From the Marshall News Messenger:

One area that Collier said has to improve is the use of the Emergency Department for primary care.

“The Emergency Department has to revert back to what it was designed for — emergency care. We have to transform the Emergency Department from primary care for people who don’t have a physician or insurance. It’s the most expensive medicine you can deliver and it is the absolute worst way to deliver it.”

The Rural Health Clinic across from the Emergency Room has yet to slow the flow of people to the emergency room. There are five providers and the clinic is open seven days a week.

Self-pay, or uninsured, is part of the reason for the explosion. “Self-pay in this region is second highest in the state, second only to the (Rio Grande) Valley and only a couple of percentage points less than the Valley, which surprises a lot of people,” he said, adding 16 percent of Marshall’s patients last year were self-pay and that when the fiscal year started in October the number was at 21 percent.

The average self-pay patient in Marshall is a 42-year-old employed male. “Eighty percent of the businesses employ 50 or less, and that category finds health care prohibitive to offer. Plus, the oil and gas industry brings in a lot of contract pay that, while it pays good, does not provide insurance,” he said.

He noted visits to the Emergency Department this year are expected to be at 30,000 — and 90,000 at Good Shepherd Medical Center-Longview — for a total 120,000 visits that far exceeds the population.

From amednews (AMA):

… disruptive behaviors that persist among physicians and nurses at hospitals, group practices and other health care facilities, according to anonymous responses to a national survey of 13,000 physician and nurse executives conducted by the American College of Physician Executives.

The survey comes almost one year after the Joint Commission began requiring health care facilities to implement zero-tolerance policies that define intimidating and disruptive behaviors. The commission also required that facilities establish disciplinary procedures for medical staff and other health care professionals who violate the standards.

With increasing concern over the impact of bad behavior on patient care, the findings renew questions about how to curb the problem effectively.

From JEMS (Quoting the AP):

COLUMBIA, S.C. — When an ambulance brought Daniel Webb home from the hospital after he hurt his knee in March, paramedics warned the then 550-pound man he probably wouldn’t be able to get up from his recliner if they put him there, his wife said.

Webb told them to leave him there anyway. He would sit in that recliner, slowly dying, for the next eight months. Finally, paramedics were called back to his Greenwood home on Wednesday because he was in a lot of pain.

Webb’s body was physically stuck to the power recliner and firefighters had to cut him from the chair to take him to the hospital. He died a few hours later, his body covered with sores and a “very bad odor,” according to a police report.

From Forbes:

Primary care physicians, essential to keeping chronic conditions like diabetes and high blood pressure from escalating into expensive hospital visits, are in short supply: The American Academy of Family Physicians predicts a shortage of 40,000 general practice docs within ten years as U.S. med school grads favor higher-paying specialties. (At the moment 32% of the 941,000 U.S. doctors are in primary care.) That shortfall will only get worse if the federal government expands coverage. “If 40 million people come online with access to medicine, the system won’t be able to accommodate them,” says Dr. Russell Robertson, chairman of the Council on Graduate Medical Education and a professor at Northwestern’s Feinberg School of Medicine.

One solution would be to import doctors from other countries, but a combination of tight licensing rules and a limited number of residency slots holds down their numbers. Last year 10,000 foreign-trained docs applied for slots in American residency programs, a necessary first step to practicing in the U.S.; 7,000 got in. “They are turned away all the time,” says Carl Shusterman, a Los Angeles immigration lawyer who specializes in representing medical professionals.

From JEMS (quoting the LA Times)

Patients will be routed to one of 10 hospitals that have a specialized stroke neurologist available at all times. Officials hope the new policy will save lives.

Paramedics on Monday began transporting suspected stroke victims in Los Angeles County to the nearest certified stroke center, a change that officials hope will save lives and brings L.A. into line with other urban counties in the state.

The policy shift will route patients to 10 hospitals, including one in Orange County, that have a specialized stroke neurologist available at all times.

From Critical Care Medicine:

Objective: To evaluate whether implementation of a therapeutic hypothermia protocol on arrival in a community hospital improved survival and neurologic outcomes in patients initially found to have ventricular fibrillation, pulseless electrical activity, or asystole, and then successfully resuscitated from out-of-hospital cardiac arrest.

Design: A retrospective study of patients who presented after implementation of a therapeutic hypothermia protocol compared with those who presented before the protocol was implemented.

Setting: Harborview Medical Center, Seattle, WA.

Patients: A total of 491 consecutive adults with out-of-hospital, nontraumatic cardiac arrest who presented between January 1, 2000 and December 31, 2004.

Interventions: An active cooling therapeutic hypothermia protocol, using ice packs, cooling blankets, or cooling pads to achieve a temperature of 32°C to 34°C was initiated on November 18, 2002 for unconscious patients resuscitated from cardiac arrest.

Measurements and Main Results: Demographics and outcomes were obtained from medical records and an emergency medical database. The primary outcomes were survival and favorable neurologic outcome at discharge associated with the therapeutic hypothermia protocol. An adjusted analysis was performed, using a multivariate regression. During the therapeutic hypothermia period, 204 patients were brought to the emergency department; of these 204 patients, 132 (65%) ultimately achieved temperatures of <34°C. Of the 72 patients who did not achieve goal temperatures: 40 (20%) died in the emergency department or shortly after being admitted to the hospital, 15 (7%) regained consciousness, four (2%) had contraindications, 13 (6%) had temperature increase or did not have documented use of the therapeutic hypothermia protocol. In the prior period, none of the 287 patients received active cooling. Patients admitted in the therapeutic hypothermia period had a mean esophageal temperature of 34.1°C during the first 12 hrs compared with 35.2°C in the pretherapeutic hypothermia period (p < .01). Survival to hospital discharge improved in the therapeutic hypothermia period in patients with an initial rhythm of ventricular fibrillation (odds ratio, 1.88, 95% confidence interval, 1.03-3.45), however not in patients with nonventricular fibrillation (odds ratio, 1.17, 95% confidence interval, 0.66-2.05). In adjusted analysis, ventricular fibrillation patients during the therapeutic hypothermia period trended toward improved survival (odds ratio, 1.71, 95% confidence interval, 0.85-3.46) and had favorable neurologic outcome (odds ratio, 2.62, 95% confidence interval, 1.1-6.27) compared with the earlier period. This benefit was not observed in patients whose initial rhythm was pulseless electrical activity or asystole.

Conclusions: The therapeutic hypothermia period was associated with a significant improvement in neurologic outcomes in patients whose initial rhythm was ventricular fibrillation, but not in patients with other rhythms.

From the Wall Street Journal, via Symtym/Twitter:

The list of things to avoid during flu season includes crowded buses, hospitals and handshakes. Consider adding this: your doctor’s necktie.

Neckties are rarely, if ever, cleaned. When a patient is seated on the examining table, doctors’ ties often dangle perilously close to sneeze level. In recent years, a debate has emerged in the medical community over whether they harbor dangerous germs.

Several hospitals have proposed banning them outright. Some veteran doctors suspect the antinecktie campaign has more to do with younger physicians’ desire to dress casually than it does with modern medicine. At least one tie maker is pushing a compromise solution: neckwear with an antimicrobial coating.

From the Wichita Falls (TX) Times Record:

An emergency list — which includes room to write down prescription medications, the frequency and dosage — will be part of an insert United Regional is providing Friday in every copy of the Times Record News.

The insert, titled “A Trip to the Emergency Room — Help Us Help You,” is geared toward helping people understand the behind-the-scenes workings of the ER and the factors that can be part of the time a patient spends there.

From US News:

Compared to standard emergency room triage, CT angiography is quicker, more accurate and much less expensive for screening patients with chest pain who have low to moderate enzyme and EKG scores, according to a new study.

The study included 749 acute chest pain patients at 16 emergency rooms who were randomly assigned to receive either coronary computed tomographic angiography (CCTA) or standard screening with myocardial perfusion imaging (MPI).

Both methods were found to be safe, and similar numbers of patients underwent invasive angiography during the first visit. However, diagnosis time for patients who underwent CCTA was 54 percent shorter (3 hours vs. 6.3 hours) and the cost of care for patients in the CCTA group was 38.2 percent lower — a median of $2,137 compared to $3,458 for standard screening with myocardial perfusion imaging.

The findings from the study — called the Coronary Computed Tomography for Systematic Triage of Acute Chest Pain Patients to Treatment Trial — were to be presented Wednesday at the American Heart Association’s annual meeting in Orlando, Fla.

From the LPN to RN Blog, via the Studer Group/Twitter:

Marketing & Public Relations

Get the word out and promote your hospital with Twitter.
Monitor for problems: Find out what’s being said about your hospital, and respond to it on Twitter.
Get support for causes: Tweet about causes that are important to your hospital and patients.
Share news releases: Use your hospital’s official Twitter channel to let people know what’s happening.
Announce new locations: Let followers know when you’re opening up a new branch or department of the hospital.
Promote your brand: Use Twitter to protect your online reputation and build a consistent brand.
Share new services: Alert the community when you have new services to offer at your hospital.
Promote specials: Share health assessment specials and more to let people know about offerings available at the hospital.
Announce new physicians: Let followers know when you have a new physician join your team.
Share your hospital’s view: Let the public know your hospital’s stance and insights on health care reform.
Post events: Promote events happening at your hospital with the help of Twitter.