Pa. hospital fined after suicidal patient walks out of ER, fatally throws herself into traffic

From The Republic:

State investigators say a central Pennsylvania hospital didn’t adequately supervise a suicidal patient who walked out of the emergency room in paper scrubs shortly before she fatally threw herself into traffic.

The woman was taken to the hospital by police after they had to prevent her from jumping out a second-floor window at her home. She agreed to a voluntary mental health evaluation but soon disappeared from the hospital. She was struck and killed by a car on a nearby highway.

Why do patients with minor or moderate conditions that could be managed in other settings attend the emergency department?

From the Emergency Medicine Journal:

Objectives To estimate the potential of alternative providers of care for minor health problems to reduce demands on emergency departments (EDs).

Methods Data were collected in a type 1 urban ED over a 2-month period in two stages: questionnaire to adult attendees presenting to the ED; and a notes review.

Results The usable response rate was 68% (n=261/384). The notes review confirmed that more than two-thirds of the presenting conditions could have been managed in settings other than the ED. The attendees’ reasons on the questionnaire indicated a strong belief that the only provider able to deal with their concerns at that time was the ED. For some users, the ED was not the first contact with a healthcare provider for the same health problem. Few believed that they would be seen quicker in the ED or that the ED was more convenient. The most frequent reason for presenting to the ED was ‘being advised to attend by someone else’. The ‘adviser’ was more likely to be a health professional (doctor or nurse or NHS Direct) than to be ‘friends or family’.

Conclusions Although there appears to be considerable potential for minor conditions to be managed in settings other than the ED, our findings indicate that patients will continue to present these conditions to the ED. Patient perceptions of the urgency of their treatment need, and also the availability and capacity of alternative services may be offsetting their potential to substitute for the ED. Advice from other services may be contributing to demands on the ED.

Characteristics of patients transported by an air ambulance critical care team

From the Emergency Medicine Journal:

Background The aim of this study was to review patients conveyed by the Great Western Air Ambulance to its main receiving hospital.

Methods Retrospective data were collected for all patients transferred to Frenchay Hospital by the Great Western Air Ambulance between 1 June 2008 and 1 March 2010.

Results 115 patients were included in the review. Patients were conveyed up to 85 km, 79% bypassing the closest emergency department (ED). 51% of these patients had major trauma and 35% were intubated at the scene. On arrival, the mean time to CT scan was 78 min, reduced to 63 min for those with a head injury. 16% of patients were discharged from the ED.

Conclusions This review provides an overview of the characteristics of patients transferred to a major receiving hospital by a prehospital critical care team.

Guidelines-based CPR saves more non-shockable cardiac arrest victims

From the American Heart Association:

Study Highlights:

• CPR can save someone with cardiac arrest even if they don’t respond to a defibrillator.
• People with non-shockable cardiac arrest are more likely to live if they receive CPR based on recent guidelines emphasizing chest compressions.
• The American Heart Association’s CPR guidelines emphasizing chest compressions are saving more lives, according to a new study.