NQF Standards

From Modern Healthcare:

The National Quality Forum has added 10 standards for hospital-based emergency department care, 17 perinatal-care measures, eight outpatient-imaging efficiency measures and two hospital readmission measures to the group’s national voluntary consensus standards program. The standards are intended to improve accountability, efficiency and appropriateness, and quality across the various areas of care.

In addition, the standards-development organization endorsed a Web-based toolkit that collects race, ethnicity and language data from patients. The toolkit, designed by the Health Research & Educational Trust, is part of the NQF’s ongoing project to approve a framework for addressing cultural competency among providers.

Medical Practices: Increasing Costs Outpacing Revenue

From the MGMA:

Compounding economic pressures created by declining reimbursement and crushing administrative burdens, operating costs rose faster than revenue in many medical group practices in 2007, according to the Medical Group Management Association (MGMA) Cost Survey: 2008 Reports Based on 2007 Data. MGMA data indicate that over the past decade, operating expenses have risen from 58 cents to 61 cents per dollar of revenue.

Multispecialty group practices reported a 5.5 percent increase in median total revenue; median operating costs increased by 6.5 percent. Many single-specialty practices reported a similar trend. For example, cardiology practices’ median total medical revenue decreased 0.61 percent while their operating costs rose 6.3 percent. Family practice, OB/GYN, pediatrics and orthopedic surgery groups reported like conditions.

More on ED Wait Times from ACEP Symposium

From the Wall Street Journal Health Blog:

You know those signs at amusement parks that tell you how long the wait is for the big roller coaster? As it turns out, they tend to tell you the wait is a little longer than it’s really likely to be. That way, the chances are you won’t be disappointed when you finally do hop on board.

A group of Michigan doctors figured out that the same strategy makes patients feel better about their trip through the emergency room.

Basically, the docs calculated the mean time it took to get through the ER for a given test or procedure — then added 20% when they told patients what to expect. In a standard patient satisfaction survey, all nine variables related to wait times improved after the ER adopted this policy (the improvement was statistically significant for five of the variables).

How Long Will Patients Spend In the ER Before They Get Mad?

Reporting from the ACEP Scientific Symposium (I just got back. It was great!) from the Wall Street Journal Health Blog:

The longer it takes for a patient to get through the emergency room, the less happy the patient’s going to be with the experience. But how long is too long?

The docs, from Beaumont Hospital in Troy, Michigan, looked at more than 2,000 patient-satisfaction surveys from the first part of 2007. They found that patients whose stays in the ER lasted up to three and a half hours had satisfaction scores in the 83rd percentile as compared with patients at comparable ERs around the country.

But for those who spent between three and a half and four hours, satisfaction plunged to the 49th percentile. And those who spent more than four hours had an average satisfaction score in the 24th percentile. The analysis looked only at patients who were sent home, and excluded those who were sick enough to be admitted to the hospital.

“I was surprised that they’re so patient for three and a half hours,” Aveh Bastani, the ER doc who led the study, told the Health Blog. “Three and a half hours when you’re not feeling well is a long time.”

Bastani presented the results this week at the American College of Emergency Physicians meeting in Chicago.

GruntDoc: “Newsflash: Transportation is Dangerous”

An insightful summary and comments on recent regulatory oversight and reportage pertaining to air medical (and ground) EMS transport from GruntDoc.

NTSB Looks at Air Medical Crashes

From the Wall Street Journal Health Blog:

In less than a year, nine emergency medical helicopters have crashed, killing 35 people, the Associated Press reports.

The National Transportation Safety Board thinks that’s too many, and it voted yesterday to put EMS flights on its list of top safety priorities.

Medical helicopters have been under scrutiny for a while now. In 2005, the WSJ reported that air ambulances are often used to transport patients who are “minimally injured,” and who could make it to a hospital faster and more safely via ground transport.

In 2006, the NTSB prodded the FAA to improve the safety of the flights, but the board said yesterday that the FAA isn’t moving fast enough, the AP reports.

The NTSB says air ambulance flights carrying only medical personnel should follow the more stringent safety rules used by organ-transplant flights. Doing so could have prevented 10 of the 55 crashes between Jan. 2002 and Jan. 2005.

And a formal flight risk evaluation should be required before EMS flights — that could have prevented 15 of the 55 crashes, the board said.

EP Turned Down By Canadian Immigration

From the Calgary Sun:

Against the backdrop of an acute doctor shortage, a South African-born emergency physician in Calgary is considering job offers in the U.S. after his application for permanent residency in Canada was rejected because one of his daughters is severely handicapped.

Dr. Stanley Muwanguzi is frustrated with being in limbo while Citizenship and Immigration Canada officials review his application, which was denied in June 2006 on the grounds his cerebral palsy-stricken daughter would constitute a burden on the health-care system.

“To me, it is just an immigration system that is very insensitive,” he said.

Muwanguzi, who has practised in Canada since 2002 and works at Peter Lougheed hospital’s ICU, said his family plans to keep the 22-year-old in the same South African institution she has been in since she was a toddler. Her disability has her frozen at a mental age of three months, he said.

Muwanguzi said medical recruiters in the U.S. have told him he would be fast-tracked to receive a green card within two years because that country is also in desperate need of physicians.

“I’m looking at it and I’m thinking, ‘What’s wrong with Canada?,’ ” he said.

Muwanguzi is spending $29,000 a year on tuition for one of his daughters, who is pre-med at the University of Alberta. One of his two sons in South Africa just concluded a medical residency and could also practise in Canada.

MRIs Are a Breeding Ground for Super Bugs Like MRSA

From DotMD:

The Joint Commission–the agency that certifies hospitals–is extremely concerned about super bugs like Methicillin Resistant Staphylococcus Aureus (MRSA) and is evaluating control procedures for every department in hospitals including the MRI suite, says Peter Rothschild, M.D., a radiologist and MRI expert who authored the landmark paper “Preventing Infection in MRI: Best Practices.”

But efforts to address the problem are falling woefully short in hospitals, and are completely absent in free-standing imaging centers, according to experts.

Dr. Rothschild tells DOTmed News, “When you go to a restaurant, you know the health department has looked at it. Even the trashiest restaurant. But there’s no one watching these outpatient imaging centers–no requirement that anyone comes in there and certifies them as clean and safe.”

Furthermore, there’s a Catch 22 with MRIs in all settings, Dr. Rothschild says. “The magnets and the pads on the table can harbor MRSA and need to be cleaned. But cleaning crews are not permitted to go into the imaging room unless technologists supervise them at all times. Since the cleaning crew usually comes late at night after the technologists have gone home, the MRI rooms are rarely if ever cleaned,” Dr. Rothschild says.

Admit to the Hallway

Hallways on the floor, not to be confused with boarding (often in the hallways) in the ED:

From the Wall Street Journal Health Blog:

Here’s one way to ease overcrowding in the emergency room: Move patients to the hallway.

Some hospitals are giving it a try, putting patients in hallways when they’re ready to be admitted, the Associated Press reports. It sounds, well, strange, but advocates of the idea say that it’s dangerous to hold patients in an overcrowded ER.

Peter Viccellio, clinical director of the emergency department at Stony Brook University Medical Center in Stony Brook, N.Y., was involved with a study that found that the practice didn’t do any harm. And before the hospital went this route, on busy days “things would grind to a halt and people would wait to be seen,” he told the AP. Worse, infectious patients would wait in the ER hallways for isolation rooms to open up elsewhere.

Vitello explained that the first available rooms go to the sickest patients, and intensive-care patients never go to the hallways.

Checklists

From PookieMD:

One of my hospitalist colleagues uses the following check list at discharge, necessitated because the EMR we use makes us go between several screens and logins:

• write discharge summary
• write discharge orders
• send note to PCP
• set up follow up
• write scripts

Useful primary care check lists would be:

• State of undress for each exam:  (female pap: the full Monty, male: off with the tighty whities for the prostate check, diabetics: off with their shoes and socks!)
• Check list clipped to chart as to what screenings are done at what age, or in each room.
• Check list on cabinet door detailing what items go in each cabinet.
• Check list at discharge for assistant to review: does patient have scripts, referrals, test info, and know when to come back.
• List of items your front desk staff needs to check at each check in (check address, insurance card, HIPPA).
• List of items your assistant needs to check as they room the patient (chief complaint, allergies, meds etc.)