Online service holds your spot at hospital

From AJC.com:

Have you ever made an online reservation at your favorite restaurant? What if you could do the same for an emergency room visit?

Tyler Kiley, a 23-year-old Powder Springs entrepreneur, has applied a practice used by the restaurant industry as a remedy to long waits at hospitals. Two years ago, Kiley launched InQuickER, an online service that lets users hold their places in line in the emergency room.

Here’s how it works: People go to the company’s Web site, which shows the next available time at the closest hospital that uses the service. Users are then directed to a page where they describe their symptoms. The reserved time is usually determined by the charge nurse, who factors in current patient load, time of day and ambulance runs.

The cost is $24.99 per use.

So far, three hospitals use the system, although Smyrna’s Emory-Adventist Hospital is the only one in Georgia.

The service isn’t for everyone. If you have symptoms consistent with a stroke or heart attack, Kiley advises people to call 911.

An official at Emory-Adventist, an 88-bed hospital, said it’s helped the ER become more efficient.

And there’s an added benefit.

“The biggest selling point for nurses is that the patients are happy. That’s just something not seen in the emergency room,” said Brandon Dickey, director of the hospital’s emergency department, which sees about 23,000 patients annually.

Dickey said the hospital has more than 1,000 visits through InQuickER, with 11 percent repeat users. An average ER wait during busy hours (10 a.m. to 10 p.m.) is between two and three hours.

An Internet programmer by profession, Kiley knew other industries were using the Internet and reservation systems. “I said, ‘Why don’t we expand this to a field where it’s really, really needed?”

Texting the Emergency Room

From WALB.com

ALBANY, GA – Often those folks who can’t afford to go to a doctor’s office end up in the ER.

That’s leading to long waits in many hospitals, but one Albany hospital is working to reduce wait times.

Palmyra Medical Center has a new program to let you know how long you’ll wait, before you even arrive at the hospital.

By sending the letters ER to 23000 and replying to the message with you zip code you get the approximate wait time at the hospital.

“If someone is trying to decide which hospital they want to go to they can go to one of these avenues and see how long it’ll be before they arrive to see a physician,” Mark Swicord, Palmyra ER Director.

When you send the letters ER to 23000 in addition to getting the wait time you also receive a 1-800 number to call a nurse before heading to the emergency room.

The texting feature has been up and running for about two weeks.

Caught On Tape: Scuffle Between Paramedic And Trooper

From Digital Triad:

Paden, OK — A scuffle between first responders in Oklahoma is caught on tape.

Highway Patrol troopers and a paramedic nearly come to blows while a patient waits to be taken to the hospital. The encounter was caught on a cell phone came by Kenyada Davis, the son of the patient in the ambulance.

The incident started when the ambulance failed to yield to state troopers en route to a call. Davis say the ambulance driver was trying to avoid hitting a car that slowed down and wasn’t aware that troopers were nearby until it was too late.

After the troopers finished their official business, they pulled the ambulance over. A struggle ensued as they tried to arrest the driver.

According to Oklahoma Highway Patrol, the paramedics assaulted the trooper just before the fight broke out.

The Okfuskee County District Attorney’s office is reviewing footage and could file criminal charges against the paramedic by the end of the week.

Here’s a link to the paramedic’s report.

A follow up report from Newson6.com

Paramedics, OHP Troopers Respond To Video

PADEN, OK — Both sides are defending themselves after a confrontation between an Oklahoma Highway trooper and paramedics which was caught on video. (Here’s a link to the video)

The OHP trooper in question identified in newly-released documents as Daniel Martin is under investigation by the state Department of Public Safety.  This comes one day after video of him trying to arrest a Creek Nation paramedic in the middle of a transport made headlines nationwide.

Gender disparities seen in EMS care for chest pain

From Reuters Health:

Women with chest pain are less likely than their male counterparts to receive aspirin and other recommended therapies by emergency medical service (EMS) personnel, according to study findings presented Friday at the Society for Academic Emergency Medicine’s annual conference in New Orleans.

“Women with heart attacks have higher death rates than men, so these findings are very concerning, and it’s important for us to try to figure out why this is happening,” lead researcher Dr. Zachary Mesiel noted in a prepared statement.

“We expected to find no differences in treatments (by gender) because so much of ambulance care is subject to protocol,” he added in comments to Reuters Health. “In general, there is not as much discretion in how to treat patients in the prehospital arena compared to hospital or outpatient care.” However, the findings showed that there was, in fact, a gender difference.

The good news is that no racial disparities in out-of-hospital care were seen, noted Mesiel, who is with the University of Pennsylvania School of Medicine. Prior studies have suggested that there might be.

The results stem from a study of 683 patients with chest pain who were brought by EMS to one of three Philadelphia hospitals in 2006 and 2007. The investigators examined the frequency with each patients received four key EMS treatment and monitoring protocols which are called for in chest pain patients over the age of 30. The measures include whether patients got aspirin and nitroglycerin, which relieves cardiac pain, and whether they received heart rhythm monitoring or had intravenous lines placed to begin medication delivery.

Women were less likely than men to receive aspirin (24% vs. 32%), nitroglycerin (26% vs. 33%), and an intravenous line (61% vs. 70%).

Among women, those with a confirmed heart attack in the ER were significantly less likely than those without a heart attack to have received the recommended EMS interventions. In fact, none of the women with heart attack had received aspirin in the field.

Videoconferencing can increase patient access to stroke specialists; immediate, thorough testing needed after “warning” strokes

From The American Heart Association:

High-quality videoconferencing can increase patient access to stroke specialists, especially in rural or other underserved areas; and a transient ischemic attack (TIA), once known as a “mini” or “warning” stroke, should be treated with the same urgency as a full-blown stroke, according to two separate scientific statements and a policy statement published today in Stroke: Journal of the American Heart Association.

A new scientific statement says a remote exam using high-quality videoconferencing equipment is as effective as a bedside stroke evaluation.

Physicians must quickly evaluate stroke patients to determine if they’re eligible for time-sensitive treatment such as tissue plasminogen activator (tPA) that can save brain function and reduce disability. Stroke and brain imaging specialists are often required to perform the evaluation. However, the United States has only an average of four neurologists per 100,000 people, and not all of them specialize in stroke, according to the statement.

Telemedicine, or telestroke, uses interactive videoconferencing via webcams connected to a TV or computer screen, which allows the patient, family and the bedside and distant healthcare providers to see and hear each other in full color and in real time.

Telestroke is coupled with teleradiology, which allows remote review of brain images. This technology can broaden the reach of neurologists in a cost-effective and time-efficient manner.

“Telemedicine is an effective avenue to eliminate disparities in access to acute stroke care, erasing the inequities introduced by geography, income or social circumstance,” said Lee Schwamm, M.D., lead author of a scientific statement and policy statement on telemedicine, and associate professor of neurology at Harvard Medical School and Vice Chairman of Neurology at Massachusetts General Hospital.

Stroke Group Expands Time for Clot-Busting Drugs

From JEMS:

A change to stroke treatment guidelines is expanding the time that some patients can get clot-busting drugs. Current recommendations limit the use of the medicine to within three hours after the start of stroke symptoms. That treatment window is now being lengthened to 4 1/2 hours for some patients.

But the committee that made the change stressed that the earlier the treatment, the better for stroke victims.

“They should call the ambulance straight away and get moving,” said Dr. Gregory del Zoppo, of the University of Washington School of Medicine in Seattle, who headed the committee for the American Heart Association Stroke Council.

The update, published online Thursday in the heart group’s journal Stroke, comes after a European study last fall found stroke sufferers still benefited from getting the medicine an hour or so beyond the three-hour window.

The new guideline is expected to increase the number of people who get the treatment. Only about a third of stroke sufferers get help within three hours, and only about 5 percent get the drug now. Many people don’t recognize the signs of a stroke: numbness or weakness in the face, arm or leg; trouble speaking, seeing or walking; a sudden, severe headache.

The Effect of Family Presence on the Efficiency of Pediatric Trauma Resuscitations

From the Annals of Emergency Medicine, via Science Direct:

Study objective

Family presence has broad professional organizational support and is gaining acceptance. We seek to determine whether family presence prolonged pediatric trauma team resuscitations as measured by time from emergency department arrival to computed tomographic (CT) scan, and to resuscitation completion.

Methods

A prospective trial offered families of pediatric trauma patients family presence on even days and no family presence on odd days. Primary outcome measures were time from arrival to CT scan and to resuscitation completion (laboratory tests, emergency procedures, portable radiographs, and secondary survey). We evaluated the effect of family presence in an adjusted Cox proportional hazards model. Staff and family experiencing a resuscitation with family presence were asked their opinions of that experience.

Results

Of 1,229 pediatric trauma activations, 705 patients were included in the study protocol, 283 with family presence on even days, 422 without family presence on odd days. Median times to CT scan (21 minutes; IQR 16 to 29 minutes) and median resuscitation times (15 minutes; IQR 10 to 20 minutes) were similar with and without family presence. There was no clinically relevant difference in CT time (hazard ratio 1.04; 95% confidence interval [CI] 0.83 to 1.30) or resuscitation time (hazard ratio 0.98; 95% CI 0.83 to 1.15). Families believed that family presence was helpful both to their child and themselves.

Conclusion

This prospective trial shows that family presence does not prolong time to CT imaging or to resuscitation completion for pediatric trauma patients. Family presence does not negatively affect the time efficiency of the pediatric trauma resuscitation.

Emergency nurse practitioners and doctors consulting with patients in an emergency department: a comparison of communication skills and satisfaction

From Emergency Medicine Journal:

Background: Emergency nurse practitioners (ENPs) play an increasingly important role in UK emergency departments (EDs), but there is limited evidence about how this affects patient care and outcome. A study was undertaken to compare the content of, and satisfaction with, consultations made with patients presenting with problems of low acuity to an ED.

Methods: Patients presenting with “primary care” problems were allocated to senior house officers (SHOs, n = 10), specialist registrars/staff grades (n = 7), sessionally-employed general practitioners (GPs, n = 12) or ENPs (n = 6) randomly rostered to work in a consulting room that had a wall-mounted video camera. At the end of each consultation the doctor/ENP and the patient were asked to complete the Physician/Patient Satisfaction Questionnaire. A stratified sample of videotaped consultations (n = 296) was analysed in depth using the Roter Interaction Analysis System. The main outcome measures were length of consultation; numbers of utterances of doctor/ENP and patient talk related to building a relationship, data gathering, activating/partnering, and patient education/counselling; doctor/ENP and patient consultation satisfaction scores.

Results: ENPs and GPs focused more on patient education and counselling about the medical condition or therapeutic regimen than did ED doctors. There were no significant differences in consultation length. ENPs had higher levels of overall self-satisfaction with their consultations than ED doctors. Patient satisfaction with how actively they participated in the consultation was significantly associated with the amount of talk relating to building a relationship and activating and partnering, and patient satisfaction with information giving in the consultation was significantly associated with the amount of talk relating to building a relationship.

Conclusion: These findings suggest differences between ENP and ED doctor consultations which are associated with some aspects of patient satisfaction. In contrast to previous reports, consultation length was not greater for ENPs than for doctors. There is a need for further research to test the generalisability of these findings and their impact on clinical outcome.

Efficacy and Safety of Tissue Plasminogen Activator 3- to 4.5-Hours After Acute Ischemic Stroke. A Metaanalysis

From Stroke:

Background and Purpose—The Third European Cooperative Acute Stroke Study (ECASS-3) demonstrated a benefit of treatment with intravenous tissue plasminogen activator (tPA) for acute stroke in the 3- to 4.5-hour time-window. Prior studies, however, have failed to demonstrate a significant benefit of tPA for patients treated beyond 3 hours. The purpose of this study was to produce reliable and precise estimates of the treatment effect of tPA by pooling data from all relevant studies.

Methods—A metaanalysis was undertaken to determine the efficacy of tPA in the 3- to 4.5-hour time-window. The effect of tPA on favorable outcome and mortality was assessed.

Results—The metaanalysis included data from patients treated in the 3- to 4.5-hour time-window in ECASS-1 (n=234), ECASS-2 (n=265), ECASS-3 (n=821) and The Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke (ATLANTIS) (n=302). tPA treatment was associated with an increased chance of favorable outcome (odds ratio 1.31; 95% CI: 1.10 to 1.56; P=0.002) and no significant difference in mortality (odds ratio 1.04; 95% CI: 0.75 to 1.43; P=0.83) compared to placebo treated patients.

Conclusions—Treatment with tPA in the 3- to 4.5-hour time-window is beneficial. It results in an increased rate of favorable outcome without adversely affecting mortality.

What are parents’ rights regarding a child’s medical treatment?

From the CNN Empowered Patient series:

Even when a child is in imminent danger of dying, parents have the latitude to reject potentially life-saving treatments if they’re experimental, or if the parents can show an alternative treatment would work just as well, says Art Caplan, director of the Center for Bioethics at the University of Pennsylvania.

Children can, on occasion, also have their wishes heard. Teenagers who are found to be “mature minors” have sometimes been allowed by courts to reject life-saving treatments, Annas says.

“Mature minors” are usually at least 15 years old and “can understand the nature and consequences of their decisions,” says Annas.

Courts have also sided with families in life-or-death situations when the parents find a licensed physician willing to administer the alternative medicine they’re seeking.