What Docs Want In Exchange for Curbing Costs

From the Wall Street Journal Health Blog:

The Health Blog just had a quick chat with AMA President-elect Jim Rohack, one of the health-industry big shots who was on hand today at the White House to talk about health reform.

If we as the profession come up with evidence-based ways to provide care, and as a result of that can reduce unnecessary tests or unnecessary procedures, then the physician and the patient should feel comfortable that if the physician has followed the guideline, the physician is not later going to be sued.

Updated A/H1N1 Guidelines in Minnesota

From the Minnesota Department of  Health:

The Minnesota Department of Health (MDH) has evidence of community transmission of Novel H1N1 influenza throughout Minnesota. Currently MDH is testing only select groups of people. Almost all cases of mild illness will not be detected. Initiation of treatment and chemoprophylaxis should be based on symptoms and suspicion of influenza, not based on results of novel H1N1 testing (see H1N1 Testing at MDH Public Health Laboratory).

Antiviral agents are a limited resource in Minnesota. This Guidance identifies priority groups for the use of antiviral agents for treatment and chemoprophylaxis from the  Minnesota state stockpile. Your prescribing practices of these resources may be audited in accordance with this guidance.

Human seasonal influenza continues to circulate in Minnesota. MDH-PHL tested samples from 495 individuals by RT-PCR for influenza from April 24 – May 5, 2009 as part of testing for Novel Influenza H1N1 (swine). Of the 44 with one type of influenza A identified, 41% were seasonal human H1 influenza type A, 32% were seasonal human H3 influenza type A, and 27% were novel influenza H1N1 type A (swine influenza). Seasonal human influenza type B was also identified by MDH-PHL in this time frame as well.

Childhood Game Inspires Hospital Emergency Department

From HealthLeaders Media:

Boston’s Beth Israel Deaconess Medical Center is using peer pressure and the threat of humiliation in a playful game of “Tag, You’re It!” in hopes of reducing hand-washing lapses among the busy emergency staff.

Last Friday, hospital ED chief Richard Wolfe, MD, persuaded his physicians, nurses, techs, and attendings to bravely accept the challenge. When any team member espies a colleague failing to wash hands between patient encounters, they get tagged. The words, “Tag. So-and-so is it” appear on the dashboard banner of all monitors throughout the hospital.

Wolfe says staff also can be marked for failing to write legibly in patient charts, writing prohibited abbreviations that can be misunderstood, or failing to correctly sign, date, and time all orders.  Having coffee in a clinical area is a big tag-able no-no as well.

But hand-washing is the biggest bête noir at the Harvard teaching hospital. “It is by far the hardest not to trip up on in the ED,” he says. “If you have just washed your hands after seeing one patient, you still are expected to wash again before entering the next patient’s room, even if you haven’t touched anything.  Between the initial evaluation, re-eval, and the discharge, each patient can require six separate episodes of handwashing.”

Steroids for Spinal Injury

From the Journal of Trauma:

Background: The use of methylprednisolone sodium succinate (MPSS) in the treatment of traumatic spinal cord injury was initially reported to enhance recovery in the National Acute Spinal Cord Injury Studies (NASCIS), 1990 and 1997. Controversy led to subsequent research and a 2002 report citing insufficient evidence for MPSS treatment standards or guidelines. Our purpose was to explore emergency department (ED) response to this shifting information by assessing the impact of NASCIS and the 2002 report on MPSS protocols and to study factors associated with MPSS administration.

Methods: Availability of protocols and hospital characteristics were determined by survey of all hospitals with EDs in South Carolina. Protocol copies were obtained and reviewed for accuracy based on NASCIS. Patient hospital discharge information was collected through the state Office of Research and Statistics, and factors associated with receiving MPSS were evaluated using multivariable techniques.

Results: Having a protocol was associated with trauma level designation and volume of traumatic spinal cord injury patients per annum, with 100% of Level I trauma facilities having a protocol. Across all trauma levels, 40% of reporting EDs had an MPSS protocol, with 86% of these accurate, and none withdrawn during the study. Patient factors associated with being less likely to receive MPSS were female gender, injury below thoracic level, and treatment in an undesignated trauma center.

Conclusions: Shifting information on the benefit of MPSS did not lead to withdrawal of protocols over the study time period. However, within those hospitals having a protocol, only 32% of eligible patients received MPSS treatment.

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