Highlights: Hospital Admissions That Began in the Emergency Department, 2003

From the HCUP project website, Statistical Brief #1

In 2003, 55 percent of 29.3 million hospitalizations (excluding pregnancy and childbirth) began in the ED.

Relative to the populations in each region, individuals in the Northeast were more likely to enter the hospital through the ED, while individuals in the Western states were less likely.

Government payers, Medicare and Medicaid, bear the greatest burden of hospital admissions through the ED, covering 66 percent of all admissions through the ED.

The mean cost for hospitalizations that began in the ED was $7,400.

The mean costs for hospitalizations that began in the ED were highest in the West ($8,500) compared to all other regions of the country ($7,200 or less).

The mean costs for hospitalizations that began in the ED were greatest for government payers.

The mean cost for uninsured stays that began in the ED was less than the cost of stays billed to Medicare and Medicaid but comparable to stays billed to private insurance.

Institute of Medicine Report on Hospital-Based Emergency Medicine

From the IOM website:

Despite the lifesaving feats performed every day by emergency departments and ambulance services, the nation’s emergency medical system as a whole is overburdened, underfunded, and highly fragmented, says this series of three reports from the Institute of Medicine.

As a result, ambulances are turned away from emergency departments once every minute on average and patients in many areas may wait hours or even days for a hospital bed. Moreover, the system is ill-prepared to handle surges from disasters such as hurricanes, terrorist attacks, or disease outbreaks.

The Institute of Medicine’s Committee on the Future of Emergency Care in the United States Health System was convened in 2003 to examine the state of emergency care in the U.S., to create a vision for the future of emergency care, including trauma care, and to make recommendations to help the nation achieve that vision. Their findings and recommendations are presented in three reports:

Hospital-Based Emergency Care: At the Breaking Point explores the changing role of the hospital emergency department and describes the national epidemic of overcrowded emergency departments and trauma centers.
Emergency Medical Services At the Crossroads describes the development of EMS systems over the last forty years and the fragmented system that exists today.
Emergency Care for Children: Growing Pains describes the unique challenges of emergency care for children.
The wide range of issues covered in this report, Hospital-Based Emergency Care: At the Breaking Point, includes:

The role and impact of the emergency department within the larger hospital and health care system.
Patient flow and information technology.
Workforce issues across multiple disciplines.
Patient safety and the quality and efficiency of emergency care services.
Basic, clinical, and health services research relevant to emergency care.
Special challenges of emergency care in rural settings.

Hospital drug ads make some critics feel ill

From The Gazette (Montreal):

It’s safe to assume that most people don’t have sex on the brain in a hospital emergency room.

That might explain why the Viagra ad in the ER area at the Montreal General Hospital once caused a bit of a fuss.

“It wasn’t the ad itself,” said Francoise Chagnon, director of professional services at the McGill University Health Centre.

But doctors felt it didn’t belong in a clinical area. “When you looked at the big ad, it kind of stood out right when you came to register in the emergency room and that wasn’t appropriate,” Chagnon said.

That incident aside, Chagnon said commercial advertising in the hospital hasn’t sparked complaints. But the revenue-generating practice isn’t without critics.

In the late 1990s, the Montreal General began accepting commercial advertising as a way to drum up new revenue. Some other cash-strapped hospitals are doing the same thing. However, even among hospitals there is no consensus on the practice.

“This is not the way we should be raising money,” said Paul Saba, a spokesperson for the Coalition of Physicians for Social Justice.

Lawsuit won over doctor’s undisclosed drug problem

From the Seattle Times, via Symtym:

Washington hospital and a malpractice insurer have successfully sued a Louisiana hospital and two doctors who wrote glowing letters of recommendation for a colleague without disclosing his drug problem.

The jury award of more than $4 million for fraud and negligent misrepresentation marks the first time one hospital has successfully sued another for failing to disclose adverse information about a doctor being considered for privileges to practice there, liability experts said.

The case was brought by Seattle-based Western Professional Insurance and Kadlec Medical Center, the Richland hospital that later hired Dr. Robert Lee Berry, unaware of his history.

In 2002, one of Berry’s patients, Kim Jones of Richland, then a 31-year-old mother of three, sustained severe brain damage during a routine procedure. Jones is in a nursing home in Michigan unable to care for herself.

Two years later, Berry, an anesthesiologist, and Kadlec agreed to an $8.5 million settlement in a lawsuit brought by Jones’ family.

During that lawsuit, Jones’ family learned that Berry had been diverting the narcotic painkiller Demerol from his patients. They also learned he had been asked to leave the Louisiana hospital and his practice for being impaired on the job — a fact neither had disclosed to Kadlec.

“Had we known, we wouldn’t have hired him,” Kadlec spokesman Jim Hall said.

Ron Perey, Jones’ lawyer, said “a case like this has never been won before.” He predicted it would bring about positive changes in “honesty in the medical industry.”

Med Tech Firms Move Standards Forward

From the Iowa Hospital Association “What’s New” Section:

Twenty-two electronics and health companies announced a joint effort to help patients by making high-technology tools work better together. Participants said they were responding to an impending crisis, as a fixed number of doctors and nurses will confront an expected explosion in chronic diseases.

The companies are forming a nonprofit organization, called the Continua Health Alliance, with initial members that include Intel Corp., International Business Machines Corp., Cisco Systems Inc., Samsung Electronics Co., Motorola Inc., Philips Electronics NV, Medtronic Inc., General Electric Co.’s GE Healthcare unit, Kaiser Permanente and Partners HealthCare System Inc., among others. Additional companies are expected to join.

Continua backers expect to shift more care to the home, using devices that monitor the condition of patients and transmit data to medical professionals for analysis and recommendations. Besides helping patients help themselves, the companies hope to make it easier for family members to remotely monitor the condition of patients.

Standard-setting bodies already have been formed to address some of those issues. Continua hopes to go a step further, publishing guidelines so manufacturers can be assured that products they make will work with those from other firms.

ACEP CME: Chest Pain

A new continuing education activity from the American College of Emergency Physicians (ACEP): Focus on Chest Pain.

We all know what to do for the patient whose pain is described as a crushing pressure in the middle of his chest radiating to his left arm, associated with diaphoresis and shortness of breath. However, many patients present with a hodgepodge of “atypical features” that require the emergency physician to balance high-risk and low-risk features. And what about other life threats? Aortic dissection and pulmonary embolism are two notoriously tricky diseases that may present in a variety of ways.

While it has been consistently shown that history alone cannot rule out these life threats altogether,1-4 it does allow an emergency physician to determine the optimal plan of treatment and disposition. To do this well, the emergency physician must know which features indicate higher risk and not be lulled into a false sense of security by one reassuring feature. This article will highlight the most important features of the patient history for chest pain from recent literature.

Disaster Medicine Resources

From Medgadget:

NYU Hospital’s Center for Health Information Preparedness (CHIP) has put their disaster medicine curriculum online — including downloadable PDA content and patient resources.

The curriculum is thorough, covering the major threats from infections and toxins, how to spot them and treat them. References, too.