Mass. hospital improves ER flow by prioritizing morning discharges

From Fierce Healthcare:

Lahey Hospital and Medical Center in Burlington developed a multidisciplinary task force to address ED compression through an early morning discharge initiative, which had a goal of discharging 20 patients by 10 a.m. across the facility, according to Hospitals & Health Networks. Despite its clear-cut goal, there were numerous barriers, including an existing culture of late-afternoon discharges within the hospital; the communications gap among the various staff involved in the discharge process; and lack of incentive among staff to prioritize discharge among providers with numerous other items on their itineraries.

To address these issues and successfully implement the program, Lahey’s task force developed several strategies, including:

  • Regular updates about progress and best practices for frontline staff
  • Promoting multidisciplinary rounds to strengthen communication throughout the continuum of care
  • Incentivizing discharge by providing gift cards for nurses who led the unit in discharges by 10 a.m.
  • Enlisting the help of family members who patients rely on for transportation by offering free parking and breakfast vouchers
  • Share results with floor units and department heads to promote data transparency and accountability
  • Deploying “social marketing,” making sure to communicate that the initiative aims for improved patient safety and satisfaction rather than merely freeing up beds

 

Research from Columbia Business School Reveals How to Shorten Emergency Room Wait Time

Press Release:

According to the U.S. Department of Health and Human Services, demand for emergency health care services is rapidly increasing, causing over-crowding and long wait-times in emergency rooms nationwide.  New research from Columbia Business School shows that predictive analytics – that is, using data about ER demand to predict future demand – could help hospitals reduce wait times and improve care by diverting patients away from emergency rooms before they become overcrowded.

Hospital diversions are intended to help patients get care faster by directing them away from overcrowded ERs and toward facilities that can care for them more appropriately and quickly. In current practice, diversion decisions are typically made based solely on information about current congestion — i.e. if a maximum threshold is reached, then new patients will be diverted.  However, the researchers suggest that by using predictions of when patient congestion is likely to build, hospitals could substantially reduce the wait times of patients seeking medical care from an ER.

“Patients on their way to the emergency room want to know that their emergency is going to be handled as expeditiously as possible,” said Professor Carri Chan, co-author of the study and Sidney Taurel Associate Professor of Business at Columbia Business School. “By using predictive modeling to develop more effective diversion policies, hospitals can reduce wait times for patients by up to 15 percent, improving care and customer satisfaction while at the same time saving time and money.”

The study, titled Using Future Information to Reduce Waiting Times in the Emergency Department via Diversion, co-authored by Chan and Kuang Xu of Stanford University, proposes a new algorithm to predict future emergency arrivals.  This algorithm can be then be applied to make decisions about diverting incoming patients.

Chan concluded: “Using predictive analytics is a step towards eliminating the over-crowding and long wait times that plague may of today’s emergency rooms, ensuring patients receive the care they need when they need it.”

To learn more about the cutting-edge research being conducted at Columbia Business School, please visitwww.gsb.columbia.edu.

About Columbia Business School
Columbia Business School is the only world–class, Ivy League business school that delivers a learning experience where academic excellence meets with real–time exposure to the pulse of global business. Led by Dean Glenn Hubbard, the School’s transformative curriculum bridges academic theory with unparalleled exposure to real–world business practice, equipping students with an entrepreneurial mindset that allows them to recognize, capture, and create opportunity in any business environment. The thought leadership of the School’s faculty and staff, combined with the accomplishments of its distinguished alumni and position in the center of global business, means that the School’s efforts have an immediate, measurable impact on the forces shaping business every day. To learn more about Columbia Business School’s position at the very center of business, please visit www.gsb.columbia.edu.

How to derive real value from “smarter” connected health products

From ReadWrite:

When a sick person – particularly a sick child – is in a moment of need, the first thing that person or those concerned parents look for isn’t simply an answer to “how high is my temperature?” What they really want are answers around what that number means and what they should do next — What is it? Should I call a doctor? How can I/he/she get better?

With smart devices that can respond to the onset of illness in real-time, we finally have the ability to deliver those answers to that person in their time of need, helping them detect illness sooner, get care faster and prevent their illness from spreading.

New reversal agent for anticoagulants

From Reuters:

An experimental drug designed to quickly counteract blood-thinning medicines has demonstrated effectiveness, according to preliminary results of a new trial done under real-world conditions.

The drug is Portola Pharmaceuticals’ AndexXa, known generically as andexanet alfa. Earlier this month, the U.S. Food and Drug Administration decided not to approve this so-called reversal agent without more data. The new test, reported on Tuesday at a European Society of Cardiology Congress in Rome and released by the New England Journal of Medicine, offers more evidence. Portola financed the study.

The drug reversed episodes of major bleeding that couldn’t be stopped because the patients were on drugs such as apixaban and rivaroxaban, which inhibit the body’s natural blood clotting chemical known as factor Xa.

Illinois emergency room visits increased after Obamacare

From the Tribune:

Hospital emergency department visits increased in Illinois after the Affordable Care Act took effect — the opposite of what many hoped would happen under the landmark health care law, according to a new study.

“Emergency departments are already overcrowded, and bringing more patients in will continue to make that worse,” said Dr. Scott Dresden, an assistant professor of emergency medicine at Northwestern University Feinberg School of Medicine, and the lead author of the study.

Emergency visits in Illinois increased 5.7 percent, or by more than 14,000 visits a month on average, in 2014 and 2015 compared with 2011 through 2013, according to the study, published online in Annals of Emergency Medicine, a peer-reviewed journal.

Iowa Board of Medicine adds CDC guideline on opioid prescribing to list of resources for chronic pain treatment

Press Release (Hat tip: Dr. Menadue):

The Iowa Board of Medicine is encouraging physicians to consider a new federal guideline aimed to reduce the risk of addiction when treating chronic pain patients with controlled substances.

The Board recently adopted a new administrative rule to update a list of recommended resources for physicians who treat chronic pain. The list now includes the new Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain.

CDC developed and published the guideline in March to provide recommendations for the prescribing of opioid pain medication for patients 18 and older in primary care settings. Recommendations focus on the use of opioids in treating chronic pain (pain lasting longer than 3 months or past the time of normal tissue healing) outside of active cancer treatment, palliative care, and end-of-life care.

The CDC said that improving the way opioids are prescribed through clinical practice guidelines can ensure patients have access to safer, more effective chronic pain treatment while reducing the number of people who misuse, abuse, or overdose from these drugs.

Clinical practices addressed in the CDC guideline include:

  • Determining when to initiate or continue opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care
  • Opioid selection, dosage, duration, follow-up, and discontinuation
  • Assessing risk and addressing harms of opioid use

The CDC has produced three brochures (attached) to highlight the message in the non-binding standards:

  • Pocketguide summary of the CDC guideline
  • A checklist for providers who prescribes opioids for chronic pain
  • Non-opioid treatments for chronic pain

In the latter brochure, the CDC emphasizes that opioids are not the first-line therapy for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. Evidence suggests that nonopioid treatments, including nonopioid medications and nonpharmacological therapies, can provide relief to those suffering from chronic pain, and are safer.

The federal guideline complements the Iowa Board’s administrative rule on appropriate pain management. This rule, 653 IAC 13.2, reinforces that physicians should not fear board action for treating pain with controlled substances as long as the physicians’ prescribing is consistent with appropriate pain management practices.

The Board’s rule encourages physicians to closely monitor patients who are prescribed opioids, including reviewing their controlled substance prescription history, considering the use of pain management agreements, and considering utilizing drug testing to ensure that the patient is receiving appropriate therapeutic levels of prescribed medications.

The Board strongly recommends that physicians consult the following resources regarding the proper treatment of chronic pain:

  • American Academy of Hospice and Palliative Medicine
  • American Academy of Pain Medicine
  • American Pain Society
  • DEA Policy Statement: Dispensing Controlled Substances for the Treatment of Pain.
  • Interagency Guideline on Prescribing Opioids for Pain (Developed by the Washington State Agency Medical Directors’ Group)
  • Responsible Opioid Prescribing: A Physician’s Guide. (By Scott Fishman, M.D.)
  • World Health Organization: Pain Relief Ladder. Cancer pain relief and palliative care. Technical report series 804
  • CDC Guideline for Prescribing Opioids for Chronic Pain

For the past five years, the Board has required primary care physicians to complete training on chronic pain management as a part o

ERs after Obamacare: More patients, fewer on-call specialists

Press Release:

The average monthly emergency department visit increased by 5.7 percent in Illinois after the implementation of the Affordable Care Act (ACA), although the population remained essentially flat. In Massachusetts, while visits to emergency departments climbed steadily between 2005 and 2014, availability of on-call specialists (surgeons, psychiatrists and other specialists) declined “significantly.” The results of two state-specific studies were published online last Thursday inAnnals of Emergency Medicine (“Increased Emergency Department Use in Illinois After Implementation of the Affordable Care Act” and “Decline in Consultant Availability in Massachusetts Emergency Departments: 2005 to 2014”).

“Emergency departments continue to be squeezed by pressures inside and outside the hospital,” said Scott Dresden, MD, MS, of Northwestern University Feinberg School of Medicine in Chicago, Ill., the lead author of the Illinois paper. “A large post-ACA increase in Medicaid visits and a modest increase in privately insured visits outpaced a large reduction in emergency department visits by uninsured patients. We still don’t know if these results represent longer-term changes in health services use or a temporary spike in emergency department use due to pent up demand.”

Annual emergency department visit volume in Illinois increased from 2.9 million in 2011 to 3.2 million in 2015, an 8.1 percent increase over the period. Comparing the pre-ACA period (2011 to 2013) to the post-ACA period (2014 to 2015), the average monthly emergency department visit volume increased by 5.7 percent. Hospitalizations were essentially unchanged, as was the size of Illinois’ population.

In Massachusetts, from 2005 to 2015 emergency departments reported that visits increased on average from 32,025 to 42,000. During the same period, there was a significant drop in availability of specialists in surgery, neurology, obstetrics-gynecology, orthopedics, pediatrics, plastic surgery and psychiatry. Availability of general surgeons declined from 98 percent to 83 percent while 24/7 psychiatry availability declined from 56 percent to 33 percent. Availability of orthopedic surgeons, pediatricians and plastic surgeons also declined significantly.

“During the studied period, the burden of increasing patient volume was clear,” said Jason Sanders, MD, PhD, of the Department of Emergency Medicine at Massachusetts General Hospital in Boston. “The proportion of emergency departments reporting any patients primarily cared for in the hallway climbed from 70 percent to 89 percent. That is obviously far from ideal and is indicative of an increasingly taxed emergency medical care system.”

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Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, the national medical society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information, visit http://www.acep.org.

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