Non-Urban Emergency Medicine

Quality Indicators: CMS Reporting

2007-11-09T16:05:00.000-06:00

From the Iowa Hospital Association Friday mailing:

PPS hospitals must begin submitting data on seven indicators (reduced from 10) to an as yet undisclosed contractor beginning with outpatient services provided on or after April 1, 2008 in order to receive the full payment update for 2009. Like the inpatient PPS quality reporting program, non-compliant hospitals will receive an update factor reduced by 2 percentage points for the duration of 2009.

The seven measures CMS is requiring for the initial implementation of the the Hospital Outpatient Quality Data Reporting Program have been endorsed by the National Quality Forum and include (emphasis added):

• Emergency department (ED) transfer acute myocardial infarction (AMI) 1: Aspirin at
arrival
• ED-AMI-2: Median time to fibrinolysis
• ED-AMI-3: Fibrinolytic therapy received within 30 minutes of arrival
• ED-AMI-4: Median time to electrocardiogram
• ED-AMI-5: Median time to transfer for primary PCI
• Physician Quality Reporting Initiative (PQRI) #20 (Perioperative Care): Timing of antibiotic prophylaxis
• PQRI #21 Perioperative Care: Selection of prophylactic antibiotic

No liability for doctor who revived newborn

2007-11-09T14:47:00.000-06:00

From the Seattle Times

A doctor can't be held liable for resuscitating a baby who was born without a heartbeat and survived with severe disabilities, the state Supreme Court says.

The baby's parents filed a malpractice lawsuit after the baby's 2004 birth. They claimed doctors in Vancouver, Wash., were negligent when they continued to resuscitate the baby for almost half an hour, after he was born without a heartbeat.

The parents also said the medical team should have gotten their consent before continuing to revive the baby.

But the Supreme Court justices say the doctor can't be held liable for failing to stop resuscitation efforts on a baby.

New High or Hoax?

2007-11-09T08:49:00.000-06:00

From ABC News:

Police in Naples, Fla., are on the lookout for users of "jenkem," a homemade drug created by allowing human urine and feces to ferment in a bottle with a balloon covering the opening. Users inhale the released methane gas from the balloon to get a "euphoric high similar to ingesting cocaine, but with strong hallucinations of times past," according to a Collier County Sheriff's Office bulletin.

The downside: "Subjects who used the jenkem disliked the taste of sewage in their mouth and the fact that the taste continued for several days."

Immunization Frequency

2007-11-09T08:41:00.000-06:00

From the Wall Street Journal Health Blog:

We may be getting far more immunizations than necessary, according to findings from a study in the current issue of the New England Journal of Medicine.

Antibodies from some vaccines stay around in the blood stream for much longer than previously thought, which means that the current schedules for some vaccinations may be overkill, the WSJ reports.

Tetanus shots, for instance, could be given every 30 years instead of every 10. And we seem to be protected from measles, mumps, and rubella for life, the researchers at Oregon Health and Science University find.

ED's: "Wrong place for mental-health care"

2007-11-09T08:32:00.000-06:00

From the Boston Globe:

Hospital emergency departments are among the least appropriate and most expensive places in Massachusetts for patients in psychiatric crisis. Yet these departments are where police, families, group homes, nursing homes, and others routinely take people who are agitated, panicked, or threatening to hurt themselves. Emergency departments are also where people go at the end of the month when their medications run out, when their primary physicians can't see them for two weeks, when they are frightened or desperate and have nowhere to turn after 5 p.m. and their therapist's answering machine tells them to go to the emergency room.

Medicaid and Self Pay

2007-11-09T08:26:00.000-06:00

From Reuters:

The government's Medicaid program for the poor may put more financial burden on overcrowded hospital emergency rooms than the nation's 47 million uninsured, according to a study published on Thursday.

Researchers at the University of California San Francisco and Stanford University found that the uninsured patients paid 35 percent of their overall emergency room bills in 2004, versus 33 percent for Medicaid.

"What surprised us was that uninsured patients actually pay a higher proportion of their emergency department charges than Medicaid does," said Renee Hsia, an emergency room doctor and researcher at UCSF who led the study.

"This runs counter to the widespread impression that the uninsured are universally poor payers," said Hsia, who noted that the ranks of uninsured include healthy young people who are employed full-time.

MRSA Isolation

2007-11-09T08:20:00.000-06:00

From the Houston Chronicle

SYRACUSE, N.Y. — A Syracuse hospital is taking an unusual approach to stopping the spread of antibiotic resistant staph infections by putting all patients with the superbug on the same floor.

Since 2000, Crouse Hospital has operated a unit on the seventh floor of its Memorial unit that cares exclusively for patients with MRSA, or Methicillin-resistant Staphylococcus aureus.

Hospital officials say the dedicated 17-bed unit — the only one of its kind in the United States — has slowed the spread of MRSA in the hospital, improved patient care and saved the hospital about $1 million.

Just Say No?

2007-11-07T17:04:00.000-06:00

From MedPage Today. Tales from the ER.

I thought I had heard it all, but I got a new threat recently. The context was one in which I felt a little bad about having to say no. The patient was a grandmotherly sort of lady in her middle years. She presented a sad and pathetic figure as she told me her tale of ongoing diffuse body pain which was poorly controlled even on high doses of methadone. Alas, she was out of her meds and wanted a refill (actually, her initial request was to be admitted to the hospital). She was unable to explain how she had come to be out of her pain medications.

She escalated; I explained my thought process. She yelled, she wept, and she begged. I held firm, and she was discharged. On her way out she stopped by the charting station and said, with a vicious spite in her voice, "I hate you. You are a terrible, terrible person, and I hope you suffer, and I hope your children suffer. In fact, I am going to make sure of it. I am going to go home and make a voodoo doll of you and all of your children and I am going to stick pins in all of them!"

Amazing Story

2007-11-07T17:01:00.000-06:00

From CNN.com

On July 2, Powers, a squad leader in the 118th Military Police Company out of Fort Bragg, and his unit were called to investigate a report of a late afternoon explosion in a Baghdad neighborhood. For the unit, it wasn't anything they hadn't seen before. They were on their second tour of duty in Iraq to train Iraqi police officers.

The explosion was minor and Powers walked away from the area to deal with the crowd that had gathered.

It was then that Powers felt something hit his head.

"I wondered briefly if I had been shot," he says.

In reality, Powers had been stabbed in the head. And the nine-inch knife was still stuck into the right side of his cranium.

Energy Drinks and EtOH Don't Mix

2007-11-04T15:48:00.000-06:00

From the WSJ Health Blog

Researchers there found that college students who down cocktails of booze and energy drinks, such as Red Bull, run a significantly higher risk of injury compared with students who stick to uncaffeinated alcoholic beverages. The students sucking down Speed Balls, Bullgaritas and Bull Breezes were much more likely to be hurt or injured, to ride with an intoxicated driver or to take advantage of someone else sexually.

The results follow several studies that found mixing alcohol, a depressant, and caffeine, a stimulant, can make people feel less drunk than they really are.

Some mental health patients to be diverted to ERs

2007-11-02T09:58:00.001-05:00

From the Austin Statesman

More people with mental illnesses could soon be sent to local emergency rooms instead of Austin State Hospital, and hospital officials say that could clog waiting rooms and cause longer waits for medical care throughout the Austin area.

On Nov. 8, the Austin Travis County Mental Health Mental Retardation Center will start reducing the number of people it sends to the state hospital by 43 percent — an estimated 600 to 900 people each year. Those people will be taken to emergency rooms, including ones at Brackenridge Hospital, Dell Children's Medical Center of Central Texas, Heart Hospital of Austin and St. David's Medical Center, said Jim Van Norman, MHMR's medical director.

Hospitals face fight for tax-exempt status

2007-11-02T08:46:00.000-05:00

From the ContraCosta Times

A U.S. senator has warned that if some nonprofit hospitals continue to oppose greater transparency in the community benefits they provide, he may seek stricter requirements on such institutions.
"While everyone talks about the need for sunshine, there are a few tax-exempt hospitals in the shadows that are bent on pulling the blinds and closing the drapes," said Sen. Chuck Grassley, R-Iowa.

The comments from the ranking member of the Senate finance committee came during a Tuesday roundtable discussion in Washington on whether nonprofit hospitals provide enough charity care to justify their hefty tax breaks.

Grassley noted that the Internal Revenue Service has proposed changes in its Schedule H and Form 990 that would require nonprofit hospitals to provide greater details on their charity care and other community benefits.

He called the proposed change in reporting requirements "a dramatic improvement over business as usual" and criticized hospitals that are opposing it.

"It is disgraceful that they are misleading Congress" in trying to water down and delay the Schedule H changes, he said.

"If these hospitals continue to press for keeping the public in the dark about how they justify $50 billion in tax breaks a year, that will greatly color my views about the need for legislation."

EM Physicians Dominate Romance Novels

2007-10-26T08:41:00.000-05:00

From Yahoo News

If romantic fiction is any guide, any doctor looking for love would be advised to be an emergency room surgeon or deliver babies rather than practise colon resection or remove in-grown toenails.

Hospital novels are one of the fastest-growing areas of romantic fiction which, according to the Romance Writers of America, generates 1.2 billion dollars in annual sales and accounts for 39.3 percent of all fiction sold in the United States.

In an offbeat letter published in Saturday's Lancet, Kelly describes the typical plot structure and characterisation in 20 randomly-selected medical romance novels.

Of the male protagonists, six worked in emergency medicine, five in surgery and three in obstetrics, neonatology and paediatrics, he found.

"There was a marked preponderance of brilliant, tall, muscular, male doctors with chiselled features, working in emergency medicine," says Kelly, a University College Dublin psychiatrist.

Pain Scale Absurdity

2007-10-26T08:37:00.000-05:00

From Scalpel or Sword:

Two patients came into the ER by ambulance complaining of pain.

One was a young woman with another migraine, who "usually gets" Dilaudid 4-6 mg IV in addition to IV Reglan and Ativan. She was allergic to many other medications, but she had a full bottle of dilaudid 8 mg pills and some Actiq lollipops in her purse from two different pain specialists. Her usual medications also included Ambien 20 mg at bedtime and Xanax 2 mg every 6 hours. Although she complained of vomiting constantly for 3 days, her vital signs, physical exam, bloodwork, urinalysis, and imaging tests were all negative, and she never vomited in the ER. She spoke calmly and was in no apparent distress.

The other patient was an elderly lady who had fallen at home, fracturing her hip. She was taking a blood thinner, so her grotesquely angulated and deformed thigh was also markedly swollen. The fact that she had crawled down the stairs after her injury in order to call the ambulance probably contributed to the swelling and deformity somewhat. She trembled a bit as she asked for something to relieve her pain.

Guess whose pain was a 5/10 and whose was a 10/10?

Visble Body Website

2007-10-24T20:35:00.000-05:00

The Argosy Visible Body, which promises to be a free virtual anatomy website, is looking like a rather impressive product already. Videos of the development, provided by the company, show a simple interface and an easy method to get to individual anatomic parts of the body. Here are the features the website will provide:

Search for and locate anatomical structures by name.
Hide, rotate, see through, and explore parts of human anatomy.
Move the model in three-dimensional space.
Zoom in and out.
Click on systems or structures to make them transparent or hide them.
Click on anatomical structures to reveal names.

In beta / demo now, "Coming in mid-November"

"25 Skills Every Doctor Should Possess"

2007-10-24T20:20:00.000-05:00

From the Cheerful Oncologist, excerpted below:

Skills all doctors should possess:

1. Recognize when a patient needs to be transferred to the ICU.

2. Deliver bad news compassionately, yet honestly.

3. Identify a pneumothorax on a chest radiograph.

4. Diagnose iron deficiency anemia.

5. Help a patient stop smoking cigarettes.

6. Diagnose thrombotic thrombocytopenic purpura, which has a mortality rate of 90% if not treated and 10-20% if treated.

ACEP on CA-MRSA

2007-10-23T08:48:00.000-05:00

From the American College of Emergency Physicians

Washington, D.C. — The spread of a potentially life-threatening antibiotic-resistant staph germ that is responsible for more deaths in the United States each year than the AIDS virus has prompted the American College of Emergency Physicians (ACEP) to launch an education initiative aimed at protecting the public against the further spread of infection.

"This emerging 'super bug,' as it's known, is causing ACEP to mobilize for two reasons," said Linda Lawrence, MD, FACEP, president of the American College of Emergency Physicians (ACEP). "First, we are concerned about the possible spread of this potentially dangerous bacterium – especially in schools, nursing homes and health-care settings – so we are asking people to practice good hygiene, such as frequent hand-washing, to help prevent public outbreaks. Second, ACEP is cautioning against the continued widespread overuse of antibiotics, a practice that has in part caused drug-resistant germ strains like this one to emerge."

At the same time, emergency physicians across the country are on the lookout for cases of antibiotic-resistant infections so these patients can be isolated and treated with the few types of antibiotics that remain effective, before developing potentially life-threatening complications or spreading their infection to others.

Air Medical Controversy in Texas

2007-10-23T08:46:00.000-05:00

From JEMS

EMS Units Bypassed Nearest Helicopters: Physician Says Ties to a Firm Don't Influence Agencies' Decisions

What happened to Bridges that night was part of a pattern repeated more than two dozen times in the last two years in the area: EMS crews did not call the closest helicopter ambulance service.

In each incident, the EMS unit on the ground and PHI shared the same medical director, Roy Yamada.

Yamada, a Fort Worth physician, works as director of emergency medicine for Midlothian and in a similar role for nine other area EMS departments, most in Tarrant County. He is also PHI’s North Texas medical director, a position for which he has apparently been paid almost $200,000 in 2 1/2 years.

Such ties are becoming increasingly common in the competitive air ambulance industry, in which people who oversee local EMS agencies also work for air medical providers.

But these alliances, critics say, can lead to delays in hospital care for critically injured patients as well as unnecessary helicopter flights that can cost patients as much as $10,000 when ground transport would be sufficient.

Defensive Medicine (ED Example) on CBS

2007-10-23T08:36:00.000-05:00

From CBS.com

CBS) It started as a simple stomach ache, but Alexandra Varipapa, a sophomore at the University of Richmond, decided to go to the emergency room.

There, doctors ordered a full CT scan, a radiation imaging test, which found a harmless ovarian cyst. She never questioned the CT scan, CBS News correspondent Wyatt Andrews reports.

But her father did - when he got the $8,500 bill, $6,500 of which was that CT scan.

“I was pretty flabbergasted,” said Robert Varipapa, himself a physician.

Varipapa says his daughter's pain could have been diagnosed far more easily and cheaply with a $1,400 ultrasound.

“A history, a pelvic examination and probably an ultrasound,” he said. And he would have started with the ultrasound.

But the hospital defends the CT scan, saying an ultrasound might have missed something more serious.

CMS Sets Requirement for Hospitals Without 24/7 Physician Coverage

2007-10-12T17:02:00.000-05:00

From the Iowa Hospital Association

IHA has received several questions from hospitals regarding a new Centers for Medicare & Medicaid Services (CMS) requirement aimed at patient safety and emergency services. The requirement, effective October 1, mandates that all hospitals, including inpatient acute (whether Prospective Payment System or exempt), Critical Access Hospitals, long-term care, psychiatric, rehabilitation, children’s and cancer hospitals, that do not have physicians available on the premises 24 hours per day, seven days per week (24/7) inform patients of that limitation prior to patients receiving an inpatient or outpatient service.

CMS does not plan to prescribe specific language for the notice, but its discussion of the requirement indicates the notice must specifically state the hospital does not have physicians on the premises 24/7. The notice also must describe how the hospital will meet any emergency service needs when a doctor is not on the premises. The disclosure would be required at the point of registration or preadmission testing.

CMS does not intend to provide standard language for the new disclosure notice, but the notice still requires federal Office of Management and Budget (OMB) review and clearance under the Paperwork Reduction Act. Hospitals subject to the requirement (those that do not have 24/7 physician coverage on site) will need to create a disclosure notice and a plan for distributing the notice at all inpatient admissions and outpatient encounters.

Available information suggests hospitals simply need to provide the notice to each patient, without obtaining patient signatures documenting individual receipt. Hospital policies and procedures must be documented. However, the American Hospital Association cautions against finalizing the notice and procedures until CMS receives OMB clearance and issues provider manual instructions.

CMS has already completed the first part of the clearance process by soliciting public comment on the proposed disclosure requirement. CMS has yet to publish another notice with a 30- day comment period directly to OMB. It is expected that instructions will not be circulated to hospitals until the instructions receive OMB clearance, which is still pending.

California ED data

2007-10-12T13:50:00.000-05:00

This week's San Diego Union Tribune features a story of one doctor's attempt to encourage hospitals to come clean with ED wait-time figures as a step toward improving traffic flow. Dr. Roneet Lev, an emergency physician at Scripps Mercy in Hillcrest, leads the Emergency Medicine Oversight Commission of the San Diego County Medical Society. She recently persuaded 19 hospitals to share emergency room procedures and statistics.

Also in California, the site of the Office of Statewide Health Planning and Development posts numbers from hospitals on the annual number of patients who enter the ED without being seen. It also asks facilities to disclose the number of hours per month they were on diversion. All you have to do is type in the city or name of the hospital you're researching.

Firefighters, police push for city's help treating drug-resistant infection.

2007-10-12T13:44:00.000-05:00

From the Fresno Bee

The Fresno City Council agreed Tuesday that a drug-resistant staph infection afflicting some city firefighters should be considered a work-related injury for firefighters and police officers.

Some firefighters are upset they're forced to pay health insurance co-payments and use their sick time to recover from the infections they believe they contracted at work.

If treated as work-related illness, the city's workers' compensation insurance would cover those bills and pay the firefighters for lost work time.

The council voted 6-1 to direct city staff to write a policy making all cases of methicillin-resistant Staphylococcus aureaus a work-related illness for firefighters and police officers. The council must approve the policy in a separate vote.

CPAP for CHF instead of ETT?

2007-10-12T08:47:00.000-05:00

From USA Today

For more than 30 years, paramedics have been saving the lives of these patients by inserting, through the vocal cords, a breathing tube about the width of a small garden hose and then pushing air into the lungs with an inflatable bag. Called intubating, it's the street version of a hospital's mechanical ventilator.

But the aggressive treatment is very uncomfortable for those on the receiving end, and it carries the risk of dangerous infection. So a device more commonly found in the hospital is making its way into the nation's ambulances, including Harper's rig in Houston.

Harper asks firefighters to bring him the breathing device known as CPAP, for continuous positive airway pressure. The football-size device with long plastic tubing and a plastic mask is being used now by emergency crews in seven other big cities, including Miami and Boston. Another 16, including Atlanta and Philadelphia, plan to put the device in ambulances soon, this month's Journal of Emergency Medical Services (JEMS) reports.

Negligent Credentialing?

2007-10-11T09:45:00.000-05:00

From the American Medical Association

Hospital can be sued for credentialing doctor with questionable qualifications, Minnesota high court rules

Physicians fear that a recent Minnesota Supreme Court decision could compromise statutory peer review protections and taint physicians in medical liability cases that are tied to negligent credentialing claims.

For the first time, the high court recognized that patients can sue hospitals for allegedly granting privileges to doctors with questionable credentials. The unanimous decision adds Minnesota to a list of at least 25 other states that recognize negligent credentialing claims.

House Bill Aims to Modernize 911 Systems

2007-10-11T09:36:00.000-05:00

From Washington Technology:

Proposed legislation in Congress that would promote implementation of IP-based 911 services is picking up support from public safety groups and disability organizations.

The 911 Modernization and Public Safety Act of 2007 (H.R. 3403), sponsored by Rep. Barton Gordon (D-Tenn.), seeks to facilitate rapid deployment of IP-enabled 911 services and IP-enabled enhanced wireless 911. It would extend enhanced 911 services to IP-based telephone services. The goal is to migrate today’s 911 systems to new technologies.

Depletion of Nitric Oxide in Bank Blood Spells Trouble

2007-10-11T09:32:00.000-05:00

Great summary of this important finding at Medgadget

It has been long known that people who receive blood transfusions have a higher chance of having all kinds of medical problems following the transfusion. Research coming out of Duke now shows that stored blood loses a great deal of its nitric oxide content which is critical in oxygen transfer from blood to tissues.

HIPPA In Action

2007-10-11T09:11:00.000-05:00

From the WSJ Health Blog

Hospital Suspends Workers for Peeking at Clooney’s File

Patient Refuses to be Seen by a Muslim Doctor

2007-10-11T09:07:00.000-05:00

From the NY Times "The Ethicist" Column

A patient came to the E.R. where I work, and a nurse gave him a preliminary evaluation. When the patient saw my name, he refused to be examined by a Muslim doctor. I couldn’t reach his primary physician, and the other physician on call was also Muslim. A physician assistant offered to complete the evaluation, but as the patient was in no immediate danger, I did not allow this. Instead I discharged the patient without a full evaluation. Was I right? — Ali Mohamed Osman, M.D., Houston

Interesting Teaching Model

2007-10-11T08:59:00.000-05:00

From Unbounded Medicine

This surgical model is made of glass fiber and has abdominal and thoracic compartments separated. A selective bronchial intubation can be done in this model. It also has a structure that simulates a diaphragm. You can perform both laparoscopy and thoracoscopy.

The organs of a pig are placed within the model.

Study Presented at ACEP Symposium: EM Physicians Risk Takers?

2007-10-09T19:24:00.000-05:00

From the WSJ Health Blog:

....she wanted to find out whether the ER really did draw thrill seekers or it was just a medical myth. So they gave a test called “Are You a Risk Taker?” (it’s something like this) to 87 emergency medicine residents and 77 family medicine residents to find out. (They chose family medicine because both family practitioners and ER docs are generalists, Bascom said.) They’re presenting the results today at the annual scientific meeting of the American College of Emergency Physicians in Seattle.

The test breaks personality types down into several categories: Impulsive Sensation Seeking, Neuroticism-Anxiety, Aggression-Hostility, Sociability, and Activity. Emergency medicine residents scored in the high range more frequently in every category than family medicine residents. The difference was only statistically significant in one category, but it’s a notable one: “Impulsive Sensation Seeking.” A tad more than 19% of emergency medicine residents scored high in that category, compared with just over 5% of family medicine residents. (FYI: Bascom took the test for fun, and she, too, scored high on Impulsive Sensation Seeking.)

The difference in Neuroticism-Anxiety is also striking, even if it’s not statistically significant: 11.4% for the ER, versus 3.8% for family practice. Bascom wasn’t surprised.of the result. ER docs “are a little more tightly wound,” she told us.

LUCAS™ Chest Compression System

2007-10-09T19:19:00.000-05:00

From Medgadget:

Physio-Control, Inc., a subsidiary of Medtronic, Inc., has announced that the LUCAS Chest Compression System is now available in the United States through an exclusive distribution partnership with JOLIFE AB, a Lund, Sweden company. The device is designed to deliver consistent CPR chest compressions without the off intervals, and to deliver direct current cardioversion during chest compressions. The device's protocol is fully compliant with the official ACLS guidelines.

Blogger Takes HealthVault for a Test Drive

2007-10-06T11:10:00.000-05:00

The Medical Quack leads us through registration and initial use of the site.

Microsoft Health Records - Special Review and Basic Information

I have included what I hope to provide is some extensive information on the new Health Vault. If you read this blog regularly, you know I am a big advocate of privacy, and for many good reasons. I hand it to Microsoft for taking a jump into the records business, and thus this morning I set up my account to go through the motions and see first hand how it works.

More Doctors in Texas After Malpractice Caps

2007-10-06T11:04:00.000-05:00

From the NY Times

Four years after Texas voters approved a constitutional amendment limiting awards in medical malpractice lawsuits, doctors are responding as supporters predicted, arriving from all parts of the country to swell the ranks of specialists at Texas hospitals and bring professional health care to some long-underserved rural areas.

The influx, raising the state’s abysmally low ranking in physicians per capita, has flooded the medical board’s offices in Austin with applications for licenses, close to 2,500 at last count.

“It was hard to believe at first; we thought it was a spike,” said Dr. Donald W. Patrick, executive director of the medical board and a neurosurgeon and lawyer. But Dr. Patrick said the trend — licenses up 18 percent since 2003, when the damage caps were enacted — has held, with an even sharper jump of 30 percent in the last fiscal year, compared with the year before.

“Doctors are coming to Texas because they sense a friendlier malpractice climate,” he said.

Microsoft's HealthVault

2007-10-04T16:21:00.000-05:00

Microsoft introduced the beta of a Electroinc Heath Record called HealthVault today.
Here's the Wall Street Journal's Health Blog's take on the event.
Here's GruntDoc's comments.

"A Dangerous Gap in Trauma Care"

2007-10-03T22:14:00.000-05:00

From the Wall Street Journal

Trauma from injuries including accidents, falls and violence is the leading cause of death for Americans under the age of 44, claiming more than 140,000 lives and permanently disabling 80,000 people annually. But only one in four lives in an area served by a coordinated system to transfer patients to designated trauma centers from less-equipped hospitals, according to the American College of Surgeons, which sets standards for trauma care. And only eight state trauma systems met nationally recommended preparedness levels in a study by the federal government after the Sept. 11, 2001, terrorist attacks. While some progress has been made, many states remain woefully unprepared, trauma experts say.

Heart Attacks in Kids

2007-10-01T15:36:00.000-05:00

From CNN

A report from Ohio doctors documenting nine cases over 11 years in kids as young as 12 says heart attacks in children are a rare but under-recognized problem.

The conditions of the patients in the Pediatrics report were diagnosed through blood tests that showed abnormal levels of an enzyme made by injured or dying heart tissue. Many also had abnormal heart-imaging tests. Both methods are used to diagnose heart attacks in adults.

Doctors control emotions with patients

2007-09-28T18:44:00.000-05:00

From UPI, via GruntDoc:

A U.S. study suggests physicians shut off the portion of their brain that helps them appreciate the pain their patients are experiencing.

Instead, the University of Chicago research indicates physicians activate a portion of the brain connected with controlling emotions during such patient encounters.

Because doctors sometimes have to inflict pain on patients as part of the healing process, they also must develop the ability not to be distracted by the suffering, said Jean Decety, a professor of psychology and psychiatry and co-author of the study.

"They have learned through their training and practice to keep a detached perspective; without such a mechanism, performing their practice could be overwhelming or distressing, and as a consequence impair their ability to be of assistance for their patients" said Decety.

Obesity Threatens Emergency Services: Report

2007-09-27T17:18:00.000-05:00

ABC News' take on the effect of obese (and "super-obese") patients in EMS and the ED.

Extra wide beds, stronger toilets and special patient lifting devices are becoming more and more common in emergency rooms. The reason for such new equipment? Hospitals across the United States are struggling to handle increasing numbers of extra-large patients.

And as the country's rates of obesity and "superobesity" continue to climb, many worry that such accommodations will put an increasingly heavy toll on an already strained emergency services system.

Hospitalists Shorten Patient Stays

2007-09-26T16:38:00.000-05:00

From the Washington Post:

Being cared for by hospital-based general physicians -- also known as "hospitalists" -- can shorten patients' hospital stays, a U.S. study finds.

The study looked at more than 9,000 patients discharged from an academic medical center between July 2002 and June 2004.

The 2,913 patients cared for by hospitalists had an average hospital stay of just over 5 days, compared to nearly 6 days for the 6,124 patients cared for by non-hospitalists, reported researchers at Montefiore Medical Center in New York City.

"Hospitalist care had the strongest association with length of stay in patients with specific diagnoses, including cerebrovascular accidents (strokes), congestive heart failure, pneumonia, sepsis, urinary tract infections and asthma/chronic obstructive pulmonary disease," the researchers wrote. "The close monitoring and continuous presence offered by hospitalists may allow for earlier discharge, because hospitalists are more likely to detect clinical improvement in real time and to make appropriate adjustments in treatment regimens."

Tamper-Proof Prescriptions

2007-09-26T16:32:00.000-05:00

From the Wall Street Journal Health Blog:

It looks like doctors and pharmacies will get a reprieve from a new rule requiring tamper-proof prescriptions for Medicaid patients.

Congress created the rule earlier this year, and it’s set to go into effect on October 1. But the Senate last night passed a bill that would push that back another six months, and a similar bill is moving through the House this week.

The shift is supposed to make it harder for patients to forge prescriptions. But doctors and pharmacies have said the quick implementation wouldn’t give them enough time to get ready and could result in patients not being able to get the medicine they need.

Obese and Super Obese Patients Challenge Emergency Medical Care Providers

2007-09-24T19:51:00.000-05:00

From ACEP:

Obese patients are presenting new challenges in emergency care, from burdening patient transport systems to complicating diagnosis and treatment. As rates of obesity and super obesity accelerate, emergency departments struggle to cope (“Emergency Departments Shoulder Challenges of Providing Care, Preserving Dignity for the ‘Super Obese’”).

“Higher levels of obesity will lead to more people getting sick with heart disease, hypertension or diabetes and coming to the emergency department,” said Dr. Theodore Delbridge, chief of emergency medicine at Pitt County Memorial Hospital in Greenville, North Carolina. “Clearly the obesity epidemic is having an effect on emergency department care. The steady increase in obese and super obese patients creates pressures across the entire spectrum of patient care, from ambulance capacity to proper drug dosing.”

A survey cited in the article finds that the emergency department has been the most affected area in hospitals by the growing population of obese patients.

Super obese patients present the greatest difficulties to emergency medical care providers, from pre-hospital care through hospital admission. Patients who weigh more than 400 pounds may require bariatric ambulances, which are rare due to their high cost. In addition, EMS workers typically only lift 100 pounds, meaning a larger patient will require extra personnel. Nearly half of surveyed EMS workers reported back injuries related to lifting extremely heavy patients. Global sales in bariatric stretchers and lift systems are expected to soar in the next five years.

In addition, super obesity may create complications in diagnosis and treatment because of difficulties with blood draws, lumbar punctures or imaging machines such as CT scanners. Drug dosing poses additional dilemmas since, for most drugs, there are few clinical studies on proper dosing for very large patients.

Between 1986 and 2000, the prevalence of super obese patients has increased by a factor of five, from one in 2,000 to one in 400. Seventy-eight percent of hospitals reported an increase in the admission of severely obese patients in the last year, a trend that seems likely to continue.

“The bottom line is that this trend is not going away and emergency care providers will have to find ways to optimize care,” said Dr. Delbridge. “Emergency physicians adapt to all kinds of changes in our patient population and this is no different.”

WSJ: "Chatty Neatnik Docs Ace Malpractice Insurance Tests"

2007-09-24T19:47:00.000-05:00

Love that title. From the Wall Street Journal Health Blog.

Paying premiums isn’t enough to get malpractice insurance for some docs these days. Some insurers now require an online personality test, reports American Medical News.

The test gauges a doctor’s “interpersonal communication skills,” “attention to detail” and “propensity for risk-taking behavior,” according to the Web site of United Medical Liability. The online test takes 15 to 20 minutes, according to the company. Insurers may send doctors who are sloppy, thrill-seeking clods to training to reduce their risk of being sued.

U of I med school eyes expansion in DM

2007-09-21T16:00:00.000-05:00

From the Des Moines Register:

The University of Iowa Hospitals and the Des Moines Area Medical Consortium is looking at a new downtown location in order to double the number of medical students receiving training in the city.

"It will improve the medical education of our students and hopefully entice more of these students to stay in Des Moines and surrounding areas," said Jean Robillard, vice president for medical affairs at the U of I.

Twenty-five to 35 U of I medical students now spend rotations each year at Iowa Methodist Medical Center, Iowa Lutheran Hospital, Blank Children's Hospital, Veterans Affairs Medical Center and Broadlawns Medical Center, said Dr. Steven Craig, the consortium's executive director.

Education space in the consortium's offices at 1415 Woodland St. is already tight and would not be adequate if the consortium agrees to increase the number of U of I medical students to 50 to 55 each year, Craig said.

"We recognize that taking in more students means we need more classrooms, conference rooms and patient simulation rooms," Craig said. "We've been exploring what type of facility we would need."

The consortium would likely develop a new facility close to its offices just south of Methodist, Craig said. Consortium leaders are now trying to figure out how much it would cost, how they would raise the money and where the building would be located, he said.

"No timeline has been set," he said. "We're now in the exploratory stage."

Hypothermia Treatment

2007-09-19T19:23:00.000-05:00

From Medgadget:

Life Recovery Systems, HD, LLC, of Alexandria, LA was just issued the CE Mark of approval by the EU to market their ThermoSuit system, indicated for emergency cooling of patients to "preserve cardiac and brain function in victims of cardiac arrest, stroke, heart attack, traumatic brain injury and hyperthermic patients."

The ThermoSuit System uses innovative technology to rapidly cool a patient's core temperature. It consists of a disposable body suit and a means to pump coolant within the suit over the skin of the patient. It is the first device for patient temperature management that conveniently provides a thin layer of rapidly flowing liquid coolant in direct contact with the skin. This approach gives the ThermoSuit System outstanding capabilities to rapidly and non-invasively change patient temperature. It has been designed for ease of use for clinicians who treat patients indicated for cooling therapy, and has the potential to quickly cool these patients conveniently and rapidly.

Mayo Clinic Calls for Universal Coverage

2007-09-15T00:02:00.000-05:00

From the (excellent) Wall Street Journal Health Blog

Make everybody in America buy health insurance, and give subsidies to help the poor afford it. Force insurance companies to offer some coverage to everyone, regardless of health status. And have everybody buy their insurance directly, rather than getting it through their employer.

Those are the broad outlines of a plan (described here) created by the Mayo Clinic’s Health Policy Center after consulting with hundreds of academics, patient activists and health-care providers in the last year and a half. The group also got input from executives at companies such as Wal-Mart and Verizon that are not part of the health-care industry.

Newsweek article about eICU's

2007-09-14T09:16:00.000-05:00

From Newsweek:

Here's the sub-heading: Small hospitals use technology to run remote ICUs.

Swedish Medical is one of a growing number of hospitals opting for a radical form of outsourcing by using technology and doctors stationed off-site to monitor the well-being of critically ill patients. Instead of listening through a stethoscope, a single doctor can track multiple patients at all three hospitals from a remote facility by watching monitors and Webcams, working from a post that looks a lot like an air-traffic controller's station.

ER Kiosks Let Patients Avoid Long Lines

2007-09-14T09:11:00.000-05:00

From ABC News

An emergency room might be the last place you'd think would have do-it-yourself check-in. But Parkland Memorial Hospital has three self-service computer kiosks, similar to those used by airport passengers and hotel guests. And so do a handful of other hospital ERs, where the long wait in line to register and explain symptoms can be grueling.

Multitasking (and why migraine patients wait)

2007-09-12T08:49:00.000-05:00

From Scalpel or Sword (a great blog)

At any given moment during the typical shift in the ER, here is what is happening:

There are 10-20 patients in the waiting room. Some have been waiting 6 hours. A couple of them have ankle sprains and were already X-rayed, and their X-rays were already read by the Radiologist as "no bony abnormality, soft tissue swelling." They would like to leave without being seen. We don't argue too much.

I'm waiting on a callback from a specialist, and I have two more calls to make after that one. If I paged them all at once, they would all call back at the same time, then two of them would hang up before I was finished talking with the first one. They would be understandably angry when they were repaged, and they would take an hour to call back the second time. So I page them one at a time. As soon as I introduce myself to the next patient I see, the first one will call back...

continues...

Nurse fired for not aiding death probe

2007-09-11T11:29:00.000-05:00

From the Des Moines (IA) Register:

A nurse at the Perry Health Care Center has been fired for failing to cooperate with an investigation into a resident's death at the nursing home.

The home was recently fined $7,000 amid allegations that workers there were unable to perform basic CPR on residents.

Communication test predicts problem doctors

2007-09-10T11:10:00.000-05:00

From Reuters:

Physicians coming out of medical school with lousy communication skills end up getting more complaints down the road from patients, and tests can find the doctors with problems, according to a study published on Tuesday.

The study confirmed that tests like one given during the medical-licensing process in Canada can predict which doctors would run into trouble and underscored the importance of a doctor's ability to communicate well with patients.

New Prehospital 12-Lead

2007-09-08T14:02:00.000-05:00

From Medgadget

The popular HeartStart line of defibrillators from Philips is getting a nice addition to its lineup. The company is now profiling its HeartStart MRx Monitor/Defibrillator that sports the ability for paramedics to transmit patient data from the ambulance to the hospital's ER en route.

New CPR Technique

2007-09-08T13:51:00.000-05:00

From Purdue University:

New CPR promises better results by compressing abdomen, not chest

A biomedical engineer at Purdue University has developed a new method to perform cardiopulmonary resuscitation that promises to be more effective than standard CPR because it increases nourishing blood flow through the heart by 25 percent over the current method.

A new technique is desperately needed because conventional CPR has a success rate of 5 percent to 10 percent, depending on how fast rescuers are able to respond and how well the procedure is performed. For every one minute of delay, the resuscitation rate decreases by 10 percent.

"In other words, at 10 minutes, the resuscitation is absolutely ineffective," said Leslie Geddes, Showalter Distinguished Professor Emeritus in Purdue's Weldon School of Biomedical Engineering. "Any medical procedure that had that low a success rate would be abandoned right away. But the alternative is not very good, either: Don't do CPR and the person is going to die."

Geddes has developed the first new CPR alternative, called "only rhythmic abdominal compression," or OAC-CPR, which works by pushing on the abdomen instead of the chest.

"There are major problems with standard CPR," Geddes said. "One is the risk of breaking ribs if you push too hard, but if you don't push hard you won't save the person. Another problem is the risk of transferring infection with mouth-to-mouth breathing."

The new CPR method eliminates both risks, Geddes said.

"Bogus doctor trapped by misspelt letter to court after speeding let-off"

2007-09-06T16:57:00.000-05:00

From the London Times

A bogus doctor who escaped a speeding fine by claiming he was on an emergency call was rumbled only after writing a badly spelt letter in an attempt to claim expenses for attending court.

Omid Chiang equipped his car with a flashing green light, a defibrillator and a “doctor-on-call” sign so he could break the speed limit at will and park anywhere he fancied.

New Oral Airway

2007-09-06T08:26:00.000-05:00

BusinessWeek reported on the device, as it recently won a design award.
Interesting name...

Tonguesucker

The Tongue Sucker is an oropharyngeal airway device specifically developed to be used by untrained persons on unconscious casualties. Located in first aid boxes, it is designed to prevent the obstruction of the oropharynx, or throat, by the tongue and may also assist in compression only cardiopulmonary resuscitation (CPR).

Cutting docs’ hours doesn’t reduce death rates

2007-09-06T08:17:00.000-05:00

From MSNBC (emphasis added)

Cutting the grueling work hours of doctors-in-training had little effect on reducing patient deaths, according to two large studies.

Death rates dropped in one group of patients in veterans’ hospitals but not in three other groups, the researchers reported.

The results come from what the authors describe as the largest and most comprehensive national look at work-hour restrictions, which were implemented four years ago in an effort to reduce medical errors by tired physicians.

For the groups with no change, Volpp said one possible explanation is that more patient handoffs by residents offset the benefits of reduced fatigue. He also noted the work-hour limits may not be strictly enforced at every hospital.

Picture Boards Speak In Health Crisis

2007-09-05T11:13:00.000-05:00

From CBS News:

With more ill and injured people needing emergency care but do not speak English, hospitals, clinics and rescue squads are turning to picture boards to bridge the communication gap with easily understood images.

The large, double-sided panels let patients point to icons showing their problem _ such as pain, a burn, breathing trouble or a fall _ as well as the part of the body that is affected. They also can point to their native language in a list so an appropriate interpreter can be located.

"They ought to be in every ambulance, in every hospital, in every clinic," said Dr. Fred M. Jacobs, head of New Jersey's health department. "Communication barriers lead to adverse impacts on (care) quality, misunderstandings and even medical errors."

His department is partnering with the state's hospital association to distribute thousands of the boards to all New Jersey hospitals, rescue squads and public health clinics.

New, small portable ultrasound

2007-09-05T08:25:00.000-05:00

From a press release:

Siemens introduces the world's smallest ultrasound device for initial diagnosis in emergency situations

The first few minutes are instrumental in emergency situations. A new portable ultrasound device from Siemens Medical Systems supports medical personnel in these efforts. The device, known as Acuson P10, is a hand-held device intended for complementary initial diagnostic care and triage, particularly in cardiology, emergency care and obstetrics. It is poised to change the physical exam by providing immediate information to health care providers at the earliest possible patient intervention points, such as intensive care units, ambulances and medical helicopters. The advantages of the new system are its portability, easy handling as well as its fast and consistent availability to the physician. The device is barely larger than a Blackberry and weighs just a little more than 700 grams.

I’ll Drive, I’m Just Having a Heart Attack

2007-09-05T08:17:00.000-05:00

From the Wall Street Journal's Health Blog:

Hey, tough guy: It’s OK to call 911 if you think you’re having a heart attack. In fact, it can help you save precious heart muscle and lower your chances of death.

But, as the WSJ’s Ron Winslow points out in this morning’s paper, a recent study in Minnesota found that only 37% of rural men who were having heart attacks arrived at the hospital in an ambulance. The rest drove themselves or got a ride from a friend or family member. Women with heart attacks did slightly better but still not great– 49% of them came by ambulance.

AED's in Schools

2007-08-30T19:18:00.000-05:00

From the Dr. Wes blog

Just in time for the back-to-school season comes this report on the epidemiology of cardiac arrest in our schools.

The report adds much to our knowledge of the epidemiology of sudden death in schools from two large counties near Seattle, WA, USA. Of 3773 episodes of cardiac arrest in a public domain over 16 years, 97 arrests occurred in 671 schools but only 12 of these occurred in children.

The incidence of sudden death among (adult) school staff was 25-fold greater than that among students. Given the additional contribution of other adults not employed by the school, greater than 90% of cardiac arrests in schools occurred among adults. The finding supports the assertion that school-based CPR and AED programs would benefit faculty and staff members, as well as visitors to the school who, because of their age, are at greater risk of cardiac arrest than the students.

These data, in my view, make a compelling case for the wide availability of public access defibrillation. It is survival to discharge from a hospital that matters, and there is nothing that will improve survival in that setting better than a beating heart. The chest thumping of CPR, while helpful temporarily, only mildly improves the chance of survival following cardiac arrest until the coordinated contraction of the heart can be restored with defibrillation.

47 Million Uninsured

2007-08-29T08:50:00.000-05:00

In a front-page article, the New York Times reports, "The nation's median household income grew modestly in 2006, the Census Bureau reported yesterday, even as the percentage of people without health insurance hit a high." Officials from the Census Bureau "attributed the rise in the uninsured -- to 47 million from 44.8 million in 2005 -- mostly to people losing employer-provided or privately purchased health insurance. The percentage of people who received health benefits through an employer declined to 59.7 percent in 2006, from 60.2 percent in 2005." In addition, "The percentage of people with government-provided health insurance...dropped, to 27 percent from 27.3 percent." The Times continues, "And the new data on the rise in the number of those uninsured prompted advocates for the poor to step up their call for Congress to reauthorize the State Children's Health Insurance Program (SCHIP), which provides subsidized insurance to children of the working poor."

The relationship between distance to hospital and patient mortality in emergencies: an observational study

2007-08-27T10:20:00.000-05:00

From the Emergency Medicine Journal

ABSTRACT
Objectives: Reconfiguration of emergency services could lead to patients with life-threatening conditions travelling longer distances to hospital. Concerns have been raised that this could increase the risk of death. We aimed to determine whether distance to hospital was associated with mortality in patients with life-threatening emergencies.

Methods: We undertook an observational cohort study of 10 315 cases transported with a potentially life-threatening condition (excluding cardiac arrests) by four English ambulance services to associated acute hospitals, to determine whether distance to hospital was associated with mortality, after adjustment for age, sex, clinical category and illness severity.

Results: Straight-line ambulance journey distances ranged from 0 to 58 km with a median of 5 km, and 644 patients died (6.2%). Increased distance was associated with increased risk of death (odds ratio 1.02 per kilometre; 95% CI 1.01 to 1.03; p<0.001). This association was not changed by adjustment for confounding by age, sex, clinical category or illness severity. Patients with respiratory emergencies showed the greatest association between distance and mortality.

Conclusion: Increased journey distance to hospital appears to be associated with increased risk of mortality. Our data suggest that a 10-km increase in straight-line distance is associated with around a 1% absolute increase in mortality.

Capnometry in the prehospital setting: are we using its potential?

2007-08-27T10:17:00.000-05:00

From the Emergency Medicine Journal:

Capnometry is a non-invasive monitoring technique which allows fast and reliable insight into ventilation, circulation, and metabolism. In the prehospital setting it is mainly used to confirm correct tracheal tube placement. In addition it is a useful indicator of efficient ongoing cardiopulmonary resuscitation due to its correlation with cardiac output, and successful resuscitation. It helps to confirm the diagnosis of pulmonary thromboembolism and to sustain adequate ventilation in mechanically ventilated patients. In patients with haemorrhage, capnometry provides improved continuous haemodynamic monitoring, insight into adequacy of tissue perfusion, optimisation within current hypotensive fluid resuscitation strategy, and prevention of shock progression through controlled fluid administration.

Medical Statistics Made Simple

2007-08-24T16:06:00.000-05:00

From Medical Economics

Medical Studies: What You Need to Know

Americans are bombarded with news of medical breakthroughs every day. How can you judge which deserve your attention? The most meaningful studies are well-designed, include hundreds of patients similar to you (in age, sex, race, and stage of disease), and have clear, dramatic results.

Consider these results with your doctor, along with your own values and concerns. Tell your physician why you want a specific test or treatment, and share what you consider important in your healthcare, whether it’s quality of life, costs, or risks vs benefits.

Fast Relief, and Simple

2007-08-23T14:17:00.000-05:00

From Surgeon's Blog:

...the subject was a simple procedure bringing rapid and dramatic relief, commenters have mentioned other similar interventions. Seems like a fun topic. Here's a list I can think of (a couple of which are those mentioned in the comments, by readers.) Anyone want to chime in with others?

Giving "Narcan" to an overdose patient: within seconds a moribund and blue, pin-point-pupilled addict is transformed to a yelling and screaming maniac.

Similarly: Dextrose IV for hypoglycemia rapidly raises from unconsciousness to lucidity.

Pain medicine use has nearly doubled

2007-08-20T11:59:00.000-05:00

From Yahoo News:

The amount of five major painkillers sold at retail establishments rose 90 percent between 1997 and 2005, according to an Associated Press analysis of statistics from the Drug Enforcement Administration.

More than 200,000 pounds of codeine, morphine, oxycodone, hydrocodone and meperidine were purchased at retail stores during the most recent year represented in the data. That total is enough to give more than 300 milligrams of painkillers to every person in the country.

Medicare to Stop Pay for Hospital Errors

2007-08-19T22:44:00.000-05:00

From AOL News:

In a significant policy change, Bush administration officials say that Medicare will no longer pay the extra costs of treating preventable errors, injuries and infections that occur in hospitals, a move they say could save lives and millions of dollars.

Private insurers are considering similar changes, which they said could multiply the savings and benefits for patients.

Under the new rules, to be published next week, Medicare will not pay hospitals for the costs of treating certain “conditions that could reasonably have been prevented.”

Among the conditions that will be affected are bedsores, or pressure ulcers; injuries caused by falls; and infections resulting from the prolonged use of catheters in blood vessels or the bladder.

In addition, Medicare says it will not pay for the treatment of “serious preventable events” like leaving a sponge or other object in a patient during surgery and providing a patient with incompatible blood or blood products.

Special Ambulance for Morbidly Obese Patients

2007-08-19T12:22:00.000-05:00

From JEMS

SAVANNAH, Ga. - Southside Fire and EMS has added a special-order ambulance meant for very obese patients to its fleet of emergency vehicles.

It's getting great business.

Southside is using the bariatric ambulance for anyone larger than 400 pounds. It has been used more than once a day since it was delivered in late June. The largest patient transported thus far weighed 730 pounds.

It's also being used to transport normal-weight patients, but special features, including a cot that can hold a 1,600-pound patient, are easing transport problems with larger patients.

Med student struggles to preserve her idealism

2007-08-19T12:18:00.000-05:00

Great article from CNN.com

Learning how to practice medicine on this sort of a time-scale is stressful. But it's totally necessary in order to properly train us for a world of health care in which the average physician visit is six minutes! When our professors went to medical school, they were taught the art of healing; we are taught how to diagnose and treat patients in a limited timeframe. I can't help but think, is this what I signed up for?

Interesting Technique

2007-08-19T12:06:00.000-05:00

From iWon News

EUGENE, Ore. (AP) - A seat belt saved a driver, police say, but not in the usual way. Steven Earp, 48, was eating a fast-food sandwich Wednesday morning, said police Sgt. Doug Mozan. Earp choked and blacked out. His 1997 Honda sedan hit a parked car.

After the wreck, Earp came to.

Mozan attributed his revival to a "seat-belt-induced Heimlich maneuver."

Lawsuit Contests Weight Rule for Helicopter Transport

2007-08-17T11:08:00.000-05:00

From EM News:

A lawsuit alleging that a Florida car crash victim might have survived if a helicopter had been sent instead of an ambulance may be the first legal challenge of its kind in the nation.

Sharon Hanlon, the attorney representing family members of the deceased woman, Diana Lopez, said Collier County emergency personnel were lax when they allegedly declined to provide air transport because of her weight, which reportedly exceeded 300 pounds. That negligence occurred due to failure to clarify the rules/procedures regarding heavy-set patients who are trauma alert patients, she said.

Ms. Lopez was in her mid-30s, was a business owner of a trucking company, recently underwent gastric bypass surgery, and had lost 94 pounds. She was in good health and looking forward to life, Ms. Hanlon asserted.

The defense countered that the sole proximate cause of the plaintiff's damages was the decedent's own negligence and actions, or omissions, including, but not limited to, failing to wear a seatbelt. County officials appear confident that neither Collier County nor its Emergency Medical Services will be held liable. We believe that the county has many viable defenses to this action, said Assistant County Attorney William Mountford, who filed Collier County's legal reply to the wrongful death suit.

Persuasive demo

2007-08-16T16:38:00.000-05:00

From the Daily Mail (Auckland, New Zealand):

An elderly New Zealand man who suffered a heart attack at a hardware store was revived by a salesman who just happened to be demonstrating a defibrillator to store staff.

Malpractice: To settle or fight

2007-08-14T08:25:00.001-05:00

From Medical Economics:

Being named in a malpractice suit is bad enough. Being told by your attorney and insurance carrier that the case "just isn't defensible" is worse still.

Those discouraging words—which, when combined, usually spell "settlement"—aren't always based on medical events. Two physicians might provide the same treatment to similarly afflicted patients, resulting in the same unfortunate outcome, but one doctor goes to court and wins, while the other is forced to settle for $1 million.

Why the difference? Partly, it's the vagaries of the legal system, which relies on judges, attorneys, and juries that differ from jurisdiction to jurisdiction and case to case. Partly it's because your insurer might prefer to avoid the expense of litigation. (See "Sued? You may never get your day in court," Aug. 4, 2006.) But mostly it's because the nonmedical aspects of a malpractice case can trump the therapeutic ones. Defense attorneys, after weighing all the pertinent factors, might conclude that you're best off settling out of court because you're not likely to fare well before a judge and jury.

Defibrillators for Lacrosse

2007-08-08T20:16:00.000-05:00

From the Baltimore Business Journal

U.S. Lacrosse said Tuesday it's teaming up with a cardiac monitoring manufacturer to get teams and leagues to have defibrillators ready on the sidelines at games.

Cardiac Science Corp. (NASDAQ: CSCX) will offer Baltimore-based U.S. Lacrosse's 250,000 national members a discounted price on the company's Powerheart automated external defibrillators.

The defibrillators use an electric shock to jolt a heart back into rhythm in the event of a sudden cardiac arrest. Since 1999, at least five players have died during live lacrosse competition as a result of sudden cardiac arrest, according to U.S. Lacrosse officials.

Bothell, Wash.-based Cardiac Science will offer the defibrillators to U.S. Lacrosse members at a price of $1,395, a 44 percent savings off the regular price of $2,495.

Automated external defibrillators are used in response to commotio cordis, which can cause sudden cardiac arrest in athletes. Commotio cordis can occur when an athlete is struck in the chest area around the heart. The impact does not have to be severe for sudden cardiac arrest to occur.

MN Level One Heart Attack Center in the WSJ

2007-08-03T10:51:00.000-05:00

From the Wall Street Journal

Mr. Femling was treated under an initiative introduced by cardiologists at Minneapolis Heart Institute to improve heart-attack care. Since 2003, the Minneapolis cardiologists have treated more than 1,200 patients who were transferred to the city's Abbott Northwestern Hospital via ambulance or helicopter from 31 community hospitals as far as 210 miles away. The strategy is patterned after trauma centers that handle victims of car crashes and gunshot wounds.

Stroke Dx Admit from the ED: Statistics

2007-08-02T12:46:00.000-05:00

From ACEP News (now in digital format)

Heads Up: Brain Injury in Your Practice

2007-08-02T12:39:00.000-05:00

An estimated 75%-90% of the 1.4 million traumatic brain injury-related deaths, hospitalizations, and emergency department visits that occur each year are concussions or mild traumatic brain injuries (MTBI).

Many individuals who sustain an MTBI are not hospitalized or receive no medical care at all. An unknown proportion of those who are not hospitalized may experience long-term problems such as persistent headache, pain, fatigue, vision or hearing problems, memory problems, confusion, sleep disturbances, or mood changes. Symptoms of MTBI or concussion may appear mild, but can lead to significant, life-long impairment affecting an individual's ability to function physically, cognitively, and psychologically.

Physicians can play a key role in helping to prevent MTBI or concussion and improve a patient's health outcomes through early diagnosis, management, and appropriate referral.

In response, CDC, in collaboration with an expert work group, has recently updated and revised the "Heads Up: Brain Injury in Your Practice" tool kit. This tool kit is available free-of-charge at http://www.cdc.gov/ncipc/tbi/physicians_tool_kit.htm

Thirty-Minute CPR Course as Effective as a Three-Hour One

2007-07-30T08:21:00.000-05:00

From Medpage Today:

A 30-minute, video-based cardiopulmonary resuscitation course (CPR) is as effective as a traditional 3-hour course, with possibly better retention at six months, researchers found.

A comparison of the short course with longer versions of CPR training was conducted by a team at the University of Texas Southwestern Medical Center, here, and reported in the August issue of Resuscitation.

Ahamed Idris, M.D., and colleagues randomized 294 volunteers to one of the two training programs; 270 completed the training -- 151 took the short course, adopted recently by the American Heart Association, and 119 took the longer one. Volunteers were all employees of American Airlines and CPR training sessions took place at corporate headquarters in Fort Worth, Tex.

The short course consisted of a 23-minute CPR video, a three-minute discussion on recognition of choking and demonstration of the Heimlich maneuver, and a five-minute demonstration on the use of an automated external defibrillator (AED).

Students each received an inflatable mini-manikin to use during training, a device that provides real-time audio feedback on the depth and rate of chest compressions, knee pads, and alcohol wipes.

In the traditional course didactic lectures on CPR, rescue maneuvers for choking, and AED use are supplemented by videos. Students share full-size manikins, which cuts the amount of hands-on training they received, the researchers noted.

With the short course, "individuals practice while they learn, allowing more time to perform and retain the critical hands-on skills required to provide more effective CPR," said Dr. Lynn Roppolo, assistant professor of emergency medicine and lead author of the study.

Skills evaluation was accomplished by having the student demonstrate CPR and AED use on a life-size manikin. They were videotaped and the manikin recorded compressions/ventilations. The videotapes were evaluated by reviewers blinded as to which of the courses the subjects took.

After evaluation, the researchers found no significant difference between the two groups in ability to provide the correct depth and rate of compressions, the amount of air delivered during ventilations, or other measures of competence.

However, at six months follow-up, more of the students in the short course called 911 appropriately, conducted a more rapid assessment of the victim, began CPR more rapidly, and were more likely to provide adequate ventilations compared with those enrolled in the longer training course.

Report: Average patient spends 4 hours in ED

2007-07-29T19:15:00.000-05:00

Source: AHA News Now (http://www.ahanews.com)
Date: June 28, 2007

The average time spent in emergency departments rose in 2006, but so did patient satisfaction, according to a new report by Press Ganey Associates. Based on the firm's patient surveys in 1,500 hospitals, patients spent an average of 4 hours in the ED, 18 minutes more than in 2005. The more patients an ED saw over the year, the longer the average visit, which increased by 30 minutes for every additional 10,000 patients annually. Patient satisfaction dropped as time in the ED increased, with the lowest satisfaction reported from 3-11 p.m. and highest from 7 a.m.-3 p.m.

To view the report, go to:
http://www.pressganey.com/ER-report.pdf

Baghdad ER

2007-07-28T16:36:00.000-05:00

Baghdad ER" an excellent documentary originally aired on HBO, is now posted, in its entirety, on Google Video.

Here's a link to a site devoted to the program at HBO.com

New Cervical Collar Design

2007-07-26T23:01:00.000-05:00

From Medgadget

"LuboCollar is designed to protect the neck by restricting the movement of the head relative to the rest of the body and to maintain an open airway in a non-invasive, simple and quick to operate way. It does so by using a "jaw-thrust"-like knob to maneuver the mandibles, pushing them forward in the direction of the chin," explains Dr. Omri Lubovsky, developer of the LuboCollar and a physician in the Department of Orthopedic Surgery at Hadassah University Hospital.

Reassurance Workup

2007-07-24T16:04:00.000-05:00

From Movin' Meat:

I have devised a simple, cheap and quick "reassurance work-up" for these folks which consists of: an ECG, an i-Stat, a D-dimer, and a troponin. Sometimes I add a chest x-ray if it seems helpful. (We are lucky in that most of these tests can be done in the ED's stat lab with a turn-around-time of about 15 minutes.) Then I sit down with the patient and invest a few minutes telling him or her about all the tests we did and all the Bad Things we ruled out. I list each electrolyte separately, the normal blood sugar (we ruled out diabetes), normal blood counts (rules out anemia), ruled out heart attack, blood clots, aneurysm, etc etc. It's interesting how well patients respond to that. The long list of things "you don't have" seems to really be effective in reassuring patients. Then a quick laugh -- I ask the question for them: "Great, doc, you told me what I don't have, so what do I have? Well, I can't tell you what is causing your symptoms, but there are only x number of Bad Things that can cause symptoms like yours, and you don't have any of those Bad Things, so I know it is safe for you to go home, we will keep an eye on it, and I expect that it will go away on its own."

ACEP Comment on CDC Data

2007-07-24T15:57:00.000-05:00

ED Visits Jump to Record 115 Million

Visits to emergency departments increased to an all-time high of 115 million in 2005, 5 million more than in 2004, according to a [new report from the Centers for Disease Control and Prevention. ACEP leaders said the increase in visits combined with closures of emergency departments threaten the safety of patients and will further endanger an already fragile system.

"With 315,000 people visiting emergency departments every day, the alarm bells are sounding and policymakers should heed the alert and respond," said ACEP President Brian Keaton, MD.

ACEP supports legislation, the Access to Emergency Medical Services Act (H.R. 882 and S.1003), that calls for the creation of a national bipartisan commission on access to emergency medical services that will examine factors that affect and may impede the delivery of care in U.S. emergency departments.

CMS Proposes Big Cuts for 2008 Medicare Payments

2007-07-24T15:56:00.001-05:00

From ACEP:

The now yearly controversy over cuts to Medicare payments has started again, and without congressional action, emergency physicians could see a 12% decrease in Medicare payments starting in 2008. The 2007 Medicare Trustees report predicts total cuts of approximately 40% for all physician payments by 2016.

Key policy makers on Capitol Hill expressed concern about the cuts and are working with ACEP, the AMA, and others in the physician community to develop a legislative solution for the next several years. The temporary fix would also allow Congress time to develop a comprehensive plan to change the sustainable growth rate (SGR) formula, the flawed metric used to set payment rates.

The legislation could reach the floor of the House before the August recess or sometime in September. Rural legislators are also considering extensions of physician payment bonuses that expire at the end of this year.

National Hospital Ambulatory Medical Care Survey: 2005 Emergency Department Summary

2007-07-24T15:48:00.000-05:00

Available as a PDF on the CDC website

Here's one graph (courtesy of GruntDoc)

Pay for Specialist Coverage for the ED

2007-07-23T17:18:00.000-05:00

From the American Hospital Association

More than one-third of hospitals now pay for some physician specialty emergency department call coverage, according to results from AHA's survey of hospital leaders. The 2007 State of America's Hospitals - Taking the Pulse also found 55% of hospitals experienced gaps in physician specialty coverage with coverage issues most prevalent in orthopedics and neurosurgery. In addition, nearly half of EDs are "at" or "over" capacity, with a majority of urban hospitals experiencing time on diversion. Hospital leaders cited a lack of staffed critical care beds as the most common reason for diversion. The survey also found that hospital workforce shortages, including an estimated 116,000 registered nurse vacancies as of December 2006, are affecting patient care. Regarding disaster readiness, hospitals are taking a variety of actions to bolster preparedness, including participating in large scale drills, establishing back-up communication plans and developing resource plans with other hospitals. The survey, which had a 17% response rate, was sent to about 5,000 ommunity hospital CEOs in late February 2007 via fax and email.

Physicain Drain in (Rural) Upstate New York

2007-07-23T17:16:00.000-05:00

It's similar in other rural areas, I'd wager...

From The New York Times

While newly licensed doctors flock to New York City, Long Island and Westchester County, where there is already a glut, far fewer choose to practice in the vast upstate region. For instance, during the years the study was conducted, Essex County in the Adirondacks lost 22 percent of its doctors, while there was a 19 percent increase in Nassau County, on Long Island.

And as doctors upstate retire — one-third of the physicians in Binghamton are 55 or older — recruiting replacements is becoming more difficult. “I worry that new physicians may not see certain areas in the state as viable or attractive,” Ms. Moore said.

There is little question why, since statistics show a steady exodus of jobs and a decline in prosperity in upstate New York. In the last three decades, the population drain has contributed to New York’s loss of Congressional seats, to 29 today from 39, and state figures show that the number of 20- to 34-year-olds in the region decreased by 22 percent in the 1990s.

Newsweek Article on Resuscitation

2007-07-20T21:53:00.000-05:00

This week's cover article.
The focus of the article is on the use of therapeudic post resuscitation hypothermia.
http://www.msnbc.msn.com/id/19751440/site/newsweek/

CMS Memo on EMTALA

2007-07-13T11:13:00.000-05:00

The Centers for Medicare & Medicaid Services (CMS) recently sent out a memo regarding EMTALA On-Call Requirements and Remote Consultation Utilizing Telecommunications Media.

Memorandum Summary
*The treating physician in a hospital’s or critical access hospital’s (CAH) dedicated emergency department (DED) who is conducting the medical screening examination and/or providing stabilizing treatment of an individual required by the EMTALA regulations at 42 CFR 489.24 may, without violating EMTALA, consult on the individual’s case with a physician who is not present in the DED by means of any telecommunications medium that the physicians choose to use.
*This does not change the obligation under EMTALA of a physician who is on-call to make an in-person appearance in the DED when requested to do so by the treating physician.
*This guidance does not affect policy by any health care third party payer, including Medicare, governing the circumstances under which it will or will not pay for remote consultation services.
*The portions of the interpretative guidelines for 42 CFR 489.20(r) and _489.24(j) that discuss telemedicine or telehealth are superseded by this guidance.

It has been brought to the attention of the Centers for Medicare & Medicaid Services (CMS) that the interpretative guidelines for 42 CFR 489.20(r) and _489.24(j), concerning hospital/CAH on-call physician requirements under EMTALA, are being interpreted by some parties as prohibiting emergency department physicians from utilizing modern telecommunications to facilitate consultation with specialists who are not present in the hospital/CAH. There is no such prohibition under EMTALA. It is necessary to distinguish among:

*a hospital’s/CAH’s obligation under EMTALA to maintain an on-call list of physicians on its medical staff in a manner that best meets the needs of its patients;
*the obligation of an on-call physician to make an in-person appearance when requested to do so by the physician who is treating an individual who has come to the emergency department of the hospital/CAH; and
*remote consultation on the individual’s case by the treating physician with another physician, who may or may not be on the hospital’s/CAH’s on-call list.

The EMTALA statute at Sections 1866 and 1867 of the Social Security Act and EMTALA regulations at 42 CFR 489.20(r) and _489.24(j) establish requirements regarding hospital/CAH on-call lists and the obligations of on-call physicians to make in-person appearances. These provisions apply to hospitals/CAHs participating in Medicare. Section 1866(a)(1)(I)(iii) and 42 CFR section 489.20(r)(2) require hospitals/CAHs to _maintain a list of physicians who are on call for duty after the initial examination to provide treatment necessary to stabilize an individual with an emergency medical condition._ Each hospital/CAH must maintain its on-call list in a manner that best meets the needs of the hospital’s patients who receive services required under EMTALA. The resources available to a hospital/CAH, including the availability of on-call physicians, are taken into account when assessing the adequacy of its on-call list.

There is no EMTALA prohibition against the treating physician consulting on a case with another physician, who may or may not be on the hospital’s or CAH’s on-call list, by telephone, video conferencing, transmission of test results, or any other means of communication. CMS is aware that it is increasingly common for hospitals/CAHs to use telecommunications to exchange imaging studies, laboratory results, EKG’s, real-time audio and video images of patients, and/or other clinical information with a consulting physician not on the hospital/CAH premises. Such practices may contribute to improved patient safety and efficiency of care. In some cases it may be understood by the hospitals/CAHs and physicians who establish such remote consulting arrangements that the physician consultant is not available for an in-person assessment of the individual at the treating physician’s hospital/CAH.

However, if a physician:
*is on a hospital’s or CAH’s on-call list; and
*has been requested by the treating physician to appear at the hospital; and
*fails or refuses to appear within a reasonable period of time,
then the on-call physician may be subject to sanctions for violation of the EMTALA statutory requirements.

It is only when the treating physician requests an in-person appearance by the on-call physician that a failure by the latter to appear in person may constitute an EMTALA violation.

It is an entirely separate issue, outside the scope of EMTALA enforcement, whether or not insurers or other third party payers, including Medicare, will provide reimbursement to physicians who provide remote consultation services.

This clarification of existing policy will be incorporated into the SOM, Appendix V the next time it is revised.

Violence in the (Hospital) Workplace

2007-07-13T09:30:00.000-05:00

From CNN

BOSTON, Massachusetts (CNN) -- Nurses understand that they have a tough job, but getting attacked and abused is not what former Boston area emergency room nurse Ellen MacInnis says she signed up for.

"It was very frightening," said the 18-year veteran. An angry and frustrated patient had grabbed MacInnis' hand, dug her nails in and made a chilling threat. "If you have children, I'll find them and I'll kill them."

This was not the only time MacInnis was assaulted on the job. Last summer, an intoxicated, H.I.V.-infected female patient tried to hit her and wound up covering her in blood.

MacInnis said the thought that her life was in danger never occurred to her until after the situation was under control. "Then it sort of hit me," she said, "And I fell apart."

Nurses are often on the receiving end of physical assaults, because they are typically the first and most frequent medical personnel by the bedside of ill and sometimes angry or frustrated patients.

Emergency rooms seem to be the hot spots for violent assaults, according to experts interviewed for this article, but general practice nurses are not immune.

Fifty percent of nurses surveyed by the Massachusetts Nurses Association (MNA) -- a union of registered nurses -- and the University of Massachusetts said they had been punched at least once in a two-year period. Some reported being strangled, sexually assaulted or stuck with contaminated needles.

Emergency Physicians Monthly

2007-07-12T17:20:00.000-05:00

The Emergency Physicians Monthly website is new and improved - and includes a blog.

ACEP "Focus On" Series

2007-07-11T14:40:00.000-05:00

More Podcasts...

The American College of Emergency Medicine's "Focus On" Series:

Each "Focus On" article has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME). ACEP is accredited by the ACCME to provide continuing medical education for physicians, and designates this educational activity for a maximum of 1 Category 1 credit toward the AMA Physician's Recognition Award and 1 ACEP Category 1 credit.

University of Iowa Department of Emergency Medicine Podcast

2007-07-11T14:37:00.000-05:00

Dr Weiss’ presentations to the UIHC EM residency have been recorded as podcasts and are available for download from our itunes site. A link to the podcast can be found at out department webpage

Lawsuit: Timing in the ED

2007-07-11T09:09:00.000-05:00

From NY Emergency Medicine, via Kevin MD:

. . . a patient presented to an Emergency Department having cut off two fingers with a table saw. The injury occurred at 6:30 p.m. The patient was triaged at 7:19 p.m. The emergency medicine physician saw the patient at 7:42 p.m. X-rays were performed at 11:33 p.m. Orthopedics was finally consulted at 1:00 a.m., more than five-and-a-half hours after the patient presented to the Emergency Department. Orthopedics arrived at 1:30 a.m. The wounds were stitched closed by orthopedics at 2:00 a.m. Reimplantation of the saved digits could not be performed within eight hours from the time of injury as an operating room would not have been available that quickly.

The emergency medicine physician was found negligent for not contacting orthopedics sooner. Due to this prolonged period of time, among other negligent acts by orthopedics, the patient and his wife were awarded $525,000.00.

Increase in Visits Combined with ER Closures Threaten Patient Safety and Will Lead to System Collapse

2007-07-05T08:23:00.000-05:00

A press release from the American College of Emergency Physicians:

Washington, DC - Visits to emergency departments increased to an all-time high of 115 million in 2005, 5 million more than in 2004, according to a new report from the Centers for Disease Control and Prevention. The American College of Emergency Physicians (ACEP) said the increase in visits combined with closures of emergency departments threaten the safety of patients and will further endanger an already fragile system.

"With 315,000 people visiting emergency departments every day, the alarm bells are sounding and policymakers should heed the alert and respond," said Brian Keaton, MD, president of ACEP. "Emergency physicians are dedicated to saving lives. We want to provide quality care to all of our patients, but we need additional resources to be able to deliver that care. That's why we are asking Congress to pass the Access to Emergency Medical Services Act. This urgently needed legislation will help reduce the dangerous trends that are limiting the public's access to high-quality, lifesaving medical care and stripping emergency departments of their ability to respond to disasters."

The Access to Emergency Medical Services Act (H.R. 882 and S.1003) calls for the creation of a national bipartisan commission on access to emergency medical services which will examine factors that affect and may impede the delivery of care in U.S. emergency departments. The proposed legislation also recognizes the need for additional resources in support of care delivery. The Senate bill directs that a working group within the Centers for Medicare and Medicaid Services be convened to develop boarding and diversion standards, as well as guidelines and incentives for implementation of those standards. The House bill requires hospitals to report to the Department of Health and Human Services statistics on how many patients are boarded and for how long. The legislation is sponsored by Reps. Bart Gordon (D-TN) and Pete Sessions (R-TX) and U.S. Senators Debbie Stabenow (D-MI) and Arlen Specter (R-PA).

According to the new report, nearly 42 million visits to emergency rooms were because of injuries. The leading patient complaints, accounting for nearly one-fifth of all visits, were abdominal pain, chest pain and fever. Only 13.9 percent of visits were for nonurgent medical reasons - conditions that can still need medical attention soon, such as bladder infections, high fevers, and extremity injuries that could be fractures.

The new report said the closure of emergency departments combined with the overall increase in visits resulted in a 31-percent increase in visits per emergency department since 1995. There were 30,388 visits per emergency department in 2005 compared with 23,119 visits per emergency department in 1995. Medicaid recipients had the highest rate of emergency visits (88/100 persons) of all groups including Medicare enrollees and the uninsured, which indicates severe health care access problems by Medicaid patients.

"Emergency departments are the nation's health care safety net for everyone, not just the uninsured," said Dr. Keaton. "But that safety net is breaking under the load, and we are asking the public to contact their members of Congress today - by logging onto ACEP's website at www.acep.org. Given the struggles we face day-to-day, how can we be ready to respond to disasters and acts of terrorism? As citizens, we all need to let Congress know that we are deeply concerned about the alarming findings of the CDC report, and this urgently needed legislation must be passed."

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

2007-06-28T21:50:00.000-05:00

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

2007-06-27T21:24:00.000-05:00

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)

2007-06-26T08:47:00.000-05:00

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

2007-06-26T08:25:00.000-05:00

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

2007-06-26T08:21:00.000-05:00

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

2007-06-22T08:55:00.000-05:00

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.