“How to improve an emergency room”

From the Daily Gleaner:

The hospital emergency room plays a similar role to the canary in a coal mine.

A canary was kept in a coal mine to determine if methane gas was building up. When the bird dropped dead, the miners left.

The emergency room is the catch-all for problems in the health-care system. When the ER is under stress from overuse or inappropriate use, it indicates problems elsewhere.

Changing EMS dispatcher CPR instructions to 400 compressions before mouth-to-mouth improved bystander CPR rates

From Resuscitation:

Background: To examine the impact of changing dispatcher CPR instructions (400 compressions: 2 breaths, followed by 100:2 ratio) on rates of bystander CPR and survival in adults with presumed cardiac out-of-hospital arrest (OHCA) in Melbourne, Australia.

Methods: The Victorian Ambulance Cardiac Arrest Registry (VACAR) was searched for OHCA where Emergency Medical Services (EMS) attempted CPR between August 2006 and August 2009. OHCA included were: 1) patients aged ≥18 years old; 2) presumed cardiac etiology; and 3) not witnessed by EMS.

Results: For the pre- and post- study periods, 1021 and 2101 OHCAs met inclusion criteria, respectively. Rates of bystander CPR increased overall (45% to 55%, p<0.001) and by initial rhythm (shockable 55% to 70%, p<0.001 and non-shockable 40% to 46%, p=0.01). In VF/VT OHCA, there were improvements in the number of patients arriving at hospital with a return of spontaneous circulation (ROSC) (48% to 56%, p=0.02) and in survival to hospital discharge (21% to 29%, p=0.002), with improved outcomes restricted to patients receiving bystander CPR. After adjusting for factors associated with survival, the period of time following the change in CPR instructions was a significant predictor of survival to hospital discharge in VF/VT patients (OR 1.57, 95%CI: 1.15 to 2.20, p=0.005).

Conclusion: Following changes to dispatcher CPR instructions, significant increases were seen in rates of bystander CPR and improvements were seen in survival in VF/VT patients who received bystander CPR, after adjusting for factors associated with survival.

HuffPo: ER Crisis: Think, Plan, Act to Get Best Emergency Care in Urgent Situations

From the Huffington Post:

This brings me to my last plea: The medical reasons for why folks typically end up in ERs offer few mysteries and plenty more places for people to take personal, preventative measures, U.S. statistics show. Without dwelling on data, they suggest that further good ways to stay out of emergency care include: frequent checkups if you have a chronic condition, especially to stay on top of heart and lung woes and diabetes; staying away from drinking and driving; getting flu shots; taking care about where and what you eat; and, guys, especially, let’s not pretend we can hoist everything with no concern for our backs or kid ourselves about our expertise in dealing properly with risky household matters (using power tools or ladders, handling chemicals or fire). Emergency rooms and departments are serious places for dealing with life-threatening care, and we all should do all we can to stay out of them and let the great experts there do what they must.