Asthma Treatment Resource from ACEP

The CME / Resource (as an Adobe Acrobat – PDF- document is available from the American College of Emergency Physicians (ACEP):

Managing Acute Exacerbations and Influencing Future Outcomes in the Emergency Department

Patients with poorly controlled asthma are frequently seen in the emergency department (ED) for asthma exacerbations.  These patients are often treated as though they have an acute disease rather than an exacerbation of a chronic disease.  Because many of these patients rely heavily on the ED for asthma care, the ED visit provides an opportunity to change future outcomes for these patients.  The National Asthma Education and Prevention Program (NAEPP) guidelines were recently updated based on he most recent evidence.  Key updates from the newest guidelines include the assessment now only of asthma severity, but also of how well the patient’s asthma as been controlled and an emphasis on asthma education in settings such as EDs, which are different from the office setting which such education typically occurs.  The purpose of this article is to summarize suggestions from the NAEPP guidelines for the management of asthma exacerbations in the ED, to provide brief and focused asthma educational information, and to provide the patient with the most appropriate discharge and follow-up instructions.

Frequent Flier Program for Hospitals?

From Running a Hospital:

Orlando, FL – January 28, 2008 – Paquin Healthcare Companies, Inc. today announced the launch of its new hospital-based customer loyalty program. The program, referred to as My Healthy Rewards, is a way of rewarding hospital’s customers for using their products and services and engaging in wellness activities.

“We are pleased to announce the availability of My Healthy Rewards. This loyalty program will play a vital role in the success of any comprehensive healthcare retail strategy by increasing customer loyalty and repeat sales,” said Tony Paquin, founder and CEO of Paquin Healthcare Companies, Inc.

My Healthy Rewards members can accumulate reward points based on their retail purchases, utilization of hospital or clinical services, or other healthcare related or wellness activities. As reward points accrue, members may receive award certificates, special offers, merchandise discounts and special sale notifications. There is no limit-the more consumers shop, the more they earn.

Hand gel may not curb patient infection rates, study suggests

From EM Today:

The AP (1/30, Ross) reports that many medical professionals “favor…an alcohol-based hand gel, thinking the quick-acting goo will kill bacteria on their hands and curb the spread of infection.” Yet, according to a study appearing in the January issue of Infection Control and Hospital Epidemiology, “cleaner hands had no bearing on the rate of infections among patients” — a finding that conflicts with the Centers of Disease Control and Prevention’s (CDC) hospital guidelines.

Placebo Effect and Pain Control

From White Coat Rants:

Lately a lot of patients have shown dramatic improvement in their pain symptoms with the placebo effect in our ED.

An issue some of our nurses have is that they have to get the patient to believe in the effectiveness of the placebo in order for it to work. If you give someone a shot and tell them that it is just some “saline,” you probably won’t get much of a response. If you give someone a shot of “obecalp” (which is placebo spelled backwards), and tell them that this is a medication for their pain that may make them sleepy, it might work. Therein lies the problem. How to you get the patient to buy into the placebo effect without lying to them? OK ….. shhhhhh. Can you keep a secret?

If a patient is looking for pain pills, hand them three regular Tylenol pills. If the patients ask what they are getting, they are told they are getting “Tylenol …. number three.” Not a lie. They really are getting three Tylenol pills. Good placebo effect. Probably half of the patients who get “Tylenol … number three” get significant relief with plain ol’ acetaminophen.

Medical Errors Often Start Small

From the Wall Street Journal Health Blog:

How does a doctor amputate a healthy limb or operate on the wrong side of the brain? Often, profound medical errors like these occur through a series of small mistakes, reports the Los Angeles Times. And with Medicare refusing to pay for some of the most egregious errors, or so-called “never events” as of Oct. 1, hospitals have fresh motivation to sweat the details.

Little changes can lead to big improvements in patient safety, says the LA Times. One successful strategy some hospitals use involves a checklist like pilots consult before takeoff and landings. Handwashing? Check. Wearing sterile gowns? Check. Some hospitals are taking their cues for better patient handoffs from auto racing pit crews, as the WSJ reported a while back.

Research suggests physicians may harbor negative attitudes toward overweight, obese people

From EM Today 

On the front page of its Health section, the  Washington Post (1/29, HE1, Rabin) reports that “[o]verweight and obese patients have long complained that doctors treat them insensitively, and are too quick to attribute health problems to their weight,” according to several studies. Previously, these “claims of bias were…met with skepticism,” but recently, researchers at various universities and at Kaiser Permanente have conducted studies to determine the accuracy of the claims. Overall, the researchers found that “many physicians harbor negative attitudes toward fat people.” The findings raised concerns because such attitudes caused patients to delay physician visits. In fact, a “2006 study of 498 women, published in the International Journal of Obesity, found that obese women delayed cancer screenings more than other women.” Therefore, last year, researchers worked with Kaiser Permanente to create “a training program to educate health providers about weight bias; the program went online in December.”

Study suggests cold, cough drugs send 7,000 kids to EDs annually

From EM Today:

The CBS Evening News (1/28, story 8, 1:30, Couric) reported that cough and cold medicines “send about 7,000 children under the age of 12 to the” ED “every year,” according to a study conducted by the CDC and published online in the journal Pediatrics.  

For the study, researchers looked at “data collected by a nationwide drug safety surveillance system that gathers information from 63 emergency rooms to provide a representative sampling of adverse drug events,” according to the  Washington Post (1/29, A3, Stein). The researchers were able to “identify[y] 301 cases between Jan. 1, 2004, and Dec. 31, 2005,” which, “[e]xtrapolated nationwide,…works out to 7,091 cases a year.” The researchers found that “[c]old and cough drugs account for 5.7 percent of all medicine-related visits to the emergency room by children younger than 12.” While “93 percent of the cases did not require the children to be hospitalized,” approximately “7 percent required additional treatment.” In the majority of cases, “the researchers were unable to determine what symptoms the children experienced.” However, “in those cases where that information was available, 19 percent had allergic reactions, and 13 percent had neurological symptoms such as sleepiness or problems walking.”  

The AP (1/29, Stobbe) added that approximately 66 percent “of the cases were children who took the medicines unsupervised,” but approximately 25 percent “involved cases in which parents gave the proper dosage and an allergic reaction or some other problem developed,” according to the researchers. The study’s lead author, Dr. Melissa Schaefer of the CDC, as saying that “[f]or the children whose symptoms were reported, allergic reactions like hives and itching were most common, and neurological symptoms like drowsiness and unsteady walking were next.” The researchers said that “[m]ost of the medicines involved were liquid combinations of cough and cold treatments.”  

Medical Humor: EM Docs

From Q-Fever:

And on it goes. Baylor, who prefers to be called an “emergentologist,” says he’s become accustomed to the challenging dilemmas he encounters every day.

“At first, it was a little daunting,” he says. “The first time I had to decide whether a patient should be admitted or not, I almost cried. It was that stressful.”

“But after a while, I began to realize that, for the patients that were sick enough to be admitted, most of the real work would be done by the doctors who actually did the admitting – the ones who would actually be taking care of the patient and making them better.”

Health care professionals making honesty their policy

From the Bangor (ME) Daily News:

A long, long time ago, in an ER far away, I missed a crucial abnormality on an X-ray and the patient died as a result. Others missed it too, he might have died anyway, but there it is; I missed it and he died. In my head I have apologized to him and to his family for my error a million times.

The thing is, I never apologized to them in person. If I had, I might not still be carrying that mistake with me to this day like a never-healing sore hidden from everyone’s view but my own. I might not still wish the patient and I could have a do over of that fateful night. It might not still depress me when I think about it.

In those days, however, when physicians or hospital staff such as nurses made mistakes, we usually hunkered down and tried to hide what happened from our patients, from the lawyers and even from our peers. We thought the truth would spread with terrible results if exposed to the light of day. We figuratively, and sometimes literally, buried our errors out of embarrassment and fear of being sued if the truth be told. We did so in ignorance of the fact that errors buried beget future errors, and did not understand that many errors in health care are not so much the result of an individual’s moment of error, but rather our failure to build systems that protect patients from the inevitability of human error.

CNN: Five Things Not To Do In The ER

From CNN.com

My favorite is #5:

5. Don’t forget the phone

If things get really bad, and no one is helping you, look for a house phone, dial zero, and ask for the hospital administrator on call, Sayah says. “Even the smallest hospitals have a hospital administrator or a patient advocate on call 24/7,” he says. “Hospital administrators don’t want to hear patients are unhappy. Their job is to break the hurdles and move forward.”