Successful emergency room automation is possible

From ZDNet:

The case studies are starting to come in. The naysayers are wrong.

You can automate hospital operations and improve results. Even in the toughest environments, like the emergency room.

I spent a pleasant morning chatting with Sherry Alton, a registered nurse who is director of emergency services for Graham Hospital in Canton, Illinois. She was touting her experience with T System, a Windows-based ER automation system produced in Dallas.

Time of day, day of week analysis of out-of-hospital cardiac arrest (OCHA) frequency and viability

From Resuscitation:

Out-of-hospital cardiac arrest frequency and survival: Evidence for temporal variability

Some cardiac phenomena demonstrate temporal variability. We evaluated temporal variability in out-of-hospital cardiac arrest (OHCA) frequency and outcome.

Methods: Prospective cohort study (the Resuscitation Outcomes Consortium) of all OHCA of presumed cardiac cause who were treated by emergency medical services within 9 US and Canadian sites between 12/1/2005 and 02/28/2007. In each site, Emergency Medical System records were collected and analyzed. Outcomes were individually verified by trained data abstractors.

Results: There were 9667 included patients. Median age was 68 (IQR 24) years, 66.7% were male and 8.3% survived to hospital discharge. The frequency of cardiac arrest varied significantly across time blocks (p<0.001). Compared to the 0001–0600 hourly time block, the odds ratios and 95% CIs for the occurrence of OHCA were 2.02 (1.90, 2.15) in the 0601–1200 block, 2.01 (1.89, 2.15) in the 1201–1800 block, and 1.73 (1.62, 1.85) in the 1801–2400 block. The frequency of all OHCA varied significantly by day of week (p=0.03) and month of year (p<0.001) with the highest frequencies on Saturday and during December. Survival to hospital discharge was lowest when the OHCA occurred during the 0001–0600 time block (7.3%) and highest during the 1201–1800 time block (9.6%). Survival was highest for OHCAs occurring on Mondays (10.0%) and lowest for those on Wednesdays (6.8%) (p=0.02).

Conclusion: There is temporal variability in OHCA frequency and outcome. Underlying patient, EMS system and environmental factors need to be explored to offer further insight into these observed patterns.

‘Tis the season for elderly emergency room visits

From McKnight’s:

The holidays are typically the time for families to gather for fun and cheer. But for families who haven’t been keeping track of an elderly relative’s health, the festivities may include a trip to the emergency room, a recent news article suggests.

Sometimes, families who spend most of their time apart are alarmed when they finally reconnect and see the health condition of an older relative, according to Dr. Tamara Kuittinen, director of medical education in the Department of Emergency Medicine at Lenox Hill Hospital in a recent HealthDay News item. In their panic, they take Grandma or Grandpa to the emergency room, increasing the flow of holiday healthcare traffic. But these trips are usually unnecessary, Kuittinen said. Often, children of aging parents are simply unaware of how the aging process works, she suggests.

Emergency Room docs offer inside scoop: How to get treated faster, better

From Daily Finance:

Here are some things you can do to be treated faster and better:

Avoid nights, weekends and holidays: Face it folks, doctors take time off, too, and you’ll be seen more quickly if you show up at 10 a.m. on a weekday rather than 10 p.m. on Saturday night — after there’s been a series of car wrecks. “Even if it happens to be less busy on a night or weekend, the staffing is lower,” the ER doc in the northeast says. “There may only be five people ahead of you, but it will take a while to get seen.” Holidays are also a bad time to go, as is the day right after, as hospital staff may extend their vacations. True emergencies, of course, give little advance warning. But if you have an inkling your bandaged finger, say, may need stitches, best head to the ER as soon as possible, rather than waiting until after work when you’ll have plenty of company.

NY Times: ER says don’t come back

From the NY Times (opinion):

Ed. Two inflammatory excerpts:

Unfortunately, an emergency room won’t help — indeed, the closest E.R. has told him not to come back, he says.

Without insurance, John has been unable to get surgery or even help managing the pain. When he collapses or suffers particularly excruciating headaches, Esther rushes him to the emergency room of one hospital or another, but an E.R. can’t do much for him. One hospital has told them not to come back unless he gets insurance, they say.

When is conduct reportable? National Practitioner Data Bank takes complaints from hospitals about physicians

From amednews:

In an effort to promote patient safety across state lines, the National Practitioner Data Bank was created to give hospitals a snapshot of any issues with a physician’s history before credentialing. The idea behind the repository was to streamline a patchwork of state laws governing the reportability of adverse actions against a doctor’s privileges.

Some medical and legal experts say the data bank can be a helpful tool to ensure patient safety. But the complexities of the peer review process continue to create uncertainty as to when competence or conduct issues are reportable, with implications for the doctor whose name ends up on such a report, experts say.

Would Adding Residency Slots Solve the Primary-Care Shortage?

From the Wall Street Journal Health Blog:

With the medical establishment warning of a looming shortage of primary-care docs and general surgeons, Sen. Chuck Schumer is getting ready to introduce an amendment to the Senate health-care bill that would add 2,000 new medical residency slots, the WSJ reports this morning. But adding residency slots may not be enough to guarantee enough primary-care doctors and general surgeons.

Stayin’ alive, stayin’ alive…

From CNN:

Debra Bader was taking a walk in the woods with her 53-year-old husband one morning when suddenly he collapsed. At first she thought the situation was hopeless.

“I looked at him and said, ‘He’s dead,’ because he wasn’t moving or making any sounds at all,” Bader remembers. “But I pulled the cell phone out of his pocket and called 911, and then a public service announcement I’d heard on the radio popped into my head.”

The one-minute PSA from the American Heart Association instructed listeners, in the event of cardiac arrest, to perform chest compressions very hard to the beat of the 1970s Bee Gees song “Stayin’ Alive.” When someone suffers cardiac arrest, as pop singer Michael Jackson did last week, the heart stops functioning completely, and brain death begins within four to six minutes if the victim doesn’t receive help.

“I sang the song and gave directions to the EMTs at the same time. It was like, ‘Stayin’ alive, stayin’ alive — take a right here, take a left here — Stayin’ alive, stayin’ alive — take this path down here — Stayin’ alive, stayin’ alive,’ ” Bader remembers.

Aortic Dissection at Any Age: The Tyler Kahle Story

Ed. I saw this video during Dr. Sullivan’s lecture at the ACEP Scientific Symposium.

From BestCare:

The tragic death of a young man named Tyler Kahle has transformed care at Methodist Hospital. After coming to us for treatment, Tyler died from an undetected rupture inside his chest, a tearing of the aorta called thoracic aortic dissection. He was just 19.

Methodist Hospital is working to raise awareness and help health care providers understand and act on the knowledge that
aortic dissection can occur at any age. The video “Aortic Dissection at Any Age: The Tyler Kahle Story,” produced with the help of Tyler’s family, offers lifesaving information for medical professionals and the general public.

The joys of practicing rural emergency medicine

From Edwin Leap, posting on the Kevin MD blog:

I practice in the rural, northwest corner of South Carolina, also known as “The Upstate.” It is a place of expansive lakes, white-water rivers and the mist covered foothills of the Blue Ridge Mountains. The area includes thousands of acres of Sumter National Forest. The natural beauty is breathtaking. Sumter National Forest and our various parks are laced with hiking trails, which are lined with unique plants and trees, some found nowhere else. Fish and game abound. In fact, our wooded hospital grounds support a flock of at least 30 wild turkey. And last deer season, the only deer I saw were the three does grazing at the end of the ED driveway one night, spotlighted by two of our paramedics.

But, as physicians in a rural area, we pay a price. Because we have to endure a certain stigma. The stigma is this: if you practice in a small, rural hospital, you must be less than competent. Because if you were competent, you’d practice in a large, urban teaching/trauma center.