Out Of The ED, Into Urgent Care

From News Channel 3 (Memphis):

Efforts are underway to shift 20,000 Shelby Countians kicked off of TennCare to 11 “quick-care” clinics county-wide, said Shelby County Mayor AC Wharton in a news conference Friday.

Wharton announced the county received a $2.4 million “one-year demonstration project” grant to provide primary medical care and social services to what he called TennCare “disenrollees” and to alleviate overcrowded conditions at The Med, the state’s largest government-funded charity hospital.

“It will clear folks out of the emergency room, and get them into urgent care or primary care away from the emergency room setting,” said Wharton, “thereby freeing up the emergency room for those individuals who have to be there.”

The Quick-Care Medical Clinic at 880 Madison Avenue will expand its hours to 8am-10pm Monday through Friday. Its weekend hours are 10am-6pm. Clinic staff will refer uninsured patients to permanent “medical homes,” either at Federally Qualified Health Clinics (FQHC’s) in the network or at faith-based clinics like the Church Health Center at 1115 Union Avenue.

"Big Game" = Low ED Volume

From ABC News:

Physicians at Children’s Hospital Boston, who collected data from emergency rooms in Boston during the Red Sox’s run to the World Series in October 2004, found that patient volume dipped significantly during the most important postseason contests.

The authors used the Nielsen television ratings to determine the magnitude of a sporting contest: the higher the rating, the more important they considered the game. The findings, published in today’s edition of Annals of Emergency Medicine, indicate that the games with the highest Nielsen television ratings — Game 4 of the World Series and Game 7 of the American League Championship Series, both of which were series-clinching contests for the Red Sox — were associated with lower emergency department volume than games with lower television viewership.

Based on their data, the authors believe that one can predict how busy an emergency room will be based on how “big” the game is. This does not come as a surprise to many emergency medicine physicians, who have found they see far fewer patients in their hospitals at times when there is a major sporting event being played.

“That seems to hold true in many occasions,” said Dr. Guillermo Pierluisi, an emergency medicine physician at the Medical College of Georgia. “Folks with nonemergent conditions — sometimes even those with emergent conditions such as chest pain — tend to wait until the televised event is over to visit the emergency department.”

Telehealth in Montana

From the Missoulian:

Every morning while Katy Jourdonnais reads her newspaper, she is interrupted by a semi-robotic female voice.

It’s time to take your vital signs, the voice reminds Jourdonnais.

The reminder is essential, as Jourdonnais suffers from congestive heart failure, a serious condition that weakens the heart over time. There is no cure, but with proper monitoring and treatment, patients can live long full lives.

The box, more of an electronic nurse, directs Jourdonnais, 89, through the process. It takes her blood pressure, monitors her weight, heart rate and even her oxygen level. Then the information is beamed via a telephone line to a central nursing station.

If there is a sudden change in Jourdonnais’ vitals, a nurse gives her a call or pays her a visit.

The new telehealth monitor has given health care providers a third eye in caring for their patients. Telemedicine – sometimes called distance medicine – is one of the newest forms of communication between clinicians and patients.

Using telecommunications technology, health care providers can prevent uncomfortable delays, travel expenses and family separation by bringing specialized medical care directly to the people who need it – or, as in Jourdonnais’ case, can simply monitor a patient’s day-to-day status.

American Telemedicine Association reports that telemedicine is being practiced in rural areas, school districts, home-health settings, and nursing homes, and on cruise ships and NASA space missions.

By monitoring a patient’s vital signs every day, nurses are able to watch for trends and make any needed treatment or medication changes.

Jourdonnais was the first person in Missoula County to receive a telehealth monitor, and she likes it, even though she said it’s a little bossy.

“You feel like there is somebody watching over your shoulder,” she said. “And I can call them up in a minute if I need to.”

Stroke Centers, tPA

Tipped off by Symtym: A very comprehensive article about the controversy in emergency treatment of CVA’s, from Sign On San Diego (a small excerpt of a much larger article):

Some doctors avoid using t-PA because of its potential downside. The drug can cause bleeding in the brain if not given to the right patients.

The American College of Emergency Physicians says t-PA should be considered, but doesn’t think its members should be required to make judgments on stroke care without backup from neurologists and neuroradiologists.

Much of the resistance is the concern that hospitals would lose patients if they don’t become stroke centers.

“Having brain-attack centers is a big economic issue and a big expense,” said Dr. Richard Stennes, who has worked at Paradise Valley Hospital in National City and was former president of the national and state chapters of the American College of Emergency Physicians.

“If paramedics determine this person is a potential stroke patient and take (him or her) to a designated place . . . a whole lot of people will be taken to hospitals where they don’t need to go,” said Stennes of San Diego. “There’s an economic issue here.”

He and others estimate that for every patient who did have a stroke, paramedics would divert as many as 10 patients who didn’t have a stroke or had one that occurred too long ago for treatment. Migraines, seizures, metabolic problems, drug reactions and hypoglycemia all could resemble symptoms of stroke.

Both of New Orleans’ public hospitals to be condemned

From the Monterey Herald:

New Orleans’ two public hospitals will have to be condemned, according to Don Smithburg, who runs the state’s public hospital system.

That decision will prevent the reopening of the city’s only trauma units capable of handling the most serious car accidents, gunshot wounds or construction mishaps that any city is bound to have.

Charity and University hospitals were also the backbone of the state’s public hospital system and of the medical schools in New Orleans.

“We’re still taking on water at both hospitals,” Smithburg said Thursday. “We don’t know if the water table is rising or what, but water is still seeping – no, not seeping, pouring – into the basements.”

Farm Safety

From the Coon Rapids (MN)Herald:

Keeping kids safe on the farm

Accidents happen. They can happen anywhere—in the home, on the road, on the job, in the schools and—on the farm.

Farming is one of the most dangerous occupations in the country. According to the National Safety Council, in 2002, agriculture came in second in the number of work-related deaths—second only to the mining/quarrying industry. As reported that year, agriculture in the United States had 21 fatalities per 100,000 workers, or approximately 730 deaths.

Some suggestions to keep everyone safe on the farm include:

• Children, especially visiting children, should not be allowed to roam freely around the farm. Instead, designate a safe play area;

• Equip all barns, shops, storage areas, livestock pens, etc. with latches that can be locked or secured so that children cannot enter;

• Always turn equipment off, lower hydraulic and remove the key before leaving equipment unattended;

• Inspect all equipment and correct any hazards before operating;

• Make certain a 20 lb. fire extinguisher is handy;

• When around farm animals, be calm, move slowly, avoid making sudden jerks or movements and always approach them from the front so they can see what is going on; and

• Never permit young children to work with poisons, chemicals or fertilizers.

Emergency Medicine Simulation Lab – On Wheels

They have an EMSLRC in Florida (just like we do in Iowa). It seems that they have a nicer “bus”:

On May 12, 2005, the Emergency Medicine Learning & Resource Center launched the State of Florida’s only emergency medicine simulation lab on wheels featuring SimMan® and SimBaby®. The lab, which features realistic emergency room and ambulance settings is built within a 45-foot coach and will take a realistic emergency medicine feel to physicians, nurses, and paramedics/EMT’s in rural parts of Florida.

This “Mobile Simulation Lab” will be targeted to the rural emergency medicine providers in the State of Florida. There are 33 counties in Florida deemed “rural” with more than one million residents of those counties. This educational tool is an essential part of getting those in the profession hands-on training in the ever evolving field of emergency medicine.

EMS Medical Director of the Year

From the Mount Pleasant (Iowa) News:

Dr. Linwood Miller of Mt. Pleasant was recently named as the recipient of the Richard Ferneau EMS Medical Director of the Year Award.

This honor is awarded through the National Association of Emergency Medical Technicians, and recognizes Dr. Miller for his leadership skills, dedication to improving the quality of emergency medical care, and innovation in system development and clinical care.

Dr. Miller began as the volunteer medical director of Henry County Health Center Emergency Medical Services over 20 years ago.

Under his medical direction, HCHC EMS has grown from a small local Basic Life Support, EMT level service, to a regional Advanced Life Support, Paramedic level system, with progressive offline medical direction that now includes critical care.

“Even while working fulltime as a family practice physician with Family Medicine of Mt. Pleasant, P.C., and as a member of HCHC’s medical staff, Dr. Miller always finds the time to be a mentor, colleague, and educator,” said HCHC EMS manager Jerry Johnston. “As a medical director, he is an EMS administrator’s dream.

“He has allowed me the latitude to grow the system clinically and is continually supportive of thinking ‘outside the box’ for the betterment of patient care.”
After finishing medical school and his residency, Dr. Miller began practicing medicine in Mt. Pleasant in 1981 with Dr. James Widmer. In 1990 they and four other physicians formed Family Medicine of Mt. Pleasant, P.C. which has grown to include several more physicians.

ACEP Action Alert

This is slick. The American College of Emergency Physicians has an web-based “Action Alert” application that allows one to compose a mail or e-mail letter of concern directed to legislators. “Talking points” are supplied and one can enter them into the text of the message with one click. A tabbed entry provides information about the membership of the US Congress and the Senate. Very impressive!

Some data:
Will Lifesaving Emergency Care Be There When You Need It?

More than 2,000 emergency departments have closed their doors since 1992. During that same period, Americans dramatically increased their dependance on the emergency care system and in 2003 made more than 114 million visits to hospital emergency departments, resulting in dramatic increases in patient volumes and waiting times.

Overcrowding causes prolonged pain and suffering for patients, long emergency department waits, and increased transport times for ambulance patients, according to a report from the U.S. General Accounting Office.

The health care system is in crisis due to a lack of hospital inpatient beds; a shortage of on-call medical specialists; an increasing elderly population; and nationwide shortages of nurses, physicians, and support staff.

Emergency physicians provide care to all who need it, regardless of their ability to pay, but the cost of treating the uninsured is passed on to all Americans through higher hospital bills, insurance premiums and taxes.

Skyrocketing jury awards and frivolous lawsuits are causing physicians to retire early or stop performing high-risk procedures, leading to a lack of medical specialists willing to provide lifesaving emergency medical care.

Bottlenecks and Traffic Flow

Excellent article from the Connecticut Post Online, excerpted below:

“Hospital emergency departments are the ultimate safety net for the public”

Against the backdrop of years of double-digit increases in medical insurance premiums, the managed care industry pitched itself as a savior of the nation’s ailing health-care system. “Managed car comparison, over an even shorter timespan, Connecticut’s hospital emergency rooms treated 1.4 million patients last year — 27.2 percent more than they did in 1996 when they saw 1.1 million.

Meanwhile, hospitals increasingly face bottlenecks transferring patients from emergency departments to hospital rooms. Sometimes there just aren’t enough nurses to oversee the beds.

To observers, untrained in the ways hospitals funnel patients through their system, none of this makes any sense. It’s hard for them to square seemingly crowded emergency rooms, with vacant beds elsewhere in the hospital.

Initially, hospitals triage patients in their waiting room to ensure that the most critical see doctors first. Once inside the ER, doctors examine the patient and order diagnostic tests if warranted. Then they work to stabilize the patient, either for discharge or transfer to a hospital bed. In some cases, patients end up waiting on gurneys in an ER’s hallway hooked up to monitors. This happens for a couple of reasons: their condition may require very close monitoring; the nurse-to-patient ratio may be too low to adequately supervise all of them on a regular floor; or there just isn’t an empty bed available.

It’s all about traffic flow. And while hospitals everywhere lament the balancing act they must conduct, trying to forecast how much nursing staff they will need to treat the patients they expect to be admitted, the exercise has a steep downside.

According to the American Hospital Association, when hospitals allow logjams in their ERs that delay transferring patients to critical care units and force sick or injured people to wait longer for treatment, that inefficiency costs each hospital on average $1.74 million annually in lost revenue.


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