Is Your Patient Throughput Sending Out an SOS?

Healthcare Financial Management Vol. 62, No. 7, P. 86; McLarty, Jim; Jeffers, Lori

The emergency department (ED) is used to gauge a hospital’s operational health and reputation and generally provides a substantial amount of revenue. However, inadequate patient throughput–not just increased demand–can lead to overcrowding in the ED and often is characterized by longer lengths of stay in the ED, higher rates of patients leaving before being seen, longer boarding periods in the ED and increased patient diversions to other beds. Even small, inexpensive improvements, such as expanding transport personnel at times when admission and discharge tend to be high, can be a big help; but regardless of the steps hospitals take, a culture change, staff training in new processes, front-line managers’ buy-in and continual monitoring are required.

Vultures eye Wis. hospital patients

From UPI.com

Patients at a Milwaukee-area hospital say the last thing they want to see while facing surgery are vultures perched outside their windows. 

Yet, that’s the view from some patient’s rooms at the Orthopedic Hospital of Wisconsin in Glendale, Wis., the Milwaukee Journal Sentinel reported Wednesday. It said patients about to go under the knife can watch up to six turkey vultures sitting on ledges of the three-story building.

Is The Lateral Cervical Spine Plain Film Obsolete?

From the Journal of Surgical Research

Background

The objective of this study was to determine the utility of a lateral cervical spine plain film in the evaluation of blunt trauma patients.

Methods

We prospectively evaluated blunt trauma patients from February 2004 to September 2006 who had both a lateral cervical spine (LCS) film and a computed tomography of the cervical spine (CTC), comparing the diagnostic accuracy of the LCS to the CTC.

Results

There were 1004 patients who met inclusion criteria. Eighty-four patients had a cervical spine fracture while 920 patients had no fracture on CTC. Of the 84 patients with fractures by CTC, 68 had a negative or incomplete LCS. Of the 920 negative CTC, there were 7 false positive LCSs. LCS compared with CTC showed a sensitivity of 19% (16/84) and positive predictive value of 69.6% (16/23). Of the 981 negative or incomplete LCS films, 96.9% were incomplete (951/981). Of the seven patients with a false positive LCS (negative CTC), none was subsequently found to have a cervical spine fracture on further evaluation. Elimination of the LCS would result in charge savings of $265,056.00 (LCS charges with interpretation, $264 each) and increase patient safety by eliminating error.

Conclusions

LCS has no value as a screening tool in the blunt trauma patient since most are either inaccurate or incomplete. It should be eliminated from the Advanced Trauma Life Support algorithm, and CTC should receive emphasis as the diagnostic gold standard.

Injured By a Spacecraft? There’s a Diagnostic Code for That

From the Wall Street Journal Health Blog:

So we’ve got this patient here who was injured in this spaceship accident. You know, just a routine, uh, orbital mishap. But how do we account for that? Oh, right, it’s ICD-9 code E845 — “Accident involving spacecraft.”

Medicare Cuts Averted for 18 Months

From the EDPMA:

H.R. 6331 reverses the 10.6 percent Medicare cut that took effect July 1 as well as the projected 5.4 percent cut forecasted for 2009. For 2008, the legislation continues the 0.5 percent increase for the remainder of 2008; in 2009 physicians will receive an additional 1.1 percent increase over 2008. The legislation also extends the Physician Quality Reporting Initiative (PQRI) through 2010, increasing the reporting bonus from 1.5 percent in 2008 to 2 percent in 2009 and 2010.

Congress Overrides Bush’s Veto on Medicare

From the NY Times:

President Bush cast a futile veto on Tuesday, rejecting a bill that would protect doctors from cuts in their Medicare payments. But hours later, the House and Senate voted to override the veto, making the Medicare measure the fourth bill to become legislation over Mr. Bush’s opposition.

The president’s veto message to the House said that he objected to the bill because it was “fiscally irresponsible” and relied on “short-term budget gimmicks” that do not address the long-term fiscal soundness of the Medicare program.

But the House voted, 383 to 41, on Tuesday afternoon to override the veto. Soon afterward, the Senate voted by 70 to 26 to do so. Although the Senate vote was close enough to provide some suspense, it was still over the two-thirds needed, as a number of conservative Republicans who typically side with the president broke with him on this issue.

Bush Veto Likely

From Modern Physician:

President Bush plans to veto a Medicare reform bill Tuesday that would stave off cuts to physician payments through 2009 and make other adjustments to the program, HHS Deputy Secretary Tevi Troy announced.

Should Medicare Stop Medical Imaging Before It Starts?

From the Wall Street Journal Health Blog:

Medicare has been trying to clamp down on burgeoning costs from medical imaging. But a new GAO report suggests the agency might have more success if it were to stop unnecessary CT scans, MRIs and the like before they happen in the first place.

To cut imaging costs, Medicare has been cutting certain physician payments, sifting through its data to spot improper claims, and educating medical practitioners about the issue. But the GAO’s suggestions for Medicare include weighing a front-end tactic that’s common in the private health-insurance market: prior authorization. That’s when, for a patient to get coverage, an insurer has to give permission before something takes place. “We believe that post-payment claims review alone is inadequate to manage one of the fastest growing parts of Medicare,” the GAO said.

ED “Super Users”

From NJ.com

Researchers studying the crisis of America’s overcrowded emergency rooms are beginning to focus on this largely undocumented phenomenon, the super users who turn to hospital emergency rooms dozens, even hundreds, of times.

Researchers say a seemingly intractable problem could be solved, in large part, by focusing on just the top 1 percent of emergency room users, who in Camden alone cost $46 million over five years.

Jaambaaro ambulance concept

From Gizmodo:

There are plenty of places in the world where getting speedy medical attention is difficult. And that’s where the Jaambaaro concept from designer Benoît Angibaud comes in. It’s a two-person pedal-powered ambulance, designed to get the sick and wounded to hospital in areas where motor vehicles are rare. It would have solar panels to help generate some energy, and be made of locally-salvaged materials.