A Hospital Steps Up Efforts to Limit Emergency Room to Emergencies

From the Wall Street Journal Health Blog:

Lots of people show up at the emergency room when they need treatment for a problem that isn’t really an emergency.

The University of Chicago Medical Center has been pushing to change that — and the effort is accelerating as the hospital struggles to deal with a financial crunch that recently led it to lay off several hundred workers, the Chicago Tribune reports.

The emergency department will be reorganized to more thoroughly evaluate patients before they get ER treatment, the Trib says. Those who don’t need immediate care may be sent to nearby health clinics. In the past, ER docs had treated the patients, then told them about health clinics and community centers they could use for follow-up care.

Sen. Chuck Grassley, who sometimes seems a ubiquitous presence in health care (see our previous post), is among those who have questioned the med center’s efforts to redirect some patients.

The med center says 40% of the 80,000 patients who show up in the ER every year don’t need emergency care. “We are trying to get the right patients to the right doctor at the right time for their disease and disorder,” the CEO told the Trib.

Methamphetamine Use is Associated With Increased Hospital Resource Consumption Among Minimally Injured Trauma Patients

From the Journal of Trauma:

Background: The clinical effects of methamphetamines (MA) may complicate medical management, potentially increasing resource utilization and hospital costs out of proportion to the patient’s severity of injury. We hypothesize that minimally injured (MI) patients testing positive for MA consume more resources than patients testing negative for MA.

Methods: Adult trauma patients were identified from 4 years of registry data, which was linked to cost data from our center’s financial department. Patients were classified as MI (Injury Severity Score <9) or severely injured (Injury Severity Score >9). Primary outcome was total direct costs for the inpatient hospital stay. Secondary outcomes included direct costs by cost center, contribution margin, and hospital length of stay.

Results: Sixty-five percent (n = 6,193) of the 10,663 adult patients during the study period were admitted with MI. Nine percent (n = 557) of those tested were positive for MA. Total direct costs were higher in MI MA patients compared to nonusers ($2,998 vs. $2,667, p < 0.001), and users consumed more resources in all 10 cost centers. The same multivariate model showed marginally increased costs with MI alcohol users, but not with MI cocaine users or severely injured MA users.

Conclusion: MI MA patients consume more resources than patients testing negative for MA. Although MA use complicates the initial evaluation of patients, resource consumption was increased for all cost centers representing the entirety of a patients hospital stay, suggesting that the influence of MA is not limited to the initial diagnostic workup. Centers with high proportions of MA users may realize significant losses if compensation contracts are inadequate.

Post Graduate Residency Program in EM for PA’s

From the University of Iowa:

The department of Emergency Medicine at University of Iowa is pleased to offer an 18-month postgraduate Physician Assistant Residency Program. This program is one of the few Emergency Medicine PA residencies offered in the Midwest and is linked to the only Emergency Medicine physician residency program in Iowa. As a PA resident, you will have the opportunity to specialize in the field of Emergency Medicine while working alongside with physician residents and seasoned clinicians at one of the top medical centers in the country.
Class size is limited to three qualified PA residents.

PA Doctoral Program in EM

From Advance:

It was a shot heard ’round the PA world.

The U.S. Army and Baylor University created a stir when they announced their PA clinical doctorate degree residency program in emergency medicine at the Physician Assistant Education Association forum in Tucson, Ariz., in November 2007.

Doctorate degrees have been increasing among health care professionals for more than a decade. Audiology, physical therapy, occupational therapy and pharmacy, for example, have all moved to the entry-level doctorate degree. The nurse practitioner profession adopted the entry-level doctorate degree in 2006, and the DNP will be mandated for all advanced practice nursing graduates by 2015.

Even though the specter of doctorate degrees has been hanging over the PA profession for years, the formal announcement of the Army program brought the controversy to the forefront. News of the Army’s program roiled educators at the PAEA forum and sparked furious debate about clinical doctorate degrees and PAs.

More than a year later, echoes of that shot reverberate around the profession. The widespread battle, however, has been slow to begin.

And the U.S. Army and Baylor recently introduced two additional PA clinical doctorate residency programs, one in orthopedics and one in general surgery.