McDonald’s May Drop Health Plan

From the Wall Street Journal:

McDonald’s Corp. has warned federal regulators that it could drop its health insurance plan for nearly 30,000 hourly restaurant workers unless regulators waive a new requirement of the U.S. health overhaul.

The move is one of the clearest indications that new rules may disrupt workers’ health plans as the law ripples through the real world.

Trade groups representing restaurants and retailers say low-wage employers might halt their coverage if the government doesn’t loosen a requirement for “mini-med” plans, which offer limited benefits to some 1.4 million Americans.

The requirement concerns the percentage of premiums that must be spent on benefits.

While many restaurants don’t offer health coverage, McDonald’s provides mini-med plans for workers at 10,500 U.S. locations, most of them franchised. A single worker can pay $14 a week for a plan that caps annual benefits at $2,000, or about $32 a week to get coverage up to $10,000 a year.

Last week, a senior McDonald’s official informed the Department of Health and Human Services that the restaurant chain’s insurer won’t meet a 2011 requirement to spend at least 80% to 85% of its premium revenue on medical care.

McDonald’s and trade groups say the percentage, called a medical loss ratio, is unrealistic for mini-med plans because of high administrative costs owing to frequent worker turnover, combined with relatively low spending on claims.

A reduction in perceived pain levels does directly relate to several indicators of customer service

From the Journal of Emergencies, Trauma and Shock:

Pain management in the emergency department and its relationship to patient satisfaction

Background : Pain is the most common reason due to which patients come to the emergency department (ED). Aim : The purpose of this study was to measure the correlation, if any, between pain reduction and the level of satisfaction in patients who presented to the ED with pain as their chief complaint. Materials and Methods : This study used a randomly selected group of patients who presented to the ED with pain of 4 or more on the Visual Analogue Pain Scale (VAS) as their chief complaint to a level one adult and pediatric trauma center. Instruments that were used in this study were the VAS, Brief Pain Inventory (BPI), and the Medical Interview Satisfaction Scale (MISS). They were administered to patients by research fellows in the treatment rooms. Statistical analysis included frequencies, descriptive, and linear regression. This study was approved by the Internal Review Board. Results : A total of 159 patients were enrolled in the study. All patients were given some type of treatment for their pain upon arrival to the ED. A logistic regression showed a significant relationship to reduction in pain by 40% or more and customer service questions. Conclusions : A reduction in perceived pain levels does directly relate to several indicators of customer service. Patients who experienced pain relief during their stay in the ED had significant increases in distress relief, rapport with their doctor, and intent to comply with given instructions.

Using AHA 2005 Guidelines Improves Outcomes

From Heart Rhythm:

Implementing the 2005 American Heart Association Guidelines improves outcomes after out-of-hospital cardiac arrest

The purpose of the study was to determine whether applying highly recommended changes in the 2005 American Heart Association (AHA) Guidelines would improve outcomes after out-of-hospital cardiac arrest.

Conclusions: Compared with controls, patients with out-of-hospital cardiac arrest treated with a renewed emphasis on improved circulation during CPR had significantly higher neurologically intact hospital discharge rates.

St. Anthony’s Sim Lab Director

From the Iowa Hospital Association:

Sara Fleecs, BSN, RN
Clinical Staff Educator/Simulation Coordinator
St. Anthony Regional Hospital, Carroll

I currently work in education and strive to develop experiences that will meet the educational needs of the staff working front line with patients and residents. It is challenging to keep education fresh, applicable and founded in evidence-based practice. The rewards are many and come from staff reporting that a training experience met their needs and they feel confident returning to work to perform skills included in the training. I have seen first-hand that training and education positively impact patient care. Health care requires that all members of the team be committed to life-long learning and it is great to be a part of that process.

Clown Responders Save Heart Attack Victim at Idaho Fair

From EMS World:

When a person suffered a heart attack at the Nez Perce County Fair this weekend, the first emergency personnel on the scene were a couple of clowns, Lewiston Fire Chief Gordy Gregg said Monday.


Two firefighters who don clown outfits as part of their public education duties did CPR on the victim until the ambulance and its crew arrived, Gregg said.

Motivations and Barriers for Recruitment of New Emergency Medicine Residency Graduates to Rural Emergency Departments

From the Annals of Emergency Medicine:

Study objective

We sought to understand the motivations and barriers for recruitment of new emergency medicine residency graduates to rural emergency departments (EDs).


We used the American Medical Association Physician Masterfile to identify 2006 to 2008 emergency medicine residency graduates and then surveyed everyone currently practicing in rural EDs and a random sample of those practicing in urban EDs. We asked these emergency physicians about the importance of various factors in their choice of practice location.


We received responses from 197 (67%) of 296 eligible emergency physicians in 47 states. The factors most often rated as “somewhat” or “very” important in choice of practice location were lifestyle (98%), access to amenities/recreation (95%), ED volume/acuity (93%), and family/spouse (90%). Access to specialists was the biggest difference between groups (very important=20% for rural versus 44% for urban; Δ24%; 95% confidence interval −37% to −11%). More rural emergency physicians spent their entire childhood in rural areas than urban emergency physicians. The changes that would have most influenced urban emergency physicians to practice in rural communities were family/spouse connection (92%), higher salary/signing bonus (90%), and increased access to specialists (90%). Of urban emergency physicians who did not participate in a rural rotation during residency, 44% said they would have, if it had been available.


Promising strategies for recruiting new emergency medicine residency graduates to rural EDs are emergency medicine residency selection of individuals with a rural upbringing and higher salaries. Increasing the availability of rural rotations during emergency medicine residency also may help to motivate and prepare some new graduates to practice in rural EDs.

Practicing EM Under Health Reform – the New Paradigm PART I

From ACEP’s The Central Line:

Imagine that you are the medical director of an ED, and you decide to take to your hospital administrator a new set of cost-effective care policies that are designed to reduce the percent of admissions from your ED from 17% to 15%. In some hospitals, you might be met with incredulity: why would you do something like this when if would cost your hospital hundreds of thousands of dollars in revenue every month? You might be looking for another job.

New ED program emphasizes extra fast, extra easy, extra great patient care and customer service

From the Courier-Gazette:

Mesquite, Texas— “ER Extra” is a revolutionary emergency room experience aimed at making sure patients get the care they need in a prompt and courteous manner. The implementation of “ER Extra” at Dallas Regional Medical Center will streamline the process while simultaneously keeping patients and their families informed about what to expect.

“A smooth visit from start to finish is our goal at Dallas Regional Medical Center, and “ER Extra” is giving our staff, nurses and physicians the necessary tools to make this a reality for each and every patient we meet,” said Ken Ward, interim CEO .

Baby found alive in a plastic bag in the woods

From the Daily Press:

A contractor working on a nearby house heard the infant’s crying and discovered the baby girl, wrapped in a knotted plastic trash bag and towels, in the wooded backyard of a one-story house around noon Friday. The baby did not have any life-threatening injuries and was taken to a local hospital for treatment.

ED Waiting Times on Billboards

From Fox News:

Still, some doctors have diagnosed these advertisements as being bad for your health. Dr. Michael Gerardi from the American College of Emergency Physicians recently expressed his concern. “What we’re afraid of is that if you post times like that, it’s going to dissuade or discourage people to go to a good hospital and bypass it for another hospital maybe 20-30 minutes away- and that can mean life or death,” said Dr. Gerardi. “It could mean being in a wheelchair after your stroke, to walking out of the hospital. I can’t emphasize enough that you cannot triage yourself or self-determine where you’re going.” He urges patients to, “go to the nearest hospital you trust, and get seen.”