Mercy Medical Center Des Moines is reorganizing its administrative structure effective on Feb. 1 to give physicians more control, responsibility and accountability.

“The current structure is very hospital-centric and less physician-centric,” said Mercy chief executive David Vellinga.

The new structure places seven physicians in lead roles where they will partner with non-medical administrators to develop strategy and ensure proper delivery of medical care and services at the hospital.

Driven by a desire to improve the quality of and access to care, health systems both large and small are tapping into the power of telemedicine at a feverish pace.

But clinical considerations aren’t the only market forces driving adoption. Supply-and-demand economics, the utility and reliability of new wireless devices and cost pressures are also significant factors.

Principal investigator and lead author Lynn Sweeney, M.D., an emergency medicine physician at Rhode Island Hospital, is a member of the hospital’s Simulation Center. Sweeney and her colleagues developed Project CLEAR! (Communication Leading to Excellence and Ameliorating Risk) to give structure and consistency to the manner in which staff communicate with each other and with patients. “This is the first program that we know of its kind to combine traditional teamwork training with simulation-based customer service training,” Sweeney says.

“Excellence in health care is no longer defined merely by the quality of clinical care offered, but also by the superiority of service provided to those who seek care. The importance of patient satisfaction has grown over the past decade,” she adds. “To be recognized as a top-quality organization, we have to not only provide exceptional care, but our patients and their families have to truly feel how much we care about them.”

Project CLEAR! has provided training for a staff of nearly 400, including nurses, physicians, medical assistants and secretaries in one of the busiest emergency departments in the country. The CLEAR! training day includes a 7-hour interactive experience that features three medical simulation scenarios using both standardized patients and high-fidelity manikans, to teach both Crew Resource Management concepts and customer-service. The simulation scenarios are used to elicit specific teaching points that will impact quality of care, safety and service.

Implementation of the laryngeal tube for prehospital airway management : Training of 1,069 emergency physicians and paramedics

OBJECTIVE: The European Resuscitation Council recommends that only rescuers experienced and well-trained in airway management should perform endotracheal intubation. Less trained rescuers should use alternative airway devices instead. Therefore, a concept to train almost 1,100 emergency physicians (EP) and emergency medical technicians (EMT) in prehospital airway management using the disposable laryngeal tube suction (LTS-D) is presented.

METHODS: In five operational areas of emergency medicine services in Germany and Switzerland all EPs and EMTs were trained in the use of the LTS-D by means of a standardized curriculum in the years 2006 and 2007. The main focus of the training was on different insertion techniques and LTS-D use in children and infants. Subsequently, all prehospital LTS-D applications from 2008 to 2010′were prospectively recorded.

RESULTS: None of the 762 participating EMTs and less than 20% of the EPs had previous clinical experience with the LTS-D. After the theoretical (practical) part of the training, the participants self-assessed their personal familiarity in using the LTS-D with a median value of 8 (8) and a range of 2-10 (range 1-10) of 10 points (1: worst, 10: best). Within the 3-year follow-up period the LTS-D was used in 303 prehospital cases of which 296 were successfully managed with the device. During the first year the LTS-D was used as primary airway in more than half of the cases, i.e. without previous attempts of endotracheal intubation. In the following years such cases decreased to 40% without reaching statistical significance. However, the mean number of intubation attempts which failed before the LTS-D was used as a rescue device decreased significantly during the study period (2008: 2.2 ± 0.3; 2009: 1.6 ± 0.4; 2010: 1.7 ± 0.3).

CONCLUSION: A standardized training concept enabled almost 1,100 rescuers to be trained in the use of an alternative airway device and to successfully implement the LTS-D into the prehospital airway management algorithm. Because the LTS-D recently became an accepted alternative to endotracheal intubation in difficult airway scenarios, the number of intubation attempts before considering an alternative airway device is steadily decreasing.

Ed. This is an AW 139, not ORNGE’s exact ship.

ORNGE’s top doctor has checked out the medical interior of the air ambulance’s multimillion-dollar helicopters and found a disaster waiting to happen.

Dr. Bruce Sawadsky, in a report written Monday, calls the cramped interior of the brand new AW 139 helicopter a “high risk environment.”

His findings? Tough to do CPR. Hard to prop up a patient who is having difficulty breathing. Takes too long to load and unload a patient. Risky, too. Many equipment malfunctions.

A Randomized Trial of Compression First or Analyze First Strategies in Patients with Out-of-Hospital Cardiac Arrest: Results from an Asian Community

Background: It is still under debate whether a period of cardiopulmonary resuscitation should be performed prior to rhythm analysis for defibrillation for out of hospital cardiac arrests (OHCA). This study compared outcomes of OHCA treated by “compression first” (CF) versus “analyze first” (AF) strategies in an Asian community with low rates of shockable rhythms.

Methods: This randomized trial was conducted in Taipei City between February 2008 and December 2009. Dispatches of suspected OHCA that activated advanced life support teams were randomized into the CF and AF strategies. Patients assigned to CF strategy received 10 cycles of CPR prior to analysis by automatic external defibrillator. The primary outcome was sustained (> 2hours) return of spontaneous circulation (ROSC) and secondary outcome was survival to hospital discharge.

Results: We included 289 cases in the final analysis after exclusion by pre-specified criteria, 141 were allocated to CF strategy and 148 to AF strategy. Baseline characteristics were similar. Thirty-seven (26.2%) of those receiving CF strategy and 49 (33.1%) of the AF strategy achieved sustained ROSC (p=0.25). In a post-hoc analysis of patients who achieved ROSC, those that received CF strategy were more likely to be discharged alive from the hospital (16/37=43.2% vs. 11/49=22.4%, p=0.02).

Conclusion: In this study population of low rates of shockable rhythms, there was no difference in ROSC for CF or AF strategies. Considering the EMS operation situations, a period of paramedic-administered CPR for up to 10 cycles prior to rhythm analysis could be a feasible strategy in this community.

Background: On July 22, 2011, a single perpetrator killed 77 people in a car bomb attack and a shooting spree incident in Norway. This article describes the emergency medical service (EMS) response elicited by the two incidents.

Methods: A retrospective and observational study was conducted based on data from the EMS systems involved and the public domain. The study was approved by the Data Protection Official and was defined as a quality improvement project.

Results: We describe the timeline and logistics of the EMS response, focusing on alarm, dispatch, initial response, triage and evacuation. The scenes in the Oslo government district and at Utøya island are described separately.

Conclusions: Many EMS units were activated and effectively used despite the occurrence of two geographically separate incidents within a short time frame. Important lessons were learned regarding triage and evacuation, patient flow and communication, the use of and need for emergency equipment and the coordination of helicopter EMS.

Doctors at one local southern Illinois emergency room say some patients are not coming looking for help, they’re looking for drugs.

It’s called “doctor shopping” and the director of the emergency department at Memorial Hospital of Carbondale says it’s become a big concern.

Dr. Joseph Haake says the fast-paced nature of an E.R. makes it a prime target for doctor shoppers, which he says could slow down service for folks who really need help in a hurry.

“They shop from one physician to the next until they get that prescription,” said Dr. Haake. “It’s a very difficult environment to determine whose behaviors are legitimate and whose aren’t.”

One of the key goals of health reform here in Massachusetts was to improve people’s health through prevention and primary care to the point that costly trips to the emergency room would decline. Until now, that hasn’t happened, according to several earlier reports.

But a just-released analysis, by the Blue Cross Blue Shield of Massachusetts Foundation found, for the first time, that ER visits (among non-elderly adults) have started to drop. Here, according to the report, which is also published in the current issue of the journal Health Affairs are the numbers: (read more by following the link above)

According to the Henry Ford study, less than 1 percent of the CT scans performed in the emergency department revealed a more serious underlying cause for dizziness – intracranial bleeding or stroke – that required intervention.

The findings suggest that it may be more cost effective for hospitals to instead implement stricter guidelines for ordering in-emergency department CT scans of the brain and head for patients experiencing dizziness.