Nurses’ Role in Healthcare Reform

From Modern Healthcare:

Proclaiming that healthcare’s largest single workforce ought to have a voice in the reform debate, the Institute of Medicine is teaming with the Robert Wood Johnson Foundation to prepare a major report on ways that nurses can help transform healthcare, called the Initiative on the Future of Nursing.

The report, due out in the fall of 2010, will show how nurses can improve care quality, lower costs and improve access. Through their hands-on experience with patients, nurses are positioned to offer advice on areas such as chronic disease management, early screening and the benefits of an expanded nursing workforce, according to a news release.

The report will also detail some of the hurdles the profession must overcome in order to build the workforce that will be needed after passage of reform legislation. Despite the recent slowdown in the hiring of new nurses in hospitals, industry leaders say the nursing shortage will resurface after the recession ends because it is driven by the high average ages of nurses and the slow rate of entry into nursing schools.

Prehospital therapeutic hypothermia for comatose survivors of cardiac arrest: a randomized controlled trial

From IngentaConnect:

Intravenous infusion of ice-cold fluid is considered a feasible method to induce mild therapeutic hypothermia in cardiac arrest survivors. However, only one randomized controlled trial evaluating this treatment exists. Furthermore, the implementation rate of prehospital cooling is low. The aim of this study was to evaluate the efficacy and safety of this method in comparison with conventional therapy with spontaneous cooling often observed in prehospital patients.

Methods: A randomized controlled trial was conducted in a physician-staffed helicopter emergency medical service. After successful initial resuscitation, patients were randomized to receive either +4 °C Ringer’s solution with a target temperature of 33 °C or conventional fluid therapy. As an endpoint, nasopharyngeal temperature was recorded at the time of hospital admission.

Results: Out of 44 screened patients, 19 were analysed in the treatment group and 18 in the control group. The two groups were comparable in terms of baseline characteristics. The core temperature was markedly lower in the hypothermia group at the time of hospital admission (34.1±0.9 °C vs. 35.2±0.8 °C, P<0.001) after a comparable duration of transportation. Otherwise, there were no significant differences between the groups regarding safety or secondary outcome measures such as neurological outcome and mortality.

Conclusion: Spontaneous cooling alone is insufficient to induce therapeutic hypothermia before hospital admission. Infusion of ice-cold fluid after return of spontaneous circulation was found to be well tolerated and effective. This method of cooling should be considered as an important first link in the `cold chain’ of prehospital comatose cardiac arrest survivors.

Rural Family Medicine Physician Nominated for Surgeon General

From CNN:

President Obama announced Monday his choice for surgeon general — Dr. Regina Benjamin, a 52-year-old family practice doctor who has spent most of her career tending to the needs of poor patients in a Gulf Coast clinic in Alabama.

Benjamin founded the Bayou La Batre Rural Health Clinic in 1990 in the fishing village of Bayou La Batre, Alabama, and has served as its CEO since.

Like many of her patients, the clinic has suffered its own life-threatening challenges. It was heavily damaged by Hurricane Georges in 1998 and Hurricane Katrina in 2005. It also burned to the ground several years ago. But Benjamin rebuilt it after each setback and has continued to offer medical care to the village’s 2,500 residents.

Her commitment to them has meant making house calls during the rebuilding, mortgaging her house and maxing out her credit cards, Obama said.

“Regina Benjamin has refused to give up; her patients have refused to give up,” he said.

Not retail clinics, not urgent care…

From USA Today:

At his Doctors Express center in Towson, Md., Dr. Scott Burger has spent the last three years tending to the community’s night-time fevers and weekend hurts.

Now, the former emergency room physician wants to take the center’s model nationwide, doing for urgent health care what, say, Papa John’s did for pizza — making sure the public can find it anywhere and always knows what it’s going to get.

They’re hoping to open 3,000 centers around the country, at which members of the public can come in without an appointment, in the evening or on weekends when their own doctors’ offices are closed, and get stitches, something for a sore throat or even a broken bone treated for a fraction of what they’d pay for a trip to an emergency room, and without the wait.

They say they’ll differ from the roughly 8,000 other urgent-care centers, as well as smaller retail clinics that have sprung up in shopping centers in the last decade, by offering a consistent, broad range of treatment and service on the spot. Every Doctors Express will have a physician on duty at all times, unlike some centers that leave patient care to the supervision of a nurse practitioner or other professional. All will have digital X-ray equipment, a lab and a pharmacy to dispense drugs, which other urgent-care centers may not have.

Family Medicine Docs Can’t Retire…

From MSNBC:

As the nation’s debate about overhauling health care heats up, one truth remains undisputed: There are not enough general care doctors to meet current needs, let alone the demands of some 46 million uninsured, who threaten to swamp the system.

It’s a problem growing worse in Everson and across the country, where more aging doctors are finding they can’t retire. In the U.S., there are at least 4,500 primary care doctors older than 75, according to figures from the Physicians Masterfile database maintained by the American Medical Association. Overall, there are about 270,000 doctors practicing primary care, which includes family, general medicine and internal medicine.

As younger doctors increasingly choose the better pay and balanced lifestyle promised by specialty practice, older doctors, especially in poor and rural areas, are working longer, reluctant to abandon their clients — but unable to find new care for them.

“Most of them would like to fade out, but they have an obligation,” said Dr. Joseph W. Stubbs, president of the American College of Physicians. “The issue is that there is not enough primary care because there are not enough medical students going into primary care.”

Not-for-profits continue to struggle

From Modern Healthcare:

The weak economy and tight credit continue to undermine the financial strength of not-for-profit hospitals and health systems. Moody’s Investors Service lowered significantly more credit ratings than it raised among not-for-profit hospitals and health systems for the third consecutive quarter, the New York ratings agency said in a report. Analysts dropped the credit ratings for 17 hospitals and systems with a combined $4.6 billion in debt between April and June. Meanwhile, Moody’s raised the ratings for four tax-exempt healthcare borrowers with debt totaling $734 million.

Last quarter’s margin of downgrades to upgrades for tax-exempt healthcare edged up to 4.3-to-1, compared with 3.8-to-1 in the prior three months and 6.8-to-1 in the last quarter of 2008. Factors that contributed to downgrades include weak operations, dwindling cash reserves and bonds that carry a higher risk that borrowers may be forced to rapidly pay back lenders. Last quarter, Moody’s also revised the outlooks downward for 15 not-for-profit hospitals and health systems and analysts said eight providers had improved outlooks last quarter

Falls, Not Burns, Pose Biggest Bathtime Danger for Kids

From MedPage Today:

Slips, trips, and falls account for the vast majority of injuries that befall children in bathtubs and showers, a retrospective study showed.

Of the estimated 43,600 bathtub- and shower-related injuries among children treated in emergency departments each year, 81% were caused by slips, trips, and falls, according to Gary Smith, MD, DrPH, of Ohio State University and Nationwide Children’s Hospital in Columbus, Ohio, and colleagues.

Although the dangers of bathtime have long been recognized, most research has focused on more severe injuries like scalding or near drowning, the researchers reported online in Pediatrics.

“This study, for the first time, has really emphasized slips and falls,” Dr. Smith said.

Hospital’s busy emergency room prompts federal investigation and raises patients’ concerns

From the Redding Record Searchlight:

With her kidney and pancreas failing as she awaited a transplant, Pauline Paul often became nauseous, sometimes dangerously so.

When that happened, the 41-year-old Redding woman would go to the emergency room at Mercy Medical Center. Her doctors often admitted her overnight to be monitored, said her husband, Dan Paul.

But on May 14, the Redding hospital’s emergency room was packed, and they sat in the crowded waiting room for six hours as Pauline Paul vomited blackish-red gunk into a bag before she was brought inside to see a doctor, her husband said.

Such long waits at Mercy have become more common and may have prompted an investigation into laws associated with federal anti-patient dumping statutes.

Mercy officials acknowledge that emergency room visits have increased by almost 30 percent since 2005, but contend that in April, measures were put in place that reduced the average length of time emergency room patients wait before they’re evaluated and put on a triage list.

But Paul said that when his wife did eventually get in to see a doctor, the physician appeared flustered and rushed, as if there were too many patients needing care at the time.

Paul expected a quick admittance to a hospital bed but was surprised when she was sent home with orders to go to her normal dialysis treatment the next day.

“They just turned her away real quick like,” Dan Paul said. It was a decision that may have proved fatal.

Credit cards used for medical expenses

From CNN Money:

As medical bills pile up, more Americans are paying their doctors with plastic.

Consumer advocates warn that this is a dangerous trend, but industry watchers see a multi-billion dollar opportunity for lenders to offer specialized “medical” credit cards.

“Out-of-pocket health care spending was already increasing in good times,” said Bruce Carlson, publisher with health care market research firm Kalorama Information. “Now with high unemployment, consumers have to reach into their pockets even more to fund their health care.”

Americans spend an estimated $294 billion on annual out-of-pocket medical costs annually, to cover everything from doctor’s office co-payments to surgeries and prescription medications.

About 25% of that — around $74 billion — is already being charged to regular standard credit cards, according to Kalorama. McKinsey Consulting expects that $150 billion worth of health care expenses will go on credit cards by 2015.

(Sim Lab) Mannequins at Willmar lab give birth, vomit

From AM1500:

The mannequins in Ridgewater College’s SimLab L1 are ready to bleed, vomit or give birth, all on command.

The three life-size mannequins _ a man, a pregnant woman and a baby _ are the stars of the college’s mobile simulation training lab, which was unveiled recently on the Willmar campus. The lab will be available to provide onsite training to health care providers throughout the area. It includes an emergency room and a control room/debriefing room.

Equipment in the lab is state-of-the-art, including the mannequins.

There’s the baby Hal, who can cry, grunt and turn blue. He has interchangeable parts, so he can be a boy or a girl.

There’s Noelle, the pregnant mannequin, who can give birth 20 different ways and even have a C-section. “When her water breaks, it really breaks,” said Ron Flannigan, director of SimLab.

And there’s the male mannequin, 3G, who is currently away getting a technology upgrade. Until he’s ready, the manufacturer provided a fellow named SimMan as a stand-in.

With the help of prerecorded conversations or a microphone in the control room, the mannequins can interact with their caregivers, said mobile simulation specialist Jim Bode.

With the right preparation, they’ll produce all manner of bodily fluids when the computer system tells them to, adding realism to simulations. The mannequins will react to the treatment given, so participants will influence how well the mannequins fare during a session.

Flannigan said the simulations are useful for continuing education for health care and emergency professionals and for training students in paramedic and nursing programs.