Amendment to Adjust Geographic Practice Cost Index for Rural Areas

From MedPage Today, via KevinMD:

On Wednesday, the committee adopted a GOP amendment that would increase reimbursement for rural physicians. The amendment, sponsored by ranking Republican Sen. Chuck Grassley of Iowa, would adjust the Geographic Practice Cost Index, or GPCI, helping to level the current payment differential between physicians in rural and urban areas for the same procedures.

EMS Backlash Against “Trauma” on NBC

From JEMS:

No Heroes as NBC’s ‘Trauma’ Fails to Deliver – a JEMS Review

The new series Trauma premiering Monday night is being billed by NBC as “the first high-octane medical drama series to live exclusively in the field.” The show’s Website says it’s “like an adrenaline shot to the heart, an intense, action-packed look at one of the most dangerous medical professions in the world: first responder paramedics.” Unfortunately having had the opportunity to view the pilot in advance of its Sept. 28 premiere, I think the series is ripe for “Do Not Resuscitate” orders.

ACEP Launches Campaign to Dispel Dangerous Myths About EM

From the American College of Emergency Physicians:

ACEP launched a national media campaign this week to educate people about the need to strengthen emergency departments as part of health care reform and to dispel the myths about emergency care.

n addition to full-page ads in national news publications, ACEP is distributing thousands of letters to Congress, the Administration, and every key stakeholder in the health care reform debate. Saying it could mean the difference between life and death, ACEP President Dr. Nick Jouriles is asking everyone to get involved at www.acep.org/realities.

One of the biggest myths, according to Dr. Jouriles, is that the need for emergency care will decrease when the nation passes health care reform.

“Massachusetts experienced an increase in emergency visits after providing universal health coverage for its residents,” said Dr. Jouriles. ”We expect significant increases in emergency visits across the nation if national universal coverage is enacted.”

In addition, Dr. Jouriles said many people incorrectly believe that emergency departments are full of people who don’t need to be there.

“It’s simply not true,” said Dr. Jouriles. ”Most people who seek emergency care are having medical emergencies. Only 12 percent of patients have non-urgent medical problems, and many of those have the symptoms of a medical emergency, but after examination and testing, we learn their medical conditions are not emergencies, which is good news. But it was still right for them to seek emergency care.”

Dr. Angela Gardner, president-elect of ACEP, said another myth the campaign is dispelling is that emergency care is inefficient and expensive.

“Emergency care is only 3 percent of total health care expenditures,” said Dr. Gardner. “Our lights are on 24 hours a day and emergency care is highly efficient care because we have access to most of the medical options patients need in one place.”

Dr. Gardner also said one of the most dangerous myths is that emergency care will be there when they need it.

“People take emergency care for granted, and emergency physicians are dedicated to providing the best care for their patients,” said Dr. Gardner.  “But emergency care may not be fast enough to save your life if current trends continue. That’s why the nation’s emergency physicians are doing this campaign and insisting that vital, life-saving emergency care be available for all who need it.”

The campaign is promoting four crucial areas to be addressed in any health reform initiative:

• Every person in American must have affordable and appropriate health insurance coverage.  This is best provided through a combination of methods applied fairly and equitably to everyone involved.
• Health care costs must be reduced.  Eliminating the billions of dollars spent annually in defensive medicine and administrative overhead would greatly reduce costs.  Health information technology must be used to its fullest – for communication and for achieving efficiencies.
• Quality of care must improve.  Emergency patients must be taken to their inpatients beds after the decision is made to admit them to the hospital.  Languishing in an emergency hallway does not accomplish the purpose of hospital admission and is an affront to the patient’s dignity.  Quality of care must be supported 24/7.
• A national surge capacity plan must be developed.  Resources must be provided to help our nation’s hospital emergency departments be prepared for public health crises, such as the H1N1 pandemic, a terrorist attack or other catastrophes.

For more information about the campaign, visit www.acep.org/realities.

EMTALA Post-Medical Screening Exam Referral

From the Chicago Tribune:

An ongoing debate involving the U. of C. Medical Center’s Urban Health Initiative also has put charity care under review.

Grassley has a pending inquiry into the initiative, which redirects patients with less severe illnesses and injuries from its emergency room to a network of community hospitals and clinics on the South Side. Grassley’s primary concern was that the hospital might be turning away from its role of providing care to its community. The program also drew similar concerns from some doctors inside the hospital and two national physicians groups.

It is an accusation the medical center rebuts, saying the initiative brings a higher level of attention to patients when they are referred to nearby facilities, where U. of C. doctors often work. In addition, the medical center says, the program is helping it to cope with skyrocketing health-care costs and to alleviate long waits in the emergency room.

ED Smoking Cessation Study in Iowa

From ClinicalTrials.gov:

The Effectiveness of Smoking Cessation Guidelines in the Emergency Department

Although 78% of smokers report that a health professional has previously advised them to quit smoking, most smokers are not advised to stop smoking or offered assistance with smoking cessation during a given ED visit.

There are multiple barriers to routine implementation of smoking cessation guidelines by emergency clinicians, however, and rigorously performed clinical trials are needed to demonstrate that routine screening and counseling of ED patients results in increased quit rates. To determine the feasibility of implementing the Agency for Healthcare Research and Quality (AHRQ) Smoking Cessation Guideline in the ED, we will conduct a clinical trial in 974 ambulatory adult smokers who present to 2 emergency departments, using a pre-post design. During the 3-month baseline period, clinicians will perform their usual duties but will not receive training in use of the AHRQ Guideline. Based on the Chronic Care Model, the 3-month intervention period will include: 1) a tutorial on brief cessation counseling for ED nurses and physicians, 2) use of an ED algorithm that includes recommended tobacco counseling items, 3) fax referral of motivated smokers to Quitline Iowa for proactive telephone counseling plus free nicotine replacement therapy, and 4) group and individual feedback to ED staff. We will conduct exit interviews of ED patients to assess performance of guideline-recommended actions by ED staff and 3- and 6-month telephone follow-up to determine 7-day point-prevalence abstinence (with biochemical confirmation of self-reported quitters at 6 months). Our main analyses will examine the contrast between the intervention and control periods in the performance of guideline-recommended actions and in 6-month quit rates, using hierarchical logistic regression to adjust for baseline differences in potentially confounding patient variables. In secondary analyses, we will assess the change in attitudes of ED nurses and physicians toward smoking cessation counseling.

This feasibility study will determine the receptivity of patients and ED staff to the guideline-based intervention and will provide estimates of effect size in planning a full scale multi-site clinical trial of the study intervention in community hospital EDs.

USFA Administrator Urges H1N1 Vaccinations for Fire and EMS Personnel

From JEMS:

Washington D.C.-With the first deliveries of the H1N1 vaccine already underway, the Federal Emergency Management Agency (FEMA) as part of its mission to support first responders joins the United States Fire Administration (USFA) in recommending that firefighters who provide emergency medical services and EMS workers receive the H1N1vaccination as soon as it becomes available in their local jurisdiction.

The Centers for Disease Control’s (CDC’s) Advisory Committee on Immunization Practices (ACIP) has recommended that certain groups of the population receive the 2009 H1N1 vaccine when it first becomes available. These target groups include pregnant women, people who live with or care for children younger than 6 months of age, healthcare and  emergency medical services personnel , persons between the ages of 6 months and 24 years old, and people ages of 25 through 64 years of age who are at higher risk for 2009 H1N1 because of chronic health disorders or compromised immune systems.

“Given that firefighters and EMS personnel who provide direct patient care are eligible for early vaccination, their first responder agencies should be contacting their local doctors offices, clinics, local health department or other agencies to make arrangements now for their workforces to be vaccinated as soon as supplies of the H1N1 vaccine are received in their jurisdictions,” said U.S. Fire Administrator Kelvin J. Cochran.

“Being vaccinated for both seasonal influenza and the H1N1 influenza represents an important way to assure the well being of our first responder workforces, their families, and most importantly the patients to whom they provide emergency medical care. It also enhances their agencies’ ability to continue to provide critical services to their communities during periods when they may encounter an increased demand for emergency medical care resulting from the H1N1 virus,” Cochran said.

First responders and agencies seeking additional information on the H1N1 influenza are encouraged to visit:

www.flu.gov
www.cdc.gov/h1n1flu
www.usfa.dhs.gov
www.cdc.gov/h1n1flu/guidance_ems.htm

Therapeutic Hypothermia in the ED and in Ambulances

From PRWeb:

October 2, 2009 — On October 19, 2009, Baptist Medical Center’s Emergency Department will begin using a new procedure, called therapeutic hypothermia, to increase a patient’s chances of survival after their heart has stopped (cardiac arrest).

The new procedure involves decreasing the core body temperature to 89ºF after the patient’s heart has been restarted. Cooling may be started by paramedics if they have been able to restart the heart prior to getting the patient to the hospital. This involves injecting a patient with chilled intravenous (IV) fluids. Portable iceboxes (coolers) will be on ambulances to cool down the IV fluids. Upon further stabilization at Baptist’s emergency room, the patient then undergoes placement of a specialized cooling catheter into a large vein in the chest and abdomen, which safely cools them down to 89º.

Baptist Emergency Department Medical Director Eric Zoog, MD said, “The American Heart Association has recommended therapeutic hypothermia following resuscitation from cardiac arrest, because the treatment has been shown to significantly improve a patient’s chances of survival without brain damage.”

He added that Baptist has already used this technique on one patient utilizing chilled water blankets in direct contact with the patient’s skin, which enabled the patient to return to the same quality of life he had prior to his heart attack. “This treatment allows us to reduce the impact of a heart attack on a patient’s body and increase their chance of survival once they get to the hospital.”

Brain injury, heart dysfunction, systemic inflammation and the underlying disease that caused the cardiac arrest all contribute to the high death rate of patients who initially have their pulse re-started. Collectively, these symptoms are known as post-cardiac arrest syndrome.

This treatment method is able to increase not only a patient’s chances of survival, but survival with normal or nearly normal brain function by a factor of 2.5. In fact, every sixth time a cardiac arrest patient is treated with therapeutic hypothermia, physicians can rescue one life.

Baptist and its ER physicians will make a donation of iceboxes (coolers) to American Medical Response on October 5, 2009, at 2:00 pm in the Baptist Cardiovascular Center.

Kansas Hospital See Flu Surge

From HutchNews:

Hospitals in Newton and Liberal imposed restrictions against children visiting this week because of the rising number of suspected H1N1 flu cases showing up in their emergency rooms.

Though it has implemented no restrictions on visitation, Dodge City’s hospital has also seen a significant influx of flu cases, officials there confirmed.

“Our emergency room is getting slammed,” said Barrick Wilson, Newton Medical Center’s director of marketing and community relations.

The hospital has seen roughly 275 cases of suspected flu in the past month, Wilson said, with a heavy influx particularly in the past few days. About 25 percent of flu-like cases in the emergency room have tested positive for Influenza A, which officials assume to be H1N1.

“We are seeing entire families over the past 24 hours that are testing positive for Influenza A,” said Jo Miller, R.N., NMC’s emergency department nurse manager.

Because of the large volume of patients in the emergency department, as well as a sharp increase in H1N1 activity in Harvey County, the hospital’s emergency department went to “Yellow Status,” according to Miller.

“This means that we are stressed as a department, as I am sure are some of the ancillary services such as laboratory,” Miller said. “NMC nursing units may see additional admissions coming from the ED over the next few hours, and we are ramping up for accelerated activity.”

The medical center has admitted only two people with the suspected H1N1 virus, so inpatient staffing levels are normal, Barrick said. It has expanded staffing in the emergency room, however.