Ethical Pain Management in the ED

From Physicians Weekly:

According to published reports, up to 75% of ED patients present with pain-related complaints, and more than half come to the ED with severe or moderate pain. Pain management is a fundamental component of emergency medicine, but there are barriers to providing effective pain control in the ED. “There is growing tension between the ethical and professional obligations of emergency physicians (EPs) to treat pain and their reluctance to contribute to the growing problems of opioid abuse and diversion,” explains Arvind Venkat, MD.

A more in-depth understanding of how to resolve issues surrounding ethical pain management in the ED may help EPs in their efforts to treat pain. In an article published in Academic Emergency Medicine, Dr. Venkat and colleagues proposed an ethical framework to address the clinical dilemmas surrounding the management of pain in ED patients. “Given the frequency of ED patients presenting with pain and the barriers to effective pain relief, it’s important to recognize the ethical issues that can affect the treatment of pain in this setting,” says Dr. Venkat.

Heart-Attack Patients More Likely To Die After Ambulances Are Diverted

From NewsOK:

Heart-attack patients whose ambulances were diverted from crowded emergency rooms to hospitals farther away were more likely to be dead a year later than patients who weren’t diverted, according to a recent study published in the journal Health Affairs.

The study, conducted by researchers at the University of California-San Francisco and the National Bureau of Economic Research, looked at ambulance diversions affecting nearly 30,000 Medicare patients in 26 California counties from 2001 to 2011.

The study adds to a growing body of research nationally showing that temporary diversions of ambulances from the nearest hospital can harm patients with life-threatening conditions, including heart attacks and stroke. One smaller study in New York City also linked diversions with higher heart-attack death rates, while others have found that diversions can lead to delays in administering drug therapy to heart-attack patients.

Illinois to become first state to put locks on prescription painkiller bottles to stop abuse

From The Republic:

Illinois will be the first state in the country to test out a pilot program that will put locking devices on some prescription painkillers to make it harder for people to abuse the drugs.

The numerical locking devices will be similar to those used on gym lockers. Under the one-year program, participating pharmacies will place the locks on bottles of painkillers that contain hydrocodone, which is also known as Vicodin or Norco.

Refractory cardiac arrest patients brought to hospital with ongoing CPR can recover

Press Release:

London, UK – 29 Aug 2015: Refractory cardiac arrest patients brought to hospital with ongoing cardiopulmonary resuscitation (CPR) can survive with good brain function, according to research in nearly 4 000 patients presented at ESC Congress today by Dr Helle Søholm, a cardiologist at Copenhagen University Hospital Righospitalet in Denmark.1

“The faster a patient with cardiac arrest is resuscitated and brought back to life the better,” said Dr Søholm. “The prognosis for patients with refractory cardiac arrest with long resuscitation attempts has previously been shown to be poor. The use of extracorporeal life systems, which have an artificial pump to help the blood circulate the body, are currently being investigated to improve survival in these patients.”

She added: “However, we found in our study that patients with refractory cardiac arrest treated without the support of extracorporeal life systems do not have such a dismal prognosis as one might think, which encourages longer resuscitation attempts.”

Nearly 60 out of 100 000 people suffer cardiac arrest outside the hospital each year and only one in ten survive. Survival and outcome greatly depend on immediate response with early call for help, bystander resuscitation attempt and fast use of defibrillators. In patients with refractory cardiac arrest, pre-hospital physicians in the emergency medical services may terminate CPR outside the hospital or continue CPR while bringing patients to the hospital.

The current study investigated the survival and, just as importantly, the functional status in patients with refractory cardiac arrest brought to the hospital with ongoing CPR and treated conservatively without the support of extracorporeal life systems. The study included 3 992 patients who had a cardiac arrest outside hospital in a large urban area and were treated by physician-based emergency medical services between 2002 and 2011. Of these, 1 285 (32%) were successfully resuscitated outside hospital and 108 (3%) were brought to the hospital with refractory cardiac arrest.

Approximately half of the patients brought to the hospital with ongoing CPR were successfully resuscitated and were admitted to a hospital ward. In the other half the resuscitation attempt was terminated in the emergency department after more than one hour of CPR on average. Of the successfully resuscitated patients with refractory cardiac arrest about a third were suffering from cardiac arrest due to acute myocardial infarction.

The rate of survival in patients with refractory cardiac arrest who received ongoing CPR was 20% compared to 42% in those who were resuscitated before arrival at the hospital (p<0.001). Sufficient function for carrying out independent daily activities was found in approximately nine out of ten in both patient groups discharged from hospital with a high functional status (86% in the ongoing CPR group and 84% in those with successful pre-hospital resuscitation, p=0.7).

“Even though the survival rate in patients with refractory cardiac arrest is lower the prognosis is not dismal and importantly the functional status at hospital discharge is similar to patients resuscitated before arrival at the hospital,” said Dr Søholm. “Our results indicate that maybe resuscitation attempts should be extended as the prognosis for patients with refractory cardiac arrest is not as poor as we previously thought. In general we recommend that cardiac arrest patients are given post-resuscitation care in dedicated cardiac arrest centres with highly specialised treatment options and experienced physicians.”

She concluded: “Our study shows that it is worth bringing patients with refractory cardiac arrest to the hospital with ongoing CPR. Patients with refractory cardiac arrest have a higher survival than expected – even without the use of extracorporeal life systems.”

Oklahoma Grant To Draw Health Workers To Rural Areas

From the Times-Record:

Oklahoma does a good job of producing new physicians, but not enough of them want to practice primary care medicine in the state, particularly in rural areas.

Health officials announced Wednesday they will fight that problem with a $3.8 million, six-year grant that will be used along with federal funds to open dozens of medical residency slots.

The hope is that once the new doctors finish residencies in places like Ada and Ardmore, they will put down roots and continue to provide much-needed medical care in these under-served areas.

“This grant will help ensure that Oklahomans in rural areas have better access to the doctors they need,” Gov. Mary Fallin said Wednesday. “This is an excellent example of state agencies and the higher education community working hand-in-hand to support the goal of improving health outcomes across Oklahoma.”

The grant from the Tobacco Settlement Endowment Trust to Oklahoma State University Medical Authority will fund up to 118 osteopathic physician residents in six hospitals across the state.

“Partnering to bring additional doctors to rural areas complements our efforts to create a healthier Oklahoma in all pockets of the state,” said TSET Board of Director Chairman Jim Gebhart. “We know helping people — especially children and families — to develop healthy habits is our first line of defense in changing Oklahoma’s health outcomes. Partnering with Oklahoma State University to recruit more residents to areas where health care is scarce is another facet of helping to achieve this goal.”

– See more at: http://swtimes.com/news/state-news/oklahoma-grant-draw-health-workers-rural-areas#sthash.F8HhgXQY.dpuf

Police: Man shot after taking security officer’s Taser in hospital emergency room

From Fox8 Cleveland.  Let’s all be careful out there:

Garfield Heights police say a man is in critical condition after being shot in the neck by an off-duty Garfield Heights officer at Marymount Hospital.

Investigators say Cleveland police and paramedics late Wednesday night were taking the man to the psychiatric unit at the hospital.

Police say later the man fought with the Garfield Heights officer and two Cleveland Clinic officers, even grabbing for the Garfield Heights officer’s gun.

Police also say they tried to use a Taser on the man, and eventually he grabbed the Taser. Officers on the scene reported the man then used the Taser on the police there and a nurse.

Ultimately, police say the man charged at the Garfield Heights officer holding the Taser, and that officer fired a shot.

Police say the suspect was hit in the back of the neck, and he was taken by helicopter to MetroHealth Medical Center.

Medicare ACOs saved $411M in 2014, but few earned bonuses

From FierceHealthcare:

Medicare accountable care organizations generated $411 million in total savings in 2014, but few of the Pioneer and Medicare Shared Savings Program (MSSP) ACOs qualified for bonuses in the second year of the program, according to the latest data from the Centers for Medicare & Medicaid Services (CMS).

Only 97 of the 20 Pioneer ACOs and 333 MSSP ACOs qualified for shared savings payments of more than $422 million by meeting quality standards and their savings threshold. The results indicate that ACOs with more experience in the program tend to perform better over time, according to a CMS fact sheet.

The financial results came as a disappointment but were not a surprise to the National Association of ACOs (NAACOS). The total dollar savings increased due to the fact that more than 100 additional ACOs joined the program, but the data show that the average savings per ACO actually declined significantly, said Clif Gaus, chief executive officer of NAACOS, in a statement.

“This is probably due to the unfair quality penalty, which is so stringent that unless an ACO scores perfectly on every quality measure, their savings will be reduced,” he said. “We expect ACOs to deliver better care for Medicare beneficiaries, but the quality benchmarks that CMS prescribes are the government example of letting the perfect be the enemy of the good.”

Gaus said the data indicates that 92 of the ACOs in 2014 received $341 million in savings compared to 52 ACOs that received $315 million in 2013. But hundreds of organizations with thousands of doctors, hospitals and other providers have invested more than $1.5 billion of their own money in ACOs to date and have received only $656 million total in return. However, CMS has earned $848 million in savings for a small investment, he said.

“This is not a sustainable business model for the long-term future,” Gaus said. “With Medicare cost growth at record lows, now is the time for the government to invest in and support a national effort for population-based coordinated care and not just take, or be satisfied with, savings from a minority of ACOs at the risk of the majority of ACOs abandoning the program.”

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