Parents Often Choose ER for Routine Kids’ Care

From US News and World Report:

Parents who take their kids to the emergency room for non-urgent care aren’t doing it to abuse the system.

Instead, they’re doing so because they have concerns and questions about the care and attention they receive at primary care physicians’ offices.

So finds a new study published in the journal Academic Pediatrics. Often, primary care physicians (PCPs) actually refer patients to a hospital emergency department (ED), the researchers found.

“There were three main reasons parents gave [for taking children to the ED for non-urgent concerns] — problems with the PCP, referral from the PCP, and advantages of care in the emergency department,” said study co-author Dr. Jane M. Brotanek, assistant professor of pediatrics and Robert Wood Johnson Physician Faculty Scholar at the University of Texas Southwestern Medical Center at Dallas.

But there’s a price to pay for overloaded emergency departments. “If there’s an overwhelming number of ED visits, that can cause problems: longer waits, demands on ED staff, adverse events due to delays in care,” Brotanek said.

Healthcare Workers and Flu Shots

From the Washington Post:

Simple logic would make you think that health-care workers, most of whom have more education in health and medical issues than other people, would be more likely to be vaccinated. But since 1997 the vaccination rate among health-care workers nationwide has remained around the same depressing 40 percent. That is more than 20 percentage points lower than the average for the largest at-risk group, adults older than 65.

5 Myths About Our Ailing Health-Care System

An editorial in the Washington Post:

1. America has the best health care in the world.

Let’s bury this one once and for all. The United States is No. 1 in only one sense: the amount we shell out for health care. We have the most expensive system in the world per capita, but we lag behind many developed countries on virtually every health statistic you can name. Life expectancy at birth? We rank near the bottom of countries in the Organization for Economic Cooperation and Development, just ahead of Cuba and way behind Japan, France, Italy, Sweden and Canada, countries whose governments (gasp!) pay for the lion’s share of health care. Infant mortality in the United States is 6.8 per 1,000 births, more than twice as high as in Japan, Norway and Sweden and worse than in Poland and Hungary. We’re doing a better job than most on reducing smoking rates, but our obesity epidemic is out of control, our death rate from prostate cancer is only slightly lower than the United Kingdom’s, and in at least one study, American heart attack patients did no better than Swedish patients, even though the Americans got twice as many high-tech treatments.

Is the recession affecting ED volume?

From Kevin MD:

Mixed reaction from two emergency bloggers.

WhiteCoat sees a decline, and notes that in border like Arizona, Hispanics that normally visit the emergency department have left town.

I’m seeing more of what Shadowfax observes. More people are losing their jobs, and subsequently their health insurance, leading to a higher number of uninsured visiting the ED. What’s likely happening nationwide is that “there will be fewer commercially insured patients, and more Medicaid and uninsured patients,” which will “drive our reimbursement down significantly.”

This is happening in primary care settings as well.

Too Much Information

From the NY Times “Doctor and Patient” Series:

Over the last four years, there have been several studies on the effects of physician self-disclosure on patient satisfaction. It turns out that patients don’t always want to know about their doctors’ personal experiences. And doctors don’t always do a great job when they do choose to share their personal information.

Susan H. McDaniel and her colleagues at the University of Rochester School of Medicine and Dentistry found that doctors made self-disclosure statements in approximately a third of patient visits, but almost 40 percent of these statements were unrelated to the patient’s symptoms, family or feelings. In addition, in the vast majority of cases, doctors never returned to the topic that inspired the personal reference in the first place.

Interestingly enough, there is also a difference in how patients react to doctors from different specialties. Dr. Mary Catherine Beach and her colleagues at the Johns Hopkins School of Medicine in Baltimore found that when surgeons revealed something personal, patients were significantly more satisfied with their quality of care than when surgeons kept mum. But when primary care doctors disclosed a fact from their own lives, their patients were significantly less satisfied.

First Aid Software on a Phone

From Medgadget:


The Medical Phone Ltd out of Edinburgh, UK is working on a mobile device that will provide step-by-step instructions during emergency medical situations, and can quickly call 911, your doctor, as well as a nearby hospital. iCEphone™ (iCE for in Case of Emergency), though a simple and smart idea, might as well be a software package that can be installed onto any smart phone capable of handling such functions.

AHA survey finds hospitals struggling

From Modern Healthcare:

The data are in, and they are not pretty: Hospitals are reporting negative profit margins for the third quarter of 2008, reversing a trend of healthy profitability from this time last year.

A “rapid response” survey released by the American Hospital Association concluded that hospitals posted negative profit margins of 1.6% in the quarter ended Sept. 30. Last year, hospitals concluded the same quarter with a positive 6.1% margin, according to the survey. The report was based on data gathered from 736 hospitals in 30 states that responded to the AHA’s questionnaire.

The downturn has left more than half of the survey respondents pondering staff reductions, while more than a quarter of the hospitals are deciding whether to reduce services. The financial pinch comes amid falling revenue, declining admissions and negative investment earnings, even as experts predict that high unemployment will lead to more patients seeking uncompensated care at emergency rooms.

Handoffs: Why hospitalists and ED doctors “drop the baton”

From Today’s Hospitalist:

“No sign-out was given on the patient. When nursing staff called me to evaluate, patient was tachypneic and tachycardic. Patient was transferred to CCU with acute coronary syndrome. ED stated that this was an error secondary to being very busy with crowding in ED.”

Sound familiar? Given all the communication problems between ED physicians and hospitalists, it’s no wonder that both groups stereotype the other: Hospitalists complain that ED staff lack professionalism and judgment. Hospitalists, counter the ED doctors, expect too much.

Researchers who looked at transfers between the ED and the medical service in an urban academic center were surprised to find that problems went far beyond inaccurate or incomplete vital-sign information. Instead, they say it’s more often about system flaws—overcrowding, high workload and lagging technology—that intensify the pressure.

In a study titled “Dropping the Baton”, published online in June by Annals of Emergency Medicine, 40 respondents described 36 specific incidents of errors in diagnosis, treatment and disposition that caused patients harm or a near miss.

More on Disaffected Docs

From the Wall Street Journal Health Blog:

Doctors sure seem unhappy these days. Just take a look at the downbeat results from a survey out from the Physicians’ Foundation.

Here are some of the bracing findings from 11,950 primary care docs and specialists who responded to the survey:

94% said the time they’ve devote to non-clinical paperwork in the past three years has increased. 63% said the paperwork has meant they spend less time per patient.

82% said their practices would be “unsustainable” if proposed Medicare pay cuts were made.

78% believe there is a shortage of primary care docs in the U.S.

49% said that over the next three years they plan to reduce the number of patients they see or stop practicing entirely.

Half of primary care doctors want to quit

From the Kevin MD:

Today comes a study that reveals that 49 percent of primary care doctors surveyed would consider leaving medicine, with many saying “they are overwhelmed with their practices, not because they have too many patients, but because there’s too much red tape generated from insurance companies and government agencies.”

Furthermore, medical students are not replacing those who leave, with the wide disparity in salary and lifestyle resonating with prospective doctors.