances in their own specialty, physicians must also be aware of the standard of care in their locality, whether or not that standard is considered substandard at the national level," the authors wrote.

List compares hospitals' heart-related death rates

From USA Today:

In a bid to improve hospital performance, the federal government on Thursday posted online its first comparison of heart attack and heart failure death rates from more than 4,000 hospitals nationwide.

Hospital's 'scribes' help them focus more on patients, less on paperwork

From SignOnSanDiego:

Doctors struggling to keep pace with the growing volume of patients who pass through Tri-City Medical Center's emergency room are getting help from an unlikely source: college students.

The Oceanside hospital has hired undergraduate pre-med students and recent graduates as “scribes” to document physician notes and orders in the emergency room – work that doctors usually do themselves.

That change gives doctors at one of the busiest emergency rooms in San Diego County more time to spend with their patients and provides the students with real-world medical experience they normally wouldn't get until later in medical school

TabletKiosk™ Greets Patients in ER

From Medgadget:

When a patient arrives at Parkland Memorial Hospital in Dallas, he or she is now greeted by a computer, The Dallas Morning News is reporting. This electronic processing of patients at Parkland was implemented by the hospital's own IT department with the help of Sand Dune Ventures Inc., a Torrance, CA maker of TabletKiosk™.

The company is specializing in touch screen tablet PCs, mobile computers, and "custom hardware solutions and kiosk encasements." They serve different industries, but health care solutions is what interests us.

Doctors urged to make good first impression

From Reuters:

Doctors should know that when meeting a new patient for the first time there is no second chance to make a good first impression, researchers said on Monday.

Almost all patients want to be greeted by name when seeing a doctor for the first time and want to shake hands, a survey of patients found. But while handshakes are common, doctors often never utter the patient's name, the researchers said.

"Greetings are just a small slice of the visit, but they can have a lasting impact," study leader Gregory Makoul of Northwestern University Feinberg School of Medicine said in a telephone interview.

It's the first impression that can really set the tone for the rest of the encounter and for the doctor-patient relationship."

Not only that -- manners can prevent mistakes.

"It's not only a feel-good exercise," said Dr. Sheldon Horowitz of the American Board of Medical Specialties, whose 24 member boards certify U.S. physicians.

"There is some correlation between good communication between the physician and patient and actually good outcomes in patient care."

EP Expenses

From Student Doctor Network

As I was giving yet more money to the government today (I renewed my DEA) I thought it might be valuable to give everyone an idea of what sort of expenses you’ll face every year as an EP. Here goes:

•License $600 every 2 years. (I have 2 so double that)
•DEA ~$550 every 3 years.
•State pharmacy license $50/yr. Many states don’t have these. If your’s doesn’t you get a pass.
•ATLS $300 every 4 years. That’s the refresher. If you go over your 6 month grace period it’s a whole weekend and $600 for the whole course.
•ACLS varies but I have partners who have paid $200 to do an online version and avoid the class.
•PALS varies, see above.
•ACEP $550 / year.
•Hospital privileging $50 - $500 per hospital per year. Many groups pay this. Some don’t.
•CME varies. It’s easy to get free CME but some states require specific things like ethics and bioterrorism. You often get stuck paying for these. $25- $200 per class.
•LLSA $100/yr for the test.
•LLSA $80-$300/yr for the study materials. Most people I know (including me) do one that costs $225.
•ConCert exam $1625 every 10 years.

tPA Can Prevent Amputations in Frostbite

From MedPageToday:

Amputations of frostbite-damaged fingers and toes can be prevented in some patients with the use of thrombolytic therapy within 24 hours of exposure, researchers here found.

Hospital emergency rooms try to cut wait times

From MSNBC:

For those who do endure long waits, hospitals offer meal vouchers, baseball and movie passes and written apologies.

“If someone has to wait a long time it is less likely they’re going to come back,” said Deborah White, spokeswoman for Carondelet Health, which owns two acute-care hospitals in Kansas City that launched a “30-minute guarantee” program on June 1, even as a competing hospital chain pledged to see patients within 15 minutes.

Lawsuit challenges helicopter's weight rule for transporting trauma patients

From the Naples news:

One calamity after another led to the death of Diana Lopez, a 37-year-old business owner in Naples who cared for her disabled parents and helped raise a niece and nephew, her family contends in a recent lawsuit.

She was the victim of a tire blowout one January afternoon last year on Interstate 75 and was thrown from her Ford Expedition after the vehicle flipped near mile marker 63, just inside the Collier County line. She wasn’t wearing her seat belt.

The next disaster came when the Collier County Emergency Medical Services Medflight helicopter declined to fly her to the trauma unit at Lee Memorial Hospital in Fort Myers because she exceeded the 300-pound weight limit per patient, according to the wrongful death lawsuit filed by her family against Collier County government in Collier Circuit Court in February.

Patient Satisfaction / Physician Attire

From the Star-Ledger:

Over three months, 20 physicians, all obstetrician/gynecologists, were randomly assigned to dress in either business attire, casual clothing or a scrub suit each week. The physicians saw more than 1,100 new patients.

After the first visit, the patients were asked to fill out a patient satisfaction survey, which assessed their comfort with the physician as well as their perception of the physician's competency and professionalism.

Patients were not asked about attire.

"We were interested in how women, who were unaware that clothing was being evaluated, would respond to physicians in various attire," the researchers said in the study.

The study, published in the February issue of the American Journal of Obstetrics & Gynecology, concluded patients were equally satisfied with physicians, regardless of the clothes the physicians wore. All followed the Cooper dress code and everyone was neat and clean.

"We asked people about how they felt about the doctor and dress did not seem to make any difference," Fischer said.

The study concluded, "Al though patients may express a predilection for specific items of clothing or personal appearance, it is likely that other factors, such as medical knowledge, personal demeanor, and interpersonal skills play a much more important role in patient satisfaction."

Hospitals Nationwide Combat Employee Camera-Phone Abuse

From Wired, Via KevinMD

A rash of incidents in hospitals across the country involving camera phones has led to firings -- and the realization that monitoring the devices in clinical facilities is no easy task.

After sorting through red tape, a California hospital has fired nine employees who in April either took or looked at camera-phone photos of a patient's X-ray. Meanwhile, at least three other hospitals across the country are struggling with similar problems.

"I think all hospitals in the United States are going to have to deal with (camera-phone use)," said Suellyn Ellerbe, chief executive officer of Tri-City Medical Center in Oceanside, California, a suburb north of San Diego. Photo-equipped PDAs, which doctors frequently use, pose special problems, said Ellerbe, whose hospital fired the nine workers.

Camera phones are a difficult privacy issue for medical institutions because regulations banning them -- which already exist in many hospitals -- are difficult to enforce. But high-profile cases may be spreading the word that taking pictures on the job can lead to unemployment.

It’s All About Perspective - Pt's ED Experience

From Hallway Four, Via KevinMD

An ED patient Timeline: A stroll in their shoes and mine…


Ms W’s perspective:

0800-1200: I’m sitting in the waiting room with abdominal pain - I thought this was an “emergency” room.

1200-1240: Finally, I get a room. Where is the doctor?

1240-1247: The doctor talked to me and checked me out for about 5 minutes. She pushed on my stomach and asked me a few questions. She said something about my gallbladder and told me they needed to run some tests and that she’d be back later. Now, she’s already gone.

1330: What’s taking so long?

1420: My ultrasound is done. Where is the doctor?

1600-1605: The doctor said my gallbladder is filled with stones and infected and will need to be removed by ANOTHER doctor. This is absurd - that ER doctor didn’t even do anything for me!

Amount of time the doctor spent with me: 12 minutes.

Unnecessary, inappropriate ER visits hard to determine

From AMA Member Communications

In a news analysis, the UPI (5/19, Pierce) reported that although "health-care reformers say the U.S. can save a lot of money by reducing unnecessary emergency-room visits," two studies presented at the Society for Academic Emergency Medicine Annual Meeting "found that it is difficult to define what an 'unnecessary' or 'avoidable' ER visit is, and reducing those visits may not actually save a lot of money."

In the first study, researchers "examined Oregon emergency-room data before and after significant cuts in 2003 to the state's Medicaid program." While they found "a significant increase in emergency-room visits from uninsured patients, they were unable to easily divide them into categories of non-emergency, emergency, emergencies that could have been avoided with timely primary care and emergencies that could be treated if timely primary care were available." Another study "suggests there is little money to be saved from cracking down on unnecessary emergency-room visits.

During the same time period in Oregon, only 6.8 percent of Medicaid dollars were spent on emergency care, and four out of five beneficiaries never went to the emergency room at all." Eileen Moore, director of the Health Rights Project at the Georgetown University School of Medicine, told the UPI, that the "causes of patients seeking primary care in emergency departments may also range beyond simple lack of affordability. Transportation, safety concerns and work schedules also play a role - even for patients that are insured."

CPR Teddy

From Medgadget

CPR Teddy is a very special kind of teddy bear. Although he looks like a typical huggable, cuddly teddy bear, he has a very important job. Squeeze one of Teddy's paws and voice prompts walk you through the correct procedures for Choking Rescue and Infant or Child CPR. You practice chest compressions by pressing on the bright red heart on Teddy's chest as a metronome paces you. Teddy's bowtie lights up green or red to tell you if you are doing the compressions correctly and his chest rises as you perform the rescue breathing.