ED LoS and Time to Be Seen

From The World:

Whether you’re feeling nauseated or suffering a strange pain in your gut, little can be more stressful than sitting in a packed waiting room.

Coos County hospitals, like hospitals across the country, have had varying success minimizing the wait over the years.

Because each hospital measures wait times using different methods and because the hospitals differ in their type, it isn’t fair to rank them against each other. However, it is possible to map trends within them.

ED implements no narcotic prescription policy

From the Moultrie Observer:

Colquitt Regional Medical Center has adopted a procedure that will limit dispensing and prescribing narcotic medications in its emergency room.

The hospital’s new policy is to prescribe no narcotics in the emergency department but to refer patients to specialists who can better evaluate and treat their conditions. The new policy is designed to treat patients in the appropriate setting rather than the emergency department, which is specifically designed to treat emergency cases.

Colquitt Regional’s new procedure will channel patients to physicians who can perform a more thorough evaluation and allow the emergency department to provide a higher quality of care and better access to patients needing emergency care, according to Dena Zinker, MSN, RN, assistant vice president of nursing.

Naked woman wants trip to ER

From the Daily Inter Lake Law Roundup:

The Kalispell Police Department received a report of a nude man and woman walking down an alley off Third Avenue East. The woman was holding her hands in front of her as if meditating, and when confronted by police told them only that she wanted to go to the emergency room, although she wouldn’t give a reason why.

Also in the Roundup: The Flathead County Sheriff’s Office received a report from a Kalispell resident who said someone is intentionally poisoning him because he witnessed an attempted murder.

Random Medical News

Wife’s ER trip ends up saving husband’s life

From MyFoxTampaBay:

Wayne Nelson was one heart beat away from missing his 79th birthday, and his medical miracle began with his wife Donna.

Late one night, she complained of severe abdominal pain. Wayne rushed her to the emergency room at Blake Medical Center in Bradenton, where she was diagnosed with appendicitis and needed emergency surgery.

The worried husband and father called his daughter to let her know, not realizing he was about to have his own life-threatening emergency.

Donna describes watching Wayne as he spoke on the phone.

“All of a sudden, he was talking, he started speaking garble. I couldn’t understand what he was saying, and I looked over and he was sliding out of his chair, ” she said.

Wayne’s heart suddenly and unexpectedly stop beating. The emergency team at the hospital stabilized Wayne and revived his heart.

Comparison of Baldrige Award Applicants and Recipients with Peer Hospitals on a National Balanced Scorecard SCORECARD

From Thomson Reuters (pdf)

The results demonstrate that hospitals using the Baldrige process exhibit signiicantly higher rates of improvement in balanced organizational performance than non-Baldrige hospitals. And hospitals using the Baldrige process are signiicantly more likely than peers to become 100 Top Hospitals award winners, thereby achieving performance equal to or better than the top 3 percent. Although the Baldrige process and the 100 Top Hospitals statistical measurements are quite different, the results of this study suggest that the methods are complementary and identify similarly high-achieving organizations.

Half of health execs use patient satisfaction as physician incentive

From Fierce Healthcare:

With quality performance tied to hospital reimbursements and revenue, leaders are using those same scores to decide how to pay their physicians. Fifty-seven percent of healthcare executives and clinical leaders use quality metrics as an incentive for physician compensation, with 50 percent now using patient satisfaction as incentives, according to a HealthLeaders Media report released this week.

Power Outage Creates Mass Casualty Incident With 15 Ventilator Failures

From JEMS:

On May 26, 2011 the NPVFD was dispatched to a local nursing home due to a power failure. To complicate matters, a lightning strike the prior day had damaged the facility’s backup generator. The greatest concern was that the facility had 15 patients on ventilators at the time of the power failure. Although ventilators have their own internal batteries, these batteries provide a limited amount of operation time.

Additionally, the facility’s oxygen generator was out of service due to the power loss. Initial arriving EMS providers were confronted with an MCI involving multiple patients in need of respiratory support, with the potential for other patients to start developing medical problems due to a non-functioning heating, ventilation and air conditioning system.

Emergency Medicine Workforce Issues: Rural ED’s

From ACEP’s Scientific Assembly News:

“We don’t have the capacity now or ever to fill the emergency departments within the country” with residency-trained, board-certified emergency physicians, Dr. Angela F. Gardner said at a session on emergency medicine workforce issues at the Scientific Assembly of the American College of Emergency Physicians.

Proposed solutions included defining the minimum competencies, skills, and knowledge necessary for emergency care and exploring the role of nonemergency specialists. Models must be developed to fund residencies and rural electives in emergency medicine.

The idea of rural electives generated much debate about whether this would encourage physicians to join rural practices, but “if they don’t get some exposure to rural environments, there is no chance” that they will do so except for personal reasons, Dr. Gardner said.

Summit participants agreed that the skills needed for rural emergency care are the same or greater than for nonrural care, and that there is a maldistribution of emergency physicians. To deal with this, they proposed expanding the number of emergency medicine residencies, which is “not likely to happen any time soon,” she said.

Literature Review: Do/Don’t Scan the Trauma Patient

From Emergency Medicine Literature of Note:

In a study attempting to build consensus, they discovered philosophical differences between the trauma team and the emergency physician.

This is a prospective observational study in which 701 blunt trauma activations at LAC-USC were enrolled, with the EP and the trauma team each giving an opinion on which CT studies were necessary.  The authors then reviewed which scans were obtained, sorted out the scans that were undesired by one or both physicians, and determined whether any injuries would be missed.

Bafflingly, 7% of the 2,804 scans obtained during the study period were deemed unnecessary by both the emergency physician and the trauma attending – yet were still performed.  The remaining 794 undesired scans were desired by the trauma team but not the emergency physician.  Their question – would anything of significance been missed if the scans had been more selectively ordered?

The answer is – yes and no.