Lost in translation: Maximizing handover effectiveness between paramedics and receiving staff in the emergency department

From IngentaConnect:

The purpose of the present study is to investigate perceptions by paramedics and hospital receiving staff about what enables and constrains handover in the ED. Methods:

This is a qualitative study of interviews with 19 paramedics, 15 nurses and 16 doctors (n = 50) from ambulance services and ED in two states of Australia. Results:  Three main themes emerged that were evident at both sites and in the three professional groups. These were: difficulties in creating a shared cognitive picture, tensions between `doing’ and `listening’ and fragmenting communication. Conclusion:  Recommendations arising from the present study as to how handover could be improved are the need for a common language between paramedics and staff in the ED, for shared experiences and understanding between the members of the team and for the development of a standardized approach to handover from paramedics to ED receiving staff.

Dispatcher Recognition of Stroke Using the National Academy Medical Priority Dispatch System

From the American Heart Association:

Background and Purpose—Emergency medical dispatchers play an important role in optimizing stroke care if they are able to accurately identify calls regarding acute cerebrovascular disease. This study was undertaken to assess the diagnostic accuracy of the current national protocol guiding dispatcher questioning of 911 callers to identify stroke (QA Guide version 11.1 of the National Academy Medical Priority Dispatch System).

Methods—We identified all Los Angeles Fire Department paramedic transports of patients to University of California Los Angeles Medical Center during the 12-month period from January to December 2005 in a prospectively maintained database. Dispatcher-assigned Medical Priority Dispatch System codes for each of these patient transports were abstracted from the paramedic run sheets and compared to final hospital discharge diagnosis.

Results—Among 3474 transported patients, 96 (2.8%) had a final diagnosis of stroke or transient ischemic attack. Dispatchers assigned a code of potential stroke to 44.8% of patients with a final discharge diagnosis of stroke or TIA. Dispatcher identification of stroke showed a sensitivity of 0.41, specificity of 0.96, positive predictive value of 0.45, and negative predictive value of 0.95.

Conclusions—Dispatcher recognition of stroke calls using the widely employed Medical Priority Dispatch System algorithm is suboptimal, with failure to identify more than half of stroke patients as likely stroke. Revisions to the current national dispatcher structured interview and symptom identification algorithm for stroke may facilitate more accurate recognition of stroke by emergency medical dispatchers.

Number of Malpractice Suits Falls 41% in Pennsylvania

From the Wall Street  Journal Health Blog:

It looks like a few rule changes have dramatically lowered the number of malpractice suits filed in Pennsylvania. There were 1,602 filings last year, a 41% decline from the annual average between 2000 and 2002, before the changes were put in place.

One of the new rules requires a “certificate of merit” from a medical professional, establishing that “the medical procedures in a case fell below applicable standards of care,” according to a recent statement from the Administrative Office of Pennsylvania Courts. Another rule requires cases to be filed in the county where the alleged malpractice took place — an effort to discourage so-called venue shopping, where cases would be filed in counties thought to be sympathetic to plaintiffs.

The number of malpractice cases fell sharply in 2003, when the rules were in place, and have stayed down.

“The results have been extraordinarily impressive in abating the malpractice insurance crisis,” Pennsylvania’s governor said yesterday, the Philly Inquirer reports.

Free clinic’s business booms in bad economy

From CNN:

… Clinic with a Heart in Lincoln, Nebraska.

The weekly clinic offers free care to those falling through the cracks of the health care system, says Dr. Rob Rhodes, a family physician who is president and founder of the clinic.

In these tough economic times, business is booming. The clinic expects to see more than 2,000 patients this year, up from 1,400 last year, according to Rhodes.

“The economy has definitely affected the number of patients that we see,” he says.

As Insurance Coverage Increases, ERs Get Busier

From the Wall Street Journal Health Blog:

Visits to Massachusetts emergency rooms appear to have increased in the aftermath of the state’s push toward universal health insurance. The news is the latest blow to the popular idea that ERs are crowded with the uninsured.

The number of trips to the ER rose by 7% between 2005 and 2007, the Boston Globe reports this morning. The state’s universal health insurance mandate went into effect in 2006.

State officials caution that it’s too soon to say whether there’s a cause-and-effect relationship, or whether this is just a coincidence. But preliminary data for six Boston hospitals also show a rise in ER visits between 2006 and 2008, the Globe says.

NQF seeks input on proposed outcome measures

From Modern Healthcare:

The National Quality Forum is asking for comments on 11 proposed outcomes measures as part of its standards for outcomes and efficiency program.

The standards-endorsing body released its draft report of 11 measures addressing mortality rates following various cardiac procedures as well as postoperative respiratory failure, esophagus and pancreatic surgeries. The NQF intended for the report to also include efficiency measures; however, all of the 20 measures submitted for consideration focused on outcomes. Comments on the draft report are due May 21 and must be submitted online. The NQF expects to announce a final endorsement by the end of July.

This is the second phase of the standards program, which last year focused on readmission rates. The NQF in October endorsed two measures in 30-day readmission rates following acute myocardial infarction and 30-day rates following a pneumonia hospitalization during the first phase.