Community-based palliative care — care delivered at home, not the hospital — was associated with a 50 percent reduction in emergency department visits for patients in their last year of life. The results of an Australian study were published online February 3rd in Annals of Emergency Medicine (“The Association of Community-Based Palliative Care with Reduced Emergency Department Visits in the Last Year of Life Varies by Patient Factors”).
Researchers studied nearly 12,000 records for patients who died of cancer, heart failure, kidney failure, chronic obstructive pulmonary disease and/or liver failures in Western Australia from 2009 to 2010. Dying patients visited the emergency department on average twice a year during their last year of life. The average number of emergency department visits was reduced when patients received palliative care.
From the Journal of Emergency Medicine (via PubMed):
Influenza viruses are a significant cause of morbidity and mortality in the United States. Given the wide range of symptoms, emergency physicians must maintain a broad differential diagnosis in the evaluation and treatment of patients presenting with influenza-like illnesses.
This review addresses objective and subjective symptoms commonly associated with influenza and discusses important mimics of influenza viruses, while offering a practical approach to their clinical evaluation and treatment.
Influenza-like symptoms are common in the emergency department (ED), and influenza accounts for > 200,000 hospitalizations annually. The three predominant types are A, B, and C, and these viruses are commonly transmitted through aerosolized viral particles with a wide range of symptoms. The most reliable means of identifying influenza in the ED is rapid antigen detection, although consideration of local prevalence is required. High-risk populations include children younger than 4 years, adults older than 50 years, adults with immunosuppression or chronic comorbidities, pregnancy, obesity, residents of long-term care facilities, and several others. The Centers for Disease Control and Prevention recommends treatment with neuraminidase inhibitors in these populations. However, up to 70% of patients with these symptoms may have a mimic. These mimics include infectious and noninfectious sources. The emergency physician must be aware of life-threatening mimics and assess for these conditions while beginning resuscitation and treatment.
The wide range of symptoms associated with influenza overlap with several life-threatening conditions. Emergency physicians must be able to rapidly identify patients at risk for complications and those who require immediate resuscitation.
Published by Elsevier Inc.
From Health Affairs:
Hospital closures create an economic and health care access void, which is magnified in rural communities that typically have few other employment and health care service options. Job losses directly impact medical and ancillary staff, and the community tax base is diminished when a large employer like a hospital closes, forcing people to move away from communities where they want to live or to retire. When hospitals close, so do their Emergency Departments (EDs) and the life-saving care they provide. When an ED closes, patients are forced to seek care elsewhere, introducing long travel times to other EDs, which can increase mortality for time-sensitive diseases such as trauma, stroke, sepsis, and acute myocardial infarction. This has become a crisis for a large portion of rural communities: 77 percent of 2,050 rural counties are designated Health Professional Shortage Areas (HPSAs) by the U.S. Department of Health and Human Services.
Freestanding Emergency Centers (FECs) present a practical solution to this crisis. While rural communities may have insufficient demands for inpatient care to support a full hospital, FECs have a lower cost structure and higher patient volume.
As rural hospitals shoulder increasing regulatory burdens, the demands of consumerism and the consequences of aging populations — among other responsibilities — they are perhaps under more pressure than ever to provide essential health services to their communities while fighting to survive. But a panel on the second day of the 30th annual Rural Health Care Leadership Conference delved into creative ways rural hospitals have been able to do just that.
From the Times-Tribune:
Federal authorities are stepping up investigations at Department of Veterans Affairs medical centers due to a sharp increase in opioid theft, missing prescriptions or unauthorized drug use by VA employees since 2009, according to government data obtained by The Associated Press.
Doctors, nurses or pharmacy staff at federal hospitals — the vast majority within the VA system — siphoned away controlled substances for their own use or street sales, or drugs intended for patients simply disappeared. Last week, a nurse at the Veterans Affairs Medical Center in Plains Twp. was sentenced for stealing drugs for her personal use.