Nurse Lee the Slayer of Psychopaths

From Impacted Nurse:

He came rushing at me with a bull-bar stare that locked onto the green glow of the exit sign and the promise of freedom just below it. Arms pumping hard, legs spinning in a Road-Runner blur of motion. He was BIG and he was mad and the corner of his mouth was white froth. I could see by his sudden lift in velocity that he had already calculated the threat level that I posed to his escape plan.

Post-Taser ED Care

From the Journal of Emergency Medicine:

Background: Conductive energy weapons (CEWs) are used daily by law enforcement, and patients are often brought to an emergency department (ED) for medical clearance.

Study Objectives: To review the medical literature on the topic of CEWs and to offer evidence-based recommendations to Emergency Physicians for evaluation and treatment of patients who have received a CEW exposure.

Methods: A MEDLINE literature search from 1988 to 2010 was performed and limited to human studies published from January 1988 to January 20, 2010 for English language articles with the following keywords: TASER, conductive energy device(s), electronic weapon(s), conductive energy weapon(s), non-lethal weapon(s), conducted energy device(s), conducted energy weapon(s), conductive electronic device(s), and electronic control device(s). Studies identified then underwent a structured review from which results could be evaluated.

Results: There were 140 articles on CEWs screened, and 20 appropriate articles were rigorously reviewed and recommendations given. These studies did not report any evidence of dangerous laboratory abnormalities, physiologic changes, or immediate or delayed cardiac ischemia or dysrhythmias after exposure to CEW electrical discharges of up to 15 s.

Conclusions: The current medical literature does not support routine performance of laboratory studies, electrocardiograms, or prolonged ED observation or hospitalization for ongoing cardiac monitoring after CEW exposure in an otherwise asymptomatic awake and alert patient.

Quantifying Off-hour Emergency Physician Coverage of In-hospital Codes

From the Journal of Emergency Medicine:

Background: Community emergency physicians (EPs) are often required to respond to unstable patients outside of their department during off-hours.

Objective: The primary objective of this study was to describe the critical care responsibility of community EPs outside of their departments.

Methods: A one-page survey was mailed to emergency department (ED) directors of 10 states and Washington, DC.

Results:  Three hundred forty of 1169 surveys were returned. The median (interquartile range [IQR]) number of hospital and intensive care unit (ICU) beds was 145 (IQR 60–242) and 11 (IQR 6–20), respectively. Median ED annual volume and ICU admission percentage was reported to be 25K (IQR 14–40) and 5% (IQR 2–10), respectively. Seventy-six percent of reporting institutions require EPs to leave their department and respond to medical codes on the floors after hours. In 57% of institutions, the EP was the only physician required to respond. In addition, 48% of EPs must respond to unstable patients in the ICUs after hours. Hospitals in which EPs were required to respond to medical codes and unstable ICU patients were more likely to have fewer hospital beds (137 vs. 275; p<0.001), fewer ICU beds (12 vs. 27; p<0.001), and have a smaller ED annual volume (24K vs. 39K; p<0.001).

Conclusions: Many community EPs are responsible for covering critically ill patients outside of their ED. Further investigation is required to determine the impact on patient care.

Plea for Psychiatric Care Resources

From the St. Louis Today:

While some private hospitals have psychiatric units, demand far exceeds supply. Shutting down these state facilities leaves a large number of psychiatric patients with few options. In fact, 4,634 patients with acute psychiatric conditions were evaluated in the emergency rooms at MPC and Farmington in 2009. More than 2,700 of these patients required admission.

State officials hope that community hospitals can accommodate these additional patients. The perspective of nurses and doctors working in emergency rooms as well as courts overseeing commitment hearings of acutely psychotic patients suggests otherwise.

Department of Health Criticism of Seattle Pediatric Transport Team

From FierceHealthcare:

A Washington state report blasted Seattle Children’s Hospital for not properly supervising registered nurses on transport teams. Deficiencies put the lives of 12 patients at risk and may have led to the death of a newborn last September, the Seattle Post Intelligencer reports. The state health department claims that the hospital allowed a non-authorized healthcare provider to give medication orders. The baby died after a nurse gave it a muscle relaxant, an anti-anxiety drug, epinephrine, and morphine. The state health department found no doctor’s order for the meds for the baby, who was being transported to the hospital, and for 11 other patients who received meds while being moved to the hospital last September.

iPhone app dispatches citizen responders

From O’Reilly Radar:

Today the San Ramone Valley Fire Protection District (SRVFPD) in California is launching an iPhone app that will dispatch trained citizens to help others in cardiac emergencies. The new app, available at firedepartment.mobi, is the latest evolution of the role of citizens as sensors, where resources and information are connected to those who need it most in the moment.

ED CPOE Associated with Decreased Length of Stay…

… for discharged patients.

From the American Journal of Emergency Medicine:

Objectives: We evaluated whether implementation of computerized physician order entry (CPOE) reduces length of stay (LOS) for discharged emergency department (ED) patients.

Methods: Emergency department LOS for discharged and admitted patients were analyzed in a university-affiliated ED before and after introduction of CPOE. Patient demographics and covariates that may affect LOS (mode of arrival, provider staffing, daily census, and admission rate) were measured.

Results: The study included 71 188 patients; 49 175 (69%) were discharged from the ED (28 687 before and 20 488 after CPOE). Length of stay for discharged patients decreased from 198 to 168 minutes (difference of −30; 95% confidence interval [CI], −28 to −33), whereas LOS for admitted patients increased from 405 to 441 minutes (difference of +36; 95% CI, 26-46). After controlling for covariates, CPOE implementation was associated with a 23-minute decrease in LOS for discharged patients (β = −23 [95% CI, −26 to −19]).

Conclusion Implementation of CPOE was associated with a clinically significant (23-minute) decrease in LOS among patients who were discharged from the ED.

Study: ED Length of Stay Averaged More Than Eight Hours

From the Annals of Emergency Medicine:

Study objective: We ascertain the components of emergency department (ED) length of stay for adult patients receiving psychiatric evaluation and to examine their variability across 5 hospitals within a health care system.

Methods: This was a prospective study of 1,092 adults treated between June 2008 and May 2009. Research staff abstracted length of stay and clinical information from the medical records. Clinicians completed a time log for each patient contact. Main outcomes were median times for the overall ED length of stay and its 4 components, or time from triage to request for psychiatric evaluation, request to start of psychiatric evaluation, start to completion of psychiatric evaluation with a disposition decision, and disposition decision to discharge from the ED.

Results: The overall median length of stay was more than 8 hours. Median times for the components were 1.8 hours from triage to request, 15 minutes from request to start of psychiatric evaluation, 75 minutes from start of psychiatric evaluation to disposition decision, and nearly 3 hours from disposition decision to ED discharge. The median disposition decision to discharge time was substantially shorter for patients who went home (40 minutes) than for patients who were admitted (2.5 hours) or transferred for psychiatric admission at other facilities (6.3 hours). When adjustments for patient and clinical factors were made, differences in ED length of stay persisted between hospitals.

Conclusion: ED length of stay for psychiatric patients varied greatly between hospitals, highlighting differences in the organization of psychiatric services and inpatient bed availability. Findings may not generalize to other settings or populations.

MinuteClinic plans to double number of sites by 2015

From Fierce Healthcare:

MinuteClinic has its sights set on playing a bigger role in the healthcare system in the coming years. It plans to open about 100 more clinics per year over the next five years, which would allow it to roughly double its number of clinic sites to 1,060 clinics in 100 markets. MinuteClinic currently has more than 550 sites in 55 markets.

CT Scan Dilemma: Diagnoses Improve, but Cancer Risks Remain

From My Health News Daily:

Patients who come to the emergency room with abdominal pain present a diagnostic challenge to doctors — the symptom could be attributed to a number of conditions. A computer tomography (CT) scan gives doctors a view of the troublesome area, but also subjects the patient to a dose of potentially hazardous radiation.

So doctors face a dilemma — they can turn to CT, to save time and improve their diagnosis, or they can err on the side of caution, and spare their patient the radiation.