Physician-Owned Hospitals Faulted on Emergency Care

From the Washington Post

Most physician-owned specialty hospitals are poorly equipped to handle medical emergencies, federal investigators will report today, underscoring a long-standing concern about the rapid rise in the number of such hospitals.

The report found that 55 percent of 109 physician-owned hospitals reviewed had emergency departments — and that the majority of those had only one bed, wrote Inspector General Daniel R. Levinson at the Department of Health and Human Services.

Fewer than a third of the hospitals had physicians on site at all times, and 34 percent relied on dialing 911 to get emergency medical assistance for patients in trouble, according to the report.

ABC News: 24 Hours in the ER

From ABC News

Featuring Parkland Hospital in Dallas

More Lecturing and Less Drinking at U of Iowa

Our own University of Iowa made the Wall Street Journal Health Blog

More Friday classes. That’s the University of Iowa’s new strategy to cut student drinking on Thursday nights.

Since Thursdays are the not-so-new Fridays for partying, scheduling some early Friday classes reduces binge boozing by causing some students to think twice at the bar, the WSJ reports.

Iowa Vice Provost Tom Rocklin told the WSJ that the school wants to offer an incentive for students “to do the right thing” and “send a clear message to students on what it means to be a full-time [student] seriously.” Yet he also says, “I don’t have any illusions – this won’t be a silver bullet.”

To help make the schedule change stick — professors don’t like it much either — departments will be given $20 for each student per class that is changed to include Friday lectures or discussions. That could mean a $10,000 windfall for departments with large lecture classes of several hundred students. Administrators may be keen on that change, but whether student behavior will change remains to be seen. “I go to class on Friday; they’re all [messed] up and hungover,” Krista Farnsworth told the WSJ. “They hate class, but they’re there.” (Take a look at the lean Friday attendance before Spring Break in the image from a math class at Purdue, a Big Ten rival of Iowa’s.)

If Political Pundits Covered an Emergency Department Shift

From Blogorygmi:

This long, rambling dialog took shape while I walked home from the ED just now, to yet another night of surprising election results. To follow the analogy, just substitute “doctors” with “voters,” “patients” with “primaries” … and the causes of abdominal pain… as major US presidential candidates:

Jeff Greenfield: If you’re joining us from home, this is a very special night in the ER. After hearing about diseases for so long, a group of doctors is finally going to step up and decide what’s ailing a waiting room full of patients.

Wolf Blitzer: It’s a big night, no doubt, and let’s see how doctors are evaluating their first patient.

Dan Rather: She’s a young woman with several hours of periumbilical pain. Now it seems to hurt a little more on the right. She’s vomited. That’s all we’ve been able to uncover.

Wireless Monitoring of Patient Vital Signs in the ED (Waiting Room)

From Medgadget

One of the hazards of hospital emergency rooms is that patients can deteriorate without staff noticing. Now they can be given a device to monitor their vital signs.

The Scalable Medical Alert Response Technology (SMART), developed by Dorothy Curtis and colleagues at the Massachusetts Institute of Technology, consists of an infrared blood oxygen sensor that clips onto a finger, and chest electrodes that monitor heartbeat. Both are attached to a PDA that sits in a belt pack and runs software that monitors their readings, and sounds the alarm if they change to a worrying extent. It also beams the data to a PC monitored by a paramedic.

In tests on 145 volunteers in the ER at Brigham and Women’s Hospital in Boston, SMART flagged three patients who were stable when admitted but later developed dangerously irregular heartbeats.

Man Walks Into Detroit Emergency Room With Grenades, Tackled By Security

DETROIT —  A man with a history of mental illness entered an emergency room with two live grenades and was tackled by a security officer, authorities said.

Detroit Receiving Hospital guards searched the man after he triggered a metal detector Saturday night. An officer found the man had a grenade in one hand with the pin out, The Detroit Free Press reported.

The officer tackled him, and the emergency room was evacuated. No injuries were reported.

Police spokesman James Tate said the 44-year-old man has a history of mental illness and a military background. The grenades were a type that might be used in training and much less powerful than combat grenades.

Police found two pipe bombs and two grenades in the man’s house. He was hospitalized for evaluation.

Medicare Compensation Update

In addition to replacing the scheduled 10.1% cut in payments to physicians with an 0.5% increase, the Medicare package approved by the Senate and the House this week extends the “pay for performance” system in which doctors report data on the quality of their care.

It also revises a mechanism — the Physician Assistance and Quality Initiative Fund — that can be used to pay doctors more for the reporting of that data.

In addition, the agreement extends through June 30, 2008, a 5% bonus payment to doctors who practice in areas where there are relatively few physicians.

It also extends through that date the current floor on payment levels to physicians that can be calculated using an index that adjusts for geographic differences in wages.

In-Hospital Defibrillation Takes “Too Long”

From the Wall Street Journal

American hospitals frequently take too long to restart stopped hearts after cardiac arrest, a new study found.

About half a million patients suffer cardiac arrest inside a U.S. hospital each year. Less than a third survive. In many cases, a medical device called a defibrillator can restart a stopped heart by delivering an electrical shock, but only if it’s used quickly.

Since 1991, the American Heart Association has recommended that hospitals be ready to shock a stopped heart within two minutes after detecting cardiac arrest. But the study, published in Thursday’s edition of the New England Journal of Medicine, found that in 30% of cardiac-arrest episodes, hospitals waited longer than two minutes, leading to more deaths.

Study: Race and Narcotics in the ER


Emergency room doctors are prescribing strong narcotics more often to patients who complain of pain, but minorities are less likely to get them than whites, a new study finds. 

Even for the severe pain of kidney stones, minorities were prescribed narcotics such as oxycodone and morphine less frequently than whites. 

The analysis of more than 150,000 emergency room visits over 13 years found differences in prescribing by race in both urban and rural hospitals, in all U.S. regions and for every type of pain. 

The gaps between whites and nonwhites have not appeared to close at all,” said study co-author Dr. Mark Pletcher of the University of California, San Francisco. 

The study appears in Wednesday’s Journal of the American Medical Association. Prescribing narcotics for pain in emergency rooms rose during the study, from 23 percent of those complaining of pain in 1993 to 37 percent in 2005.

President Signs Six Month Medicare Fix for 2008

On December 29, 2007, President Bush signed into law Medicare, Medicaid, and SCHIP Extension Act of 2007 (S. 2499).  The legislation provides a 0.5 percent positive update for the 2008 Medicare Physician Fee Schedule for six months - from January 1 through June 30, 2008.  The fee schedule for July 1 through December 31, 2008 would be calculated as if the six month patch had not been enacted unless further congressional action occurred to stave off future cuts.  

The 2008 Medicare Physician Fee Schedule was scheduled for an across the board cut of 10.1 percent from 2007 rates.  Due to regulatory changes, emergency medicine is scheduled to take an additional reduction of approximately 2 percent in 2008.  The legislation signed by the President averts the 10.1 percent cut to all Medicare physician payments, but does not directly avert the additional 2 percent reduction anticipated for emergency medicine.  A positive update, however, will reduce somewhat the impact of the expected reduction in payments. 


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