Naloxone Curbs Opioid-Related Emergency Department Visits

From Pain Medicine News:

Naloxone coprescription reduces emergency department (ED) visits caused by unintentional opioid overdoses, according to a new study published in Annals of Internal Medicine.

In a two-year, nonrandomized intervention study, Phillip Coffin, MD, director of substance use research at the San Francisco Department of Public Health, investigated the effect of naloxone coprescription among 1,985 adult primary care patients who were receiving opioid therapy for chronic pain (Ann Intern Med2016 June 28 [published online]). The researchers examined potential relationships between opioid dose, the proportion of patients who received a prescription for naloxone and opioid-related ED visits, based on a chart review.

Proposed Iowa Coaching CPR Certification Rules

From the Iowa Medical Society:

Recently, the Board of Educational Examiners (BOEE) voted to move forward with implementing an IMS 2016 policy priority to require that all school coaches in Iowa obtain certification in cardiopulmonary resuscitation (CPR). The draft rules, on track to take effect later this year, require individuals to hold a current CPR training certificate as a condition of obtaining a coaching endorsement or authorization. This week, IMS submitted written comments in support of this common-sense measure to protect Iowa’s student athletes.

This proposed policy was first put forward by an IMS member physician from Northwest Iowa. Last fall, the IMS Committee on Legislation endorsed the idea and recommended that it be among the proactive measures IMS pursue during the 2016 Legislative Session. Through the course of legislative discussions around the bill to require this training, the BOEE indicated that it felt it has sufficient statutory authority to impose such a requirement absent legislation. Following session, IMS met with BOEE staff to begin the process of drafting these administrative rules. These new rules mark another public health success in pursuit of the IMS core purpose: To assure the highest quality health care in Iowa through our role as physician and patient advocate.

Hospital hires robot to patrol emergency room parking lot

From UPI:

A California hospital unveiled the newest member of its security staff — a robot charged with patrolling the emergency room parking lot.

Bakersfield Memorial Hospital officials said the egg-shaped robot, which stands at about the height of a human child, is equipped with cameras and sensors to allow it to navigate its way around the parking lot without being controlled by a human.14440847_10210555944952527_3386228797054863408_n

ACEP Statement on Violence and Bias Involving Police

Press Release:

In response to a series of events involving acts of violence by and against police, the president of the American College of Emergency Physicians Jay Kaplan, MD, FACEP released a statement:

“Emergency physicians every day care for all patients who enter the doors of our emergency departments regardless of their race, religion, or beliefs.  The American College of Emergency Physicians, representing more than 37,000 of those physicians, has been deeply distressed by the ever more apparent sense of divisiveness and bias being demonstrated in our society.  The recent shooting deaths of African American men by police in Tulsa, Okla. and Charlotte, N.C., just months after similar violence in Baton Rouge, La. and St. Paul, Minn. are appalling evidence of the prejudice which has been directed toward those who are black.

In addition, the lawless shooting and killing of police officers in Dallas, Texas and Baton Rouge, La. and others who wear blue in the line of duty is unconscionable.  As the physicians who most often care first for all victims of violent injury, we call for an end to all forms of gun violence.  Our prayers go out to the families of all those who have been slain or injured.

ACEP joins with other professional physician organizations in supporting the institution of measures that will prevent the continued loss of life and the eradication of racial prejudice in the enforcement of law.  It is irrational that people of color or different religious beliefs cannot walk their own streets without fearing of violence against them and the sudden loss of life.  We must confront the role of racism and bigotry in our culture, and we must not allow those who promote continued escalation of hate, anger and violence to divide us.”

ACEP is the national medical specialty 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.

UPMC launches telemedicine startup for nursing home patients

From Modern Healthcare:

Pittsburgh-based UPMC health system this week announced the launch of a telemedicine software company that will help patients reach doctors during off hours. The move is aimed at reducing avoidable hospital admissions among nursing home patients.

The wholly owned UPMC subsidiary, Curavi Health Inc., will provide nursing homes with telemedicine software and equipment so nurses and patients can consult University of Pittsburgh Physicians’ geriatricians on evenings and weekends, according to a UPMC statement released Thursday.

Factors influencing time to computed tomography in emergency department patients with suspected subarachnoid haemorrhage

From the Emergency Medicine Journal:

Background CT has excellent sensitivity for subarachnoid haemorrhage (SAH) when performed within 6 hours of headache onset, but it is unknown to what extent patients with more severe disease are likely to undergo earlier CT, potentially inflating estimates of sensitivity. Our objective was to evaluate which patient and hospital factors were associated with earlier neuroimaging in alert, neurologically intact ED patients with suspected SAH.

Methods We analysed data from two large sequential prospective cohorts of ED patients with acute headache undergoing CT for suspected SAH. We examined the time interval from headache onset to CT, both overall and subdivided from headache onset to hospital registration and from registration to CT.

Results Among 2412 patients with headache, 194 had SAH, with 178 identified on unenhanced CT. Of these, 91 (51.1%) were identified by CT within 6 hours of headache onset and 87 after 6 hours. Patients with SAH had a shorter time from headache onset to hospital presentation (median 4.5 hours, IQR 1.7–22.7 vs 9.6 hours, IQR 2.8–46.0, p<0.001) and were imaged sooner after headache onset (6.4 hours, IQR 3.5–27.1 vs 12.6 hours, IQR 5.5–48.0, p<0.001) compared with those without SAH. The median time from in-hospital registration to CT scan was significantly shorter in those patients with SAH although this difference was less than 1 hour (1.9 hours, IQR 1.2–2.8 vs 2.5 hours, IQR 1.5–3.9, p<0.001). Arrival by ambulance (OR 3.1, 95% CI 1.94 to 4.98, p<0.001) and higher acuity at triage (OR 1.39, 95% CI 1.02 to 1.88, p=0.032) were among the factors associated with having CT imaging within 6 hours of headache onset.

Conclusions Time from headache onset to imaging is moderately associated with positive imaging for SAH. Delay to hospital presentation accounts for the largest fraction of time to imaging, especially those without SAH. These findings suggest limited opportunity to reduce lumbar puncture rates simply by accelerating in-hospital processes when imaging delays are under 2 hours, as diagnostic yield of imaging decreases beyond the 6-hour imaging window from headache onset.

“Emergency rooms slow to treat, transfer psychiatric patients”

From Reuters (I don’t like the headline, thus the use of quotes):

Emergency room patients needing mental health care were transferred to other facilities six times more often than patients needing other services, and they waited longer to be treated or moved, a new study found.

“This study provides data showing that ERs are the de facto dumping ground for psychiatric patients,” senior author Dr. Renee Hsia told Reuters Health.

“Our goal in reporting this is to provide data to the public and policymakers so that they look at it squarely in the face and decide if it’s acceptable or if it’s something that needs to be changed,” said Hsia, who is a professor of emergency medicine at the University of California, San Francisco.