ER Off-Load Nurse Saving Paramedics Time

From CFRA:

A nurse accepting patients from paramedics in the emergency room is credited for saving Ottawa Paramedics 15-thousand hours in service time last year.

As part of an Off-Load Nurse Program pilot project in Ottawa hospitals, a nurse is located in the emergency room to accept a patient from paramedics, allowing crews to return to service faster.

The 2011 Ottawa Paramedic Service annual report shows paramedics spent over 40-thousand hours in excess of the 30-minute target waiting to off-load a patient in the ER.

Stroke Robot Arrives in Iowa

From the Clinton Herald:

Nichols, 69 of Clinton, arrived at the Mercy Medical Center emergency room at 8:30 that morning with stroke symptoms. Doctors expeditiously deployed a remote presence robot manned by University of Iowa neurology specialist Dr. Enrique Leira to evaluate her condition.  

The remote presence robot is the first of its kind in Iowa. Through a partnership between Mercy Medical and University of Iowa Hospitals and Clinics in Iowa City, specialists in Iowa City can evaluate patients to determine the severity of their conditions through two-way video conferencing. Mercy’s medical personnel began using the robot on May 8; since then they have treated 12 patients.

To Transmit or Not to Transmit: How Good Are Emergency Medical Personnel in Detecting STEMI in Patients With Chest Pain?

From the Canadian Journal of Cardiology:

BACKGROUND: There is growing use of prehospital electrocardiograms (ECGs) in establishing early diagnosis of ST segment myocardial infarction (STEMI) to facilitate early reperfusion. This study aimed to determine the predictive value of prehospital ECGs interpreted by nonphysician emergency medical services (EMS) in chest pain presentations.

METHODS: In our city of 658,700 people, EMS/paramedics received 21 hours of instruction on STEMI management, ECG acquisition, and interpretation. Suspected STEMI ECGs were wirelessly transmitted to and discussed with a physician for possible therapy. ECGs deemed negative for STEMI by EMS were not transmitted; patients were transported to the closest hospital without prehospital physician involvement.

RESULTS:From July 21, 2008 to July 21, 2010, there were 5426 chest pain calls to EMS, 380 were suspected STEMI cases. The remaining ECGs were deemed negative for STEMI by EMS. To audit the nontransmitted ECGs we analyzed 323 consecutive patients over 2 selected months (January and June 2010) for comparison. Of nontransmitted cases there was 1 missed and 2 STEMIs that developed subsequently. Based on 380 transmitted and 323 nontransmitted cases, the sensitivity and specificity of EMS detecting STEMI were 99.6% and 67.6%, respectively. The positive and negative predictive values for STEMI were 59.5% and 99.7%, respectively.

CONCLUSIONS:Our findings demonstrate nonphysician EMS interpretation of STEMI on prehospital ECG has excellent sensitivity and high negative predictive value. This finding supports the use of prehospital ECGs interpreted by EMS to help identify and facilitate treatment of STEMI. These results may have broad implications on staffing models for first responder/EMS units.

One Syringe, One Needle, Only One Time

CDC’s One & Only campaign:

The One & Only Campaign is a public health campaign, led by the Centers for Disease Control and Prevention (CDC) and the Safe Injection Practices Coalition (SIPC), to raise awareness among patients and healthcare providers about safe injection practices. The campaign aims to eradicate outbreaks resulting from unsafe injection practices. 

Discussion: Study Measures Survival for Trauma Patients Based on Mode of Transport

From JEMS:

The only conclusion was that helicopter mode of transport was associated with longer prehospital times, more advanced life support procedures and more severely injured patients.

Dr. Wesley: The role and clinical impact of helicopter EMS (HEMS) transport for trauma patients competes closely with prehospital intubation as one of the most controversial topics in emergency medical care. There have been more than a half dozen papers published on the issue during this past year, and each provides a slightly different answer.

Are Foreign Physicians Practicing in the U.S Smarter Than American Doctors?

From MGMA:

Even in today’s politically correct climate, some patients and healthcare professionals hold on to the belief that a foreign doctor’s education is far inferior to that of American physicians. Though possibly true in certain instances, a study published in the August 2010 issue of Health Affairs, calls this belief into question.

In the study, the performance of primary-care clinicians, internal medicine physicians and cardiologists related to the care of congestive heart failure (CHF) and/or heart attack patients were tracked and the clinical outcomes of the patients noted. Despite popular opinion, the results of the study showed that patients of foreign physicians trained outside the United States had a lower patient death rate compared to American doctors.