Carroll hospital determined to continue serving mentally ill, bucking tide of closures

From the Des Moines Register:

St. Anthony Regional Hospital’s leaders couldn’t bring themselves to do what eight other rural Iowa hospitals have done in recent years: Shutter their psychiatric unit.

The Carroll hospital’s board nearly pulled the plug several years ago. The inpatient mental-health program was losing money, and it struggled to keep psychiatrists and other professionals on staff.

But St. Anthony’s is the only hospital in Carroll County or the seven surrounding counties that offers inpatient care to people having mental health crises.

“If we don’t do it, who’s going to?” said Ed Smith, the hospital’s chief executive officer.

Minnesota hospitals see spike in unpaid bills

From the Star Tribune:

The increase is the biggest jump since the Affordable Care Act (ACA) took effect in 2013, according to a report released Wednesday by the Minnesota Hospital Association.

Objective Evaluation of a Simulation Course for Residents in the Pediatric Emergency Medicine Department: Breaking Bad News

From Cureus:

Introduction: Breaking bad news (BBN), especially in the pediatric emergency medicine department, requires significant skill and delicacy due to the acute context of a busy emergency department (ED) and the lack of prior rapport with the patients and families. Pediatric literature on breaking bad news has mostly focused on pediatric oncology and pediatric critical care, with limited literature focused on pediatric emergency medicine. Review of the literature also reveals that most existing studies solely assess the learners’ self-ratings of efficacy and comfort, and far fewer studies objectively evaluate learners’ actual performance using simulation. Our objectives for this study was to use an objective assessment tool to assess residents’ breaking bad news skills, pre- and post-simulation training, specifically in the setting of a pediatric emergency medicine department.

Methods: 34 residents were evaluated on their performance in breaking bad news via videotaped simulation encounters before and after teaching intervention. The “Modified Breaking Bad News Assessment Scale” (mBAS) was used as the assessment tool. A paired t-test analysis was conducted to examine the mean difference in pre- and post-simulation scores in each of the five mBAS domains.

Results: Breaking bad news performance score improves one to two weeks post-intervention, and was statistically significant in three of five domains.

Conclusion: Our study shows that breaking bad news is a teachable skill that can be improved by simulated education in the pediatric emergency medicine department. This study demonstrates the utility of simulation course in improving breaking bad news skills in the pediatric emergency medicine department. Future work in developing focused simulation curriculums is important to improve provider communication skills and patient-physician relationships.


Perceived vs. actual distractions in the emergency department

From the American Journal of Emergency Medicine:


The emergency department (ED) has been shown to be an interrupt-driven workplace fraught with potential for distractions and interruptions that increase the potential for medical error. Accuracy of provider perception of these distractions and interruptions has yet to be investigated.


An observational two-phase study was conducted over a 9-week period in the highest acuity zone of the ED at an urban, academic medical center with about 90,000 visits/year. Phase I, conducted over the initial 5-weeek period, consisted of observers recording the type and frequency of all overhead pages in the ED. In phase II, conducted over the final 4-week period, direct observation of faculty and residents was done to record all individual interruptions for different levels of training. Actual data was compared to provider perceptions, as determined by survey responses.


2438 overhead pages were recorded and occurred, on average, 23.2 times per shift. The perceived rate of overhead pages was 43.2 per shift. 333 individual interruptions occurred, on average, 4.26 times per shift. The perceived rate was 53.5 per shift. Attending providers perceived a significantly higher number of individual interruptions compared to all resident providers.


The perceived amount and rate of distractions and interruptions are significantly higher than the actual amount and rate of distractions and interruptions. Attending physicians both perceive and experience more distractions and interruptions. Further work should be done to evaluate the power of provider perception, and the potential contribution of inaccurate perception to medical error and provider burnout.

Iowa Prescriber Activity Reports Coming Out this Month

From the Iowa Hospital Association:

The Iowa Prescription Monitoring Program (PMP) is designed to reduce and prevent prescription drug abuse and drug overdose. As a central depository of information on controlled substance prescribing and dispensing, a major role of the PMP is to make the data available to authorized users.

Beginning in late January 2019, PMP information will be disseminated to authorized users through the Prescriber Activity Report (PAR), which provides a health care provider with a prescribing history summary, including their ranking compared to the median of prescribers within the same specialty. The PAR also includes a summary or graphical representation of each health care professional’s prescribing history.

The intent of providing a health care professional with relevant and accurate information is to constructively assist his/her controlled substance prescribing practices. Informing health care professionals of their prescribing behaviors relative to their peers may provide insightful, concise data that may assist with treatment protocols.

PRCs will be generated and distributed every quarter and sent only to health care professionals who have issued at least one controlled substance prescription during the previous quarter. The PAR categorizes health care professionals by specialty and each health care professional receives a PAR specific to their prescribing history. The specialty group is determined using taxonomy codes maintained by the Centers for Medicare & Medicaid Services. The PAR identifies the following metrics for each prescriber:

  • Opioid related patient and prescription volumes
  • Prescribing percentages based on daily Morphine Milligram Equivalents (MME) of opioid prescriptions
  • Patient percentages based on opioid duration of therapy
  • Prescribing volume based on total MME of selected opioids
  • Anxiolytic/sedative/hypnotic prescribing
  • Patient volumes exceeding multiple provider thresholds
  • Patient volumes receiving dangerous combination therapy
  • PMP usage

GoFundMe’s place in the health care system

From Axios:

Crowd-funding sites like GoFundMe have become a critical part of the health care system — and GoFundMe’s CEO recognizes that that’s a bad thing.

By the numbers: GoFundMe sees more than 250,000 campaigns each year related to medical expenses. They account for about a third of the roughly $5 billion people donate through the site, according to Kaiser Health News.

Keeping Pace with the Emergency Department: The Value of Electronic Informed Consent


Informed Consent’s Paper Problem – Delays, Costs and Risks

In order to launch telehealth sessions in the ED, an informed consent form, such as the one that is required when receiving medical care, is generally required.

From the bedside, to the video conferencing screen and even from the patient’s home computer, informed consent’s vital role in healthcare remains the same. And, when this process of capturing informed consent falls short, it opens a door of legal risks, compliance, delays in care, additional costs, patient safety risks and operational issues.

In a world where technology advances in healthcare include remarkable breakthroughs such as telehealth, artificial intelligence and data analytics, just to name a few, it is surprising to discover one of the most important processes in healthcare: the informed consent – has yet to capitalize on existing technology.