Mandatory Reporter / News Investigation

Interesting insight into the way an investigative reporter views a mandaory reporter, from the Denver Channel:

DENVER — When children are brought to an emergency room, doctors must report certain injuries to police and social services. The laws are there to protect kids from possible child abuse.

But 7NEWS Investigator Tony Kovaleski uncovered a case in which some doctors made a big mistake.

In October, a first-time mom took her 3-month-old son, Tyler, to the emergency room, expecting to get help. She didn’t expect to find herself in the center of an investigation into child abuse.

Medical copters refuse to fly meth victims

From WHAS11.com:

You’re at home when the lights go out. You smell gas. You won’t pull out your lighter to see, would you?

Now you have an idea why StatCare is taking no chances–because possible meth victims and choppers don’t mix.

Virtually every day, one of StatCare’s three choppers is in the air — an injured man in Kentucky, a burned baby in Tennessee, a sick mother in Ohio. If they need the specialized help of Louisville’s hospitals, StatCare stands ready.

But all bets are off when it comes to airlifting suspected meth victims, whose clothes may be saturated with toxic and flammable fumes.

This past weekend’s house explosion in Harrison County was an example, StatCare forced to back off taking them by air — the burned victims were instead transported by ground and into a special plastic enclosed emergency room; the dangers posed by such possible meth contaminated too great.

By the way, regarding that Harrison County, Indiana house explosion: StatCare says it wasn’t the only one that decided air transport would be too hazardous.

StatCare says authorities called a second air ambulance service. That service refused for the same reason.

Malpractice bill vetoed by governor

From AZ Central:

Gov. Janet Napolitano vetoed a bill Tuesday that aimed to make it more difficult for patients to collect damages in lawsuits against emergency-room personnel.

House Bill 2315 was one of four bills vetoed by Napolitano. Supporters of the measure said the threat of costly lawsuits has led to fewer doctors, especially specialists such as brain surgeons, working in emergency rooms. Opponents said the bill would have left the public at risk of not being able to receive compensation for injuries caused by negligence.

Napolitano wrote in her veto letter that there isn’t any proof that the bill would have alleviated a shortage of emergency-room doctors. She also said five former Arizona Supreme Court justices wrote to her to express concern that the bill may have been unconstitutional.

The legislation would have raised the burden of proof necessary to win a lawsuit against emergency-room personnel from a preponderance of evidence to clear and convincing evidence, the highest standard in civil cases.

Doctors said that would encourage specialists to return to the ER by reducing their chances of losing a career-ending lawsuit. Opponents, led by trial attorneys, said the bill would hurt those least able to defend themselves while doing nothing to help the problems of overcrowded emergency rooms.

Press Ganey: "Gap Widens in Hospital Patient Satisfaction — Hospitals Committed to Service Excellence Improve While Nationally, Satisfaction Declines

From a press release on prnewswire.com:

SOUTH BEND, Ind., May 3 /PRNewswire/ — The gap in patient satisfaction
is widening between hospitals that deliver exemplary patient service and
those that provide lower levels of care. Press Ganey Associates Inc., which
measures health care satisfaction across thousands of health care delivery
organizations, captured the disquieting trend in its 2006 Health Care
Satisfaction Report, which includes data from more than 2.2 million
patients who had inpatient stays at nearly 1,600 U.S. hospitals.

According to Press Ganey data, hospitals, emergency departments,
physicians’ offices and other health care facilities have shown significant
improvement over the past several years, directly opposite the trends in
health care at large. The hospitals with the greatest commitment to
improvement averaged a 2.7 mean score increase over the past year despite
the national decline in health care satisfaction.

“The American Consumer Satisfaction Index (ACSI) from the University of
Michigan has shown that consumers’ satisfaction with health care has
decreased significantly over the past several years,” says Melvin F. Hall,
Ph.D., president and chief executive officer of Press Ganey. “Hospitals
that partner with Press Ganey to continually measure and improve patient
satisfaction challenge that trend.”

Press Ganey data confirms what many health care policy experts have
been saying about health care — the landscape presents a lot of mediocrity
with pockets of excellence and very poor care. Patients receiving care at
health care facilities in the upper 90th percentile of Press Ganey’s
database almost never report “very poor” or “poor” care while patients at
health care facilities in the 10th percentile report “very poor” or “poor”
care with far greater frequency.

ROI: CPOE

An investigation on the Return on Investment (ROI) for the implementation of Computerized Physician Order Entry (CPOE), as reported by Gruntdoc:

Results: Between 1993 and 2002, the BWH spent $11.8 million to develop, implement, and operate CPOE. Over ten years, the system saved BWH $28.5 million for cumulative net savings of $16.7 million and net operating budget savings of $9.5 million given the institutional 80% prospective reimbursement rate. The CPOE system elements that resulted in the greatest cumulative savings were renal dosing guidance, nursing time utilization, specific drug guidance, and adverse drug event prevention. The CPOE system at BWH has resulted in substantial savings, including operating budget savings, to the institution over ten years.

Conclusion: Other hospitals may be able to save money and improve patient safety by investing in CPOE systems.

ACEP Renews Call for Emergency Medical Services Act During "Cover the Uninsured Week"

From the American College of Emergency Physicians:

ACEP is asking the public to visit http://www.acep.org and send messages to Congress to pass HR 3875, the Emergency Medical Services Act, to address the critical problems affecting their access to emergency care. The bill, introduced by Representatives Bart Gordon (D-TN) and Pete Sessions (R-TX) has three objectives:

1. Provide financial incentives to end the practice of “boarding” patients in emergency departments in order to expedite the movement of patients to inpatient beds. The practice of leaving or “boarding” admitted patients in emergency departments until an inpatient bed becomes available in the hospital is the cause of the gridlock in emergency departments, resulting in long waits for treatment and ambulance diversion to other hospitals.

2. Provide an alternate medical liability system for physicians who provide uncompensated care in an emergency department. The liability risk of caring for emergency patients is so great, it is deterring many medical specialists from being on-call to emergency departments and driving many emergency physicians out of practice.

3. Increase Medicare payments to physicians who provide care in emergency departments. The continuing decline in payments for emergency medical care reduces resources to care for more patients, decreases access to on-call medical specialists who lack financial incentive to be on-call to emergency departments and makes emergency medicine unattractive to medical students who are choosing a specialty.

Three-Fourths Of Emergency Department Directors Report Shortages Of Medical Specialists

From the American College of Emergency Physicians:

Three-fourths of emergency department medical directors responding to a survey reported inadequate on-call specialist coverage, compared with two-thirds in 2004, according to a new report released by the American College of Emergency Physicians (ACEP), in conjunction with researchers from Johns Hopkins University and funded by a grant from the Robert Wood Johnson Foundation.

The findings indicate that on-call coverage in the nation’s emergency departments has deteriorated significantly since 2004. Both surveys were conducted to assess the effects and potential unintended consequences of changes made to the regulations governing the Emergency Medical Treatment and Labor Act (EMTALA). The changes include permitting specialists to be on-call at more than one hospital at the same time and limiting the amounts of call time.

“The availability of specialists has spiraled downward in just one year and confirms what was reported in the National Report Card on the State of Emergency Medicine, released in January by ACEP,” said Frederick Blum, MD, President of ACEP. “These survey findings are evidence of further strain on an already frayed health care system, which coupled with the growing demands for emergency services, means patients could be at risk. If emergency departments can’t handle the day-to-day emergencies, how will we ever be able to save lives and respond effectively to acts of terrorism and other disasters?”

The top five shortages were among the specialties of orthopedics; plastic surgery; neurosurgery; ear, nose and throat; and hand surgery. Seventy-three percent of emergency department directors reported problems with inadequate specialist coverage, compared with 67 percent in 2004. More specialists were negotiating for fewer on-call duty hours in 2005 – 42 percent compared with 18 percent in 2004. Forty-five percent of directors reported patients were leaving without being seen, compared with 29 percent in 2004. The percent of hospitals paying stipends to specialists, whether or not they see patients, more than quadrupled to 36 percent, compared with 8 percent in 2004.