Enhancing Rates Of Opioid Overdose Education And Naloxone Distribution In Emergency Departments

From Health Affairs:

Emergency departments (EDs) offer critical opportunities for addressing the opioid crisis because they are on the front lines of health and are an underutilized point of contact with people at risk of opioid overdose. Key interventions include reducing inappropriate ED opioid prescribing and thereby reducing excess availability of opioids by patients and in the community; working to ensure that EDs have access to real-time information about the already existing opioid prescriptions of their patients; initiating treatment in the ED for persons with opioid use disorder (OUD), including starting medications for OUD in the ED setting; and opioid overdose education and naloxone distribution (OEND). Naloxone is a medication called an “opioid antagonist” used to counter the effects of opioid overdose.

There is a trend toward decreased opioid prescribing in EDs, at least 49 states have operational prescription drug monitoring programs (PDMPs); in the area of OUD treatment, large federally funded ED-initiated buprenorphine implementation and research projects are underway. There has also been a substantial increase in naloxone dispensing; however, the rate of naloxone prescriptions dispensed per high-dose opioid prescription remains low. For example, in 2018, only 2.81 naloxone prescriptions were dispensed for every 100 high-dose opioid prescriptions in emergency medicine settings nationally.

Continuing improvement is needed in all these areas. We focus on the substantial missed opportunities that remain to provide naloxone to ED patients at risk for overdose.

eHealth: improving tele-emergency care

From Medica:

Emergency medicine physicians at the Medical College of Georgia at Augusta University are helping rural hospitals better treat patients by establishing tele-emergency departments.

With a nearly $369,000 telemedicine grant from the United States Department of Agriculture, physicians at the state’s only public medical school have equipped five rural Georgia emergency rooms with a mobile cart that allows them to remotely consult with emergency physicians in Augusta at MCG and AU Health.

Physician recruitment has a ‘Cheesecake Factory’ problem: What that means, and how 3 CEOs are solving it

From Becker’s:

As a rural healthcare provider, Guthrie has seen lifestyle factors become a larger part of a physician’s decision to join the system or not, especially over the past three or four years, according to Dr. Scopelliti. These factors go well beyond the job description and scope of the hiring organization. They include characteristics of place: an area’s education system, the quality and availability of housing, recreational activities, social events, restaurants and shopping.

Mr. Patterson said he has observed a similar trend, referring to it as the “Cheesecake Factory” issue — that the ability for a healthcare provider to recruit top talent often hinges on local attractions, like whether there’s a Cheesecake Factory, Costco or Trader Joe’s nearby. National data support this: Early-career physicians rank work-life balance, location and culture among the top reasons they stick with a job.

Simulation-based mastery learning compared to standard education for discussing diagnostic uncertainty with patients in the emergency department: a randomized controlled trial

From BMC Medical Education:

Background

Diagnostic uncertainty occurs frequently in emergency medical care, with more than one-third of patients leaving the emergency department (ED) without a clear diagnosis. Despite this frequency, ED providers are not adequately trained on how to discuss diagnostic uncertainty with these patients, who often leave the ED confused and concerned. To address this training need, we developed the Uncertainty Communication Education Module (UCEM) to teach physicians how to discuss diagnostic uncertainty. The purpose of the study is to evaluate the effectiveness of the UCEM in improving physician communications.

Methods

The trial is a multicenter, two-arm randomized controlled trial designed to teach communication skills using simulation-based mastery learning (SBML). Resident emergency physicians from two training programs will be randomly assigned to immediate or delayed receipt of the two-part UCEM intervention after completing a baseline standardized patient encounter. The two UCEM components are: 1) a web-based interactive module, and 2) a smart-phone-based game. Both formats teach and reinforce communication skills for patient cases involving diagnostic uncertainty. Following baseline testing, participants in the immediate intervention arm will complete a remote deliberate practice session via a video platform and subsequently return for a second study visit to assess if they have achieved mastery. Participants in the delayed intervention arm will receive access to UCEM and remote deliberate practice after the second study visit. The primary outcome of interest is the proportion of residents in the immediate intervention arm who achieve mastery at the second study visit.

Discussion

Patients’ understanding of the care they received has implications for care quality, safety, and patient satisfaction, especially when they are discharged without a definitive diagnosis. Developing a patient-centered diagnostic uncertainty communication strategy will improve safety of acute care discharges. Although use of SBML is a resource intensive educational approach, this trial has been deliberately designed to have a low-resource, scalable intervention that would allow for widespread dissemination and uptake.

Rural Americans at risk of HIV outbreaks amid opioid crisis

From Becker’s:

Many communities in rural America are at risk of HIV outbreaks linked to intravenous drug use, yet few are taking proactive measures, according to a report from NPR in partnership with Kaiser Health News.

The CDC has identified 220 counties nationwide that are vulnerable to HIV outbreaks based on overdose rates and the volume of prescription opioids sold in the area, among other factors.

2019 was worst year for US rural hospital closures in a decade

From The Guardian (hat tip: Mike):

Hospital closures in rural areas of the US hit their highest point in the past decade last year, with 19 rural hospitals shutting down, according to a new report.

The number of rural hospital closures slowed somewhat during 2016 and 2017 but there has since been an uptick, with 34 facilities shuttering in the past 24 months, the analysis by the Chartis Center for Rural Health found.

IU Health to train caregivers on CPR quarterly

From Becker’s:

Indianapolis-based IU Health is rolling out a new CPR training program for its 20,000 front-line providers, the system announced Feb. 17.

Rather than sending caregivers to CPR classes every two years, the system will train employees in-house once a quarter.

The training program, called Resuscitation Quality Improvement 2020, uses online simulations and real-world practice on computerized mannequins to assess employees’ competence.