Prudent Layperson Standard in Emergency Medicine Under Attack

From ACEP Now:

In the history of the specialty of emergency medicine, there have been landmark pieces of legislation that have significantly changed the paradigm of how we practice. Perhaps the two most important have been EMTALA and the prudent layperson standard. EMTALA mandates the evaluation and stabilization of all patients who present to the emergency department, and the prudent layperson standard gives patients the protection to seek emergency care and provides hospitals and emergency physicians the assurance of payment for those services. While our obligation under EMTALA hasn’t lessened, the protection for patients and providers under the prudent layperson standard has come under increasing attack by government and private payers. Just like the fight to enact it 25 years ago, the need to protect the prudent layperson standard today is now a rallying point for the specialty of emergency medicine and the larger house of medicine.

Mississippi hospital will charge $200 upfront fee for nonurgent ED visits

From Becker’s:

Beginning Nov. 1, Memorial Hospital at Gulfport (Miss.) will ask nonurgent patients who present at the hospital’s emergency department to visit a walk-in clinic instead. Nonurgent patients who insist on receiving care in the hospital’s ED will be required to pay their insurance copay or a $200 deposit toward the cost of their care before receiving treatment.

Nursing degrees increasing, but not on track to meet goal for acute care

From Reuters:

The proportion of registered nurses with nursing bachelor’s degrees has climbed in recent years to 57 percent in U.S. acute care settings, but it’s not rising fast enough to reach a goal of 80 percent by the year 2020, researchers say.

“When more nurses have degrees, there’s a higher quality of care, lower mortality rate and better patient outcomes,” said lead author Chenjuan Ma of New York University’s Rory Meyers College of Nursing in New York City.

Tourniquets, once out of favor, helped save lives in Vegas shootings

From Reuters:

The National Security Council, with trauma and emergency care groups, has launched a “Stop the Bleed” campaign to promote training among civilians. And shopping malls and airports have begun installing bleed control kits – including tourniquets – on public walls next to emergency defibrillators.

“We want to turn it into the next CPR,” said Ian Weston, a paramedic and executive director of the American Trauma Society.

Weston belongs to a small but growing corps of instructors who teach bleeding control. The free classes were designed to take less than an hour – “quick, down and dirty,” he said, “in the hopes that more people would take advantage of the training.”

After medical errors, patients want doctors to hear them out

From Reuters:

When medical errors lead to serious injuries, patients and families may feel better when doctors take the time to listen to their feelings about the mistake and explain what can be done to prevent it from happening again, a small study suggests.

The research team interviewed 27 patients, 3 family members and 10 staff members at three U.S. hospitals that have established programs to communicate with patients about medical errors and efforts to improve safety – and offer compensation when substandard care causes harm. In every case, patients had either accepted a malpractice settlement or been injured too long ago to file a lawsuit.

After mistakes, patient satisfaction was highest when communications were not adversarial and included compensation. Patients and families also expressed a strong need to be heard and expected the physician involved in the case to listen to their feelings about the mistake, researchers report in JAMA Internal Medicine.

Leveraging telemedicine to avoid ER visits

From GCN:

Ambulance rides can be costly for patients, service providers and local governments alike. That’s why officials in Houston decided to find a way to decrease the number of unnecessary trips.

The result was the Emergency TeleHealth and Navigation (ETHAN) Project.

AHA report: Hospitals more than make up for their tax-exempt status

From Healthcare Dive:

  • The American Hospital Association (AHA) has released a report that says hospital community benefits outweigh the value of their tax exemption by a factor of 11 to one.
  • The analysis, performed by Ernst and Young at AHA’s request, used 2013 data from tax forms, community benefit reports and Medicare cost reports from nearly 3,000 non-profit general hospitals.
  • More than half the value of the community benefits were from financial assistance, unreimbursed Medicaid and unreimbursed costs from other means-tested government programs, according to the report.