Shift work linked to burnout in sleep-deprived nurses

From Reuters:

Shift-work nurses who have sleep problems are more likely to experience career burnout that has the potential to compromise their job performance, a small Italian study suggests.

Researchers studied 315 nurses who worked rotating shifts in 39 wards of seven Italian hospitals. Each week, nurses worked an average of 36 hours and typically had at least one shift starting in the morning, the afternoon and the evening.

Overall, 52 percent of the nurses reported sleep difficulties and 31 percent reported feelings of career burnout.

Physicians argue Anthem’s ER policy violates federal law

From Becker’s:

Physicians are concerned about a new policy Anthem is rolling out in Indiana in January, according to WBOI.

Under the new policy, which is already effective in three other states, Anthem will review diagnoses after members’ emergency room visits. If the condition is determined to be nonemergent, Anthem may not cover the ER visit.

Gina Huhnke, MD, American College of Emergency Physicians Indiana chapter president, told WBOI physicians believe Anthem’s ER policy violates federal law.

“Currently under federal law prudent layperson states that anyone who has symptoms suggestive of an emergency should be allowed to access care,” she told WBOI.

Anthem said it will cover claims that meet the so-called layperson standard, according to the report.

Study finds uninsured don’t use emergency rooms more than other patients

From Medical XPress:

One of the most common arguments for expanding publicly subsidized health coverage is that the uninsured overuse and overburden emergency departments. This argument persists despite evidence that, when the uninsured gain Medicaid coverage, emergency department use increases.

A new study by Katherine Baicker, dean and Emmett Dedmon professor at the University of Chicago Harris School of Public Policy, and co-authors sheds light on the potential sources of the disconnect between the evidence and the conventional wisdom.

The researchers’ descriptive findings, published in the December issue of Health Affairs, confirm that those without  do not use emergency departments more than those with insurance, and actually use them much less than those on Medicaid. Furthermore, the uninsured and the insured use the emergency department for very similar kinds of care, dispelling the misperception that the uninsured are much more likely to go to the emergency department for less serious conditions.

Collaboration between EMS and primary care physicians could reduce unnecessary emergency transport for fallen seniors

Press Release:

A protocol that couples paramedic assessment with primary care physician consultation and timely follow up significantly reduced unnecessary ambulance transport for fallen elderly residents of assisted living facilities. The findings of a prospective cohort study are published in Annals of Internal Medicine.

Unintentional falls are the leading cause of nonfatal injury for adults aged 65 years or older who are treated in emergency departments in the United States. Residents of assisted living facilities who fall may not be seriously hurt, but policy still dictates that they be transported to the emergency department. These policies burden the health care system and place patients at risk for harms, such as unnecessary tests or exposure to infection. Therefore, limiting unnecessary transport is desirable.

Researchers from Wake County Emergency Medical Services sought to determine whether unnecessary transport to the emergency department could safely be avoided for patients who experienced a ground-level fall in an assisted living facility. Wake County Emergency Medical Services collaborated with Doctors Making Housecalls, a group of  specializing in home care for older adults, to develop a protocol for specially trained paramedics to identify a subset of patients who would not be transported to the emergency department but instead would be scheduled for a visit with a  provider within 18 hours of the call for .

The study involved a convenience sample of 953 residents, 359 of whom had 840 ground-level falls over 43 months. The protocol recommended nontransport after 553 falls, which marked a substantial decrease (62.9 percent) in transports. The researchers concluded that 98 to 99 percent of nontransported patients received safe, appropriate care. If implemented on a widespread basis, this approach could potentially avoid large numbers of unnecessary ambulance transports to the  for simple falls.

 Explore further: Hospital or home? Guidelines to assess older people who have fallen

More information: Annals of Internal Medicine (2017).

Patient Navigation for Patients Frequently Visiting the Emergency Department

From Urgent Matters:

A new study from the University of Tennessee[ii] aimed to help keep frequent ED users from needing the ED through the use of a patient navigator program. The research team created a patient navigator program that worked within the ED to help patients review diagnoses and prescriptions, arrange follow-up appointments and transportation, and identify relevant community resources. The navigator would meet with the patient to perform these tasks during the initial visit, any following ED visit, and by telephone within 2 weeks and 12 months of the initial visit.

Superusers were defined as any patient presenting to the Erlanger Baroness ED for their fifth visit or more within a 1-year period. Once a patient was properly consented for participation in the pilot, they were assigned to the control arm or the experimental arm. The control group also received a call from a research assistant at the 2 week and 12-month time post the initial visit to the ED.

Maternity Wards Are Disappearing From Rural America

From Governing:

Maternal health in rural America is made more complicated by the fact that rural areas routinely rank higher than urban areas in rates of noncommunicable diseases and preventable deaths. Birth outcomes are poorer, too. And with fewer and fewer ob-gyns available, there will likely be more high-risk pregnancies, unhealthy births and resulting long-term health issues. “What happens during pregnancy sets the tone 20 or 30 years down the road,” says Lisette Jacobson, an assistant professor of preventive medicine and public health at the University of Kansas.

Meanwhile, costs and maternity ward closures are likely to continue to mount. Anderson says that by offering obstetric services, his hospital is operating at a six-figure annual loss, even after receiving funding through a public-private partnership to expand its maternity offerings. Women are coming in from two hours away to give birth, and the hospital is quickly running out of birthing space, he says.

Doctors aboard international flight perform CPR for hours, save woman’s life​

From KCRA:

WFTS reports Debbie Taylor, of Tampa, was on a Delta Airlines flight 40,000 feet above the Pacific Ocean when something went wrong.

“I remember telling the woman next to me…’I don’t feel well. I need to get home,'” she recalled.

Taylor became unresponsive and three doctors, who just happened to be on board, jumped into action to try and save her life.

“They gave me CPR for about five hours,” Taylor said.

Eventually, pilots were able to put the plane down in Alaska for an emergency landing. Taylor was rushed to the hospital.

Doctors placed her on life support and her daughter Cheryl Cowans rushed to her mother’s side.

“I was worried she was gonna be brain dead,” Cowans said.

But Taylor improved and came out of her coma, against the odds.