The exhaustion of emergency physicians, and its toll on patients and family

From Kevin MD:

When I applied for residency, the literature suggested that the burnout associated with practicing EM applies primarily to physicians who weren’t trained in this specialty. But a recent longitudinal study of EM physicians by the American Board of Emergency Physicians shows something different: It reports that one third of EM physicians report burnout. Other studies suggest an increased incidence of breast cancer, obesity and other comorbidities in night shift workers. One survey of EPs over 55 reported several “age related concerns”;  74% found it more difficult  to recover from night shifts, 44% reported a higher level of emotional exhaustion after shifts, 40% were less able to manage high patient volumes, and 36% reported less ability to manage the stress associated with EM practice.

Anecdotal evidence supports these findings. Many of my friends and colleagues who are more than eight years out of residency, claim to be exhausted. One friend has fallen asleep at the wheel, and many complain of bickering at home with spouses and kids because they have no patience after working late evening and night shifts. Some have gained a significant amount of weight and developed hypertension. Others say that days can pass without seeing their children because of the wacky hours. Several have decreased their clinical time significantly or have left clinical medicine completely.

ER Visits Keep Increasing, Survey Finds

From the Hartford Courant:

One of the most frequently mentioned goals of health care reform is reducing expensive emergency room care, but a new survey of emergency room doctors indicates that this will be difficult to achieve.

More than 80 percent of Connecticut doctors responding to a new poll by the American College of Emergency Physicians said that emergency visits are increasing at their hospitals, and more than 95 percent expect increases next year.

These results closely track the national findings of the poll, which was conducted by the American College of Emergency Physicians in March. The group sent an email questionnaire to 20,687 emergency physicians across the country, and 1,768 replied.

“Despite health care reform, the survey concludes that visits to emergency rooms are going to increase across the country, and that having health insurance doesn’t guarantee access to medical care,” said Dr. Darria Long, emergency physician at Yale Department of Emergency Medicine in New Haven.

Kevin MD’s take on Dr. Meisel’s article in TIME

From Kevin MD:

Drs. Pines and Meisel argue against blunt solutions, like the one being proposed in Washington state. Denying ER care to patients can lead to unintended consequences, like the aforementioned societal costs, along with the risk of increased malpractice litigation.

Furthermore, by targeting the ER, such policies also miss the true cause of the problem: a profound lack of primary care access.

World Cup Medics Avoid Basic Blood-Safety Guidelines

From Wired:

On-site medics at the 2010 World Cup in South Africa did not use inexpensive, disease-preventing gloves in any blood-related injury, raising questions about the potential spread of blood-borne diseases at one of the world’s most attended and diverse international sporting events, according to an analysis of match footage.

Through years of watching professional sports, infectious-disease expert Jennifer Furin noticed a disturbing trend: Trainers handling the bloody injuries of athletes often weren’t wearing protective gloves.

Since 1987, the Centers for Disease Control has called for health care workers to use latex or nitrile gloves when dealing with patients’ bodily fluids, a key part of the so-called Universal Precautions that helps prevent the spread of infectious disease from blood-borne pathogens like HIV, hepatitis B orhepatitis C.

Sending CD’s of Radiology Images Decreases Re-Imaging

From 7th Space:

Each year, more than two million critically ill patients are transferred from one hospital emergency department (ED) to another for appropriate care. With the ability to successfully import data from a CD-ROM containing the patient’s diagnostic medical images, hospitals may be able to significantly reduce unnecessary medical imaging tests, some of which expose patients to radiation. These findings are reported in a new study published in the July issue of Radiology.

According to researchers at Brigham and Women’s Hospital in Boston, the implementing a system to upload CD images of emergency transfer patients into the receiving institution’s picture archiving and communication system (PACS) decreased the rate of subsequent imaging by 17 percent.

“”Tweener” Hospitals Get Cost-Based Reimbursement Trial

From H&HN:

Tucked away in the Affordable Care Act is a provision that may give some rural hospitals a little bit of—and much needed—financial breathing room. The law expands the Rural Community Hospital Demonstration Project, which tests what happens when so-called tweener hospitals are paid on cost-based reimbursement. Tweeners are too big to be a critical access hospital, and thus are ineligible for cost-plus reimbursement, but too small to thrive under traditional Medicare PPS. The demonstration actually started in 2004 and was slated to fade into the sunset, but it was given an extra life thanks to the ACA.

Low Income, Poor Insurance Tied to Leaving ED Without Being Seen

From ACEP:

Low-income and poorly insured patients are at a disproportionately increased risk of leaving emergency departments without being seen, according to an analysis of 262 California hospitals.

The proportion of patients who leave emergency departments (EDs) without being seen has increased significantly over the last 15 years, as strains on the emergency care system have mounted. And, although it’s logical to assume that vulnerable populations and the hospitals that serve them are at greatest risk, there are few multicenter studies to show it, said Dr. Renee Y. Hsia of the University of California, San Francisco, and her associates (Ann. Emerg. Med. 2011 Feb. 21 [doi:10.1016/j.annemergmed.2011.01.009]).

“Patients who leave without being seen from an ED are a glaring measure of impaired health care access. Their observed behavior represents individual attempts to enter the health care system without success. Our study provides descriptive data about [patients who] left without being seen from a large statewide cohort of hospital EDs. … The increasing phenomenon of left without being seen patients differentially affects those at hospitals that tend to serve the most vulnerable. Real action and resources should be applied to address the disparities on a systems level,” the investigators said.