Hospitals learn ways to cut exasperating waiting times

More ink on ED wait times, from the San Diego Union-Tribune:

Get sick and head to the emergency room.

That’s what an increasing number of people have been doing as the region grows, more workers are losing their jobs and health insurance in the weak economy, and an aging population confronts unfamiliar medical challenges.

Hospital officials around the county have scrambled to keep up with the influx, which they say has been growing by 5 percent to 10 percent each year.

EMR bonus program poses tight deadline for physicians

From the AMA, via amednews:

While the final rule determining what constitutes “meaningful use” of electronic medical records provides some needed leeway for physicians, barriers to EMR adoption and implementation remain for doctors, according to the American Medical Association.

The AMA said in a July 21 statement that it had helped effect some positive changes in the final rule, including a reduction in the total number of measures, from 25 to 20, that physicians have to meet in order to qualify for Medicare and Medicaid EMR bonuses in the first two years.

The minimum thresholds for meeting several measures also were reduced. For example, the requirement that a doctor use an EMR for computerized physician order entry of medication orders decreased. Instead of mandating that more than 80% of patients have at least one drug ordered through CPOE, the threshold will be more than 30% of patients. Thresholds also were reduced for transmitting electronic prescriptions and implementing clinical decision support tools.

But the AMA says physicians still face several challenges in becoming compliant in time. There is no EMR system on the market now that offers the capabilities needed for physicians to become meaningful users. Federal officials expect such systems to become available this fall, which would give practices only a few months to install and test the technology before the Jan. 1, 2011, start date of the incentive program. Physicians who already have invested in EMRs now must upgrade their systems to meet certification criteria.

Efficiency in EMS Delivery

From Reuters:

San Francisco sends out seven ambulances in response to people thought to be in cardiac or respiratory arrest for every one person that is actually in cardiac arrest, according to a new study of the city’s Emergency Medical Dispatch system.

The results reflect an issue faced by emergency departments around the world: how do you decide where to send a limited number of ambulances and paramedics?

Some Estrogen With That? The protective and therapeutic effects of female sex hormones

From a Q&A with Dr. Paul Pepe, via EMSResponder.com:

With cardiac arrest, it can appear on the surface that men do better, because they present more often with ventricular fibrillation. But when you break it down by presenting ECG, women actually have better outcomes. Initially we didn’t think hormones were the reason, because the average age of women who have cardiac arrest is around 68.

So we conducted a prospective study in Dallas over 10 years to try to see if there were any differences between men and women, and particularly look at those under age 50 vs. older than 50. We found that the women had much better outcomes, especially in cases where they had more ischemic insult–particularly in cases of asystole and pulseless electrical activity, the women had much better outcomes relative to the men. And the cohort of women under 50 was actually accountable for most of the differences.

Interpreters boost patient satisfaction

From ModernHealthcare.com:

Providing skilled, professional interpreters to patients whose first language is not English in emergency departments boosts patient satisfaction and could reduce wait times and lower the odds of medical error, according to the results of a new study published in the Annals of Emergency Medicine.

Patients who were assigned an interpreter were four times as likely to report satisfaction with their ED visit as patients who did not, according to the study’s authors.

“The results were the same for physicians and nurses, which could be important for reducing staff burnout and errors,” Ann Bagchi, the study’s lead author and a senior health researcher at Mathematica Policy Research, Princeton, N.J., said in a news release.