HealthGrades Evaluates Hospital Emergency Medicine for the First time

From FierceHealthcare, via Beth Cesta:

The quality of emergency medical care at the nation’s hospitals varies widely – both individually and by state – according to a new HealthGrades study released today that, for the first time, examines mortality rates for patients entering hospitals through emergency departments.

The first annual HealthGrades Emergency Medicine in American Hospitals Study examined more than 5 million Medicare records of patients admitted through the emergency department of 4,907 hospitals from 2006 to 2008 and identified hospitals that performed in the top 5% in the nation in emergency medicine.

Comparing the group of hospitals in the top 5% with all others, the study found that the group had a 39% lower risk-adjusted mortality rate. These top-performing hospitals improved their outcomes over the years 2006 through 2008 at a faster rate than all other hospitals, 16% compared with 10%.

Comparing tPA use for stroke in patients in their 80’s and 90’s

From Stroke:

Outcomes of Thrombolysis for Acute Ischemic Stroke in Octogenarians Versus Nonagenarians

Background and Purpose—Little is reported on the outcomes of nonagenarians who are treated with intravenous tissue plasminogen activator for acute ischemic stroke. It is uncertain whether nonagenarians have higher mortality and worse functional outcomes than octogenarians.

Conclusions—There is no significant difference in 90-day mortality, 30-day functional outcome, or rate of symptomatic intracerebral hemorrhage between nonagenarians and octogenarians treated with intravenous tissue plasminogen activator when comparing populations of similar baseline risk.

Intra-arrest cooling using intra-nasal cooling method (Rhinochill) for immediate induction of therapeutic hypothermia

From Critical Care:

Recent investigations have demonstrated improved neurological outcome after therapeutic hypothermia in patients after successful resuscitation. The time course and duration to achieve target temperature may be an important factor to influence patient’s outcome. To determine the safety and efficacy of intranasal cooling during ongoing resuscitation, for immediate induction of therapeutic hypothermia, the Pre-Resuscitation Intra-Nasal Cooling Effectiveness (PRINCE) study involved 200 patients in Europe, using a non-invasive nasal catheter that sprays evaporating coolant liquid into the nasal cavity. Here we demonstrate data from all German participating sites.

Using the intranasal cooling method, cooling was much faster and earlier in treated patients. Neurologically intact survival and discharge rates were higher in treated patients. Transnasal cooling for the induction of therapeutic hypothermia during prehospital resuscitation is feasible and highly effective in lowering brain temperature rapidly. The method offers the possibility for immediate introduction and realization of mild hypothermia in the field.

Car crashes into NY hospital ER

From the WCAX:

A car carrying a wounded man crashed through the doors of a hospital’s emergency room. The passenger died from his gunshot wound.

Schenectady police responded to a bar around 1:30 a.m. Sunday where gunshots were heard, but didn’t find a victim.

A few minutes later, they received a call about a car that had come into the emergency room at the McClellan Street campus of Ellis Hospital.

High concentrations of supplemental oxygen during resuscitation after cardiac arrest associated with increased inhospital mortality

From Kevin MD:

Administering high concentrations of supplemental oxygen during resuscitation after cardiac arrest is associated with increased inhospital mortality, researchers said.

So-called blood hyperoxia resulting from being given pure oxygen after cardiac arrest was associated with an 80% increase in the risk of death, compared with patients whose blood gases were normal on admission to the intensive care unit (ICU), according to Stephen Trzeciak, MD, of Cooper University Hospital in Camden, N.J., and colleagues.

ACEP Responds to HealthGrades Report

From ACEP:

A new report from HealthGrades analyzes mortality data from the records of Medicare patients who were admitted in hospitals across the United States, but is not a measure of emergency care, according to the American College of Emergency Physicians (ACEP).

“Efforts to gather data on emergency medicine are critical, especially as the nation embarks on health care reform,” said Dr. Angela Gardner, president of ACEP. “This new report makes several critical points about the negative effects of delays in care and anticipated increases in emergency visits. However, the mortality rates in this report are a measure of inpatient hospital care, not just emergency care.”

EPINEPHrine pre-filled syringe shortage

From the American Society of Health-System Pharmacists

EPINEPHrine emergency syringes 1 mg/10 mL (0.1 mg/mL) are currently on backorder from the sole manufacturer of this product. Although the shortage is expected to resolve later this summer, practitioners should be aware of risk for error created by the shortage.