Post Resucitation Care

From MedPage Today:

A wide range of medical interventions should be started immediately after cardiac arrest to improve survival, according to a consensus statement released by the American Heart Association.

Besides treating the underlying cause of the arrest, clinicians need to treat myocardial dysfunction and ischemia, and prevent neurological injury, according to a statement published online simultaneously in Circulation: Journal of the American Heart Association and Resuscitation.

The consensus statement comes from the International Liaison Committee on Resuscitation — members of which include the AHA and several international critical care and cardiology organizations — and is endorsed by the American College of Emergency Physicians, the Society for Academic Emergency Medicine, and the Society of Critical Care Medicine.

Here’s a link to a (free) PDF copy of article in Circulation

Advance Notice of CVA by EMS Affect on tPA Treatment

From Prehospital Emergency Care:

Advance Hospital Notification by EMS in Acute Stroke Is Associated with Shorter Door-to-Computed Tomography Time and Increased Likelihood of Administration of Tissue-Plasminogen Activator

Background. Rapid brain imaging is a critical step in facilitating the use of intravenous (IV) tissue-plasminogen activator (tPA) or catheter-based thrombolysis. We hypothesized that advance notification by emergency medical services (EMS) would shorten emergency department (ED) arrival-to-computed tomography (CT) time and increase the use of IV and intra-arterial thrombolysis, even at a tertiary care stroke center with high baseline rates of tPA use.

Methods. We analyzed data on all acute stroke patients transported from March 2004 to June 2005 by EMS from the scene to our facility arriving ≤6 hours from symptom onset. We reviewed digital voice recordings of all EMS communications to our hospital and in-hospital time intervals and outcomes from our stroke database.

Results. Among the 118 patients who met criteria, there were no significant differences between those with notification (n = 44) and those without (n = 74) in terms of age, gender, history of prior stroke, median National Institutes of Health Stroke Scale (NIHSS) score in the ED, proportion with mild stroke (NIHSS score ≤4) , or mean onset-to-ED arrival time. Door-to-CT time was 17% shorter (40 vs. 47 minutes, p = 0.01) in the advance-notification group, and thrombolysis occurred twice as often (41% vs. 21%, p = 0.04).

Conclusion. Advance notification of patient arrival by EMS shortened time to CT and was associated with a modest increase in the use of thrombolysis at our hospital. This occurred even with protocols in place to shorten the time to CT for all acute stroke patients. Further research is needed to understand how to increase rates of advance notification by EMS in potential tPA candidates.

Waiting for the doctor … and waiting, and waiting

From the CNN.com Empowered Patient series:

“Am I seriously supposed to believe that every single one of my doctors have so many ‘emergencies’ during the day that they are forced to be late seeing me?” asked another Empowered Patient reader. “Get real. It’s called over-booking.”

One patient got so mad he even sued his doctor for being late — and won $250 in small claims court. By being four hours late, Aristotelis Belavilas says, his physician was giving the message that “I’m God and you’re not and I do whatever I want.”

It’s probably fair to say none of us ever wants to sit so long in a doctor’s waiting room that we resort to filing a lawsuit or videotaping ourselves. But there are strategies you can use to try and prevent frustrating waits.

1. Stage a revolt

“I ended up waiting two hours to see my gynecologist once, and I just went nuts…..

Treating sicker patients may hurt hospitals’ P4P

From Modern Healthcare:

Hospitals that treat lower-income, sicker patients may not be evaluated fairly in pay-for-performance programs, according to a study published in the Journal of the American Medical Association.

Hospitals ranked in the top 20% were likely to receive incentive payments, the middle 60% would get no incentives, and the bottom 20% would get payment reductions.

“Our study reveals the need to level the playing field, so hospitals serving more minority, elderly, sick or uninsured patients can compete fairly with others,” Eric Peterson, senior author of the study and director of cardiovascular research at Duke Clinical Research Institute, said in a statement.