Use of capnography during pediatric procedural sedation

From the Sacramento Bee:

The safety of children could be at risk when they undergo common procedures involving sedation, such as for fracture reduction, laceration repair, and incision and drainage of an abscess.

As a recent study published in Pediatric Emergency Care found, 72% of the episodes of prolonged hypoxia were preceded by decreases in ETco2 as measured by capnography. This suggests that the use of capnography would enhance patient safety by decreasing the frequency of hypoxia during sedation in children. A capnograph is monitoring device that measures the concentration of carbon dioxide that a person breathes out in exhaled air and displays on a numerical readout and waveform tracing. For links to the study:

Medical liability concerns drive hospital admission decisions

From AmedNews:

Medical liability is a key reason physicians admit more emergency department patients and discharge them less, say two studies in the October Annals of Emergency Medicine.

In one study, a survey of 849 emergency physicians and patients in two inner-city emergency departments found that 11% of physicians reported “medico-legal” concerns as a primary driver for admitting patients with potential acute coronary syndrome (

In another study, researchers compared admission rates for congestive heart failure patients in 27 emergency departments in New Jersey and New York between 1996 and 2010. The percentage of such patients discharged from EDs dropped from 24% to 9%.

Concerns about medical liability probably were the reason behind the decreased discharges, study authors said (

Targeting the neediest, health teams trim ER loads


The difference this year: the intervention of new “high-utilizer” teams formed as part of the nascent Trenton Health Team, a collaboration between Trenton’s hospitals, the city’s health department and the Henry J. Austin Health Center.

The teams try to identify frequent patients at each of the city’s emergency rooms and find ways to manage their care and treatment on an individual basis.

Paramedics may sidestep rural emergency rooms in trauma cases

From The Guardian:

Changes being implemented this month will allow paramedics to sidestep rural emergency rooms and take patients experiencing trauma directly to one of Prince Edward Island’s two referral hospitals

Until now, paramedics were encouraged to take most patients to the nearest emergency room.

Mountain View Regional wants to close ER

From the Wyoming Business Report:

The Wyoming State Health Department has received an application from Mountain View Regional Hospital (MVRH) in Casper to close their emergency room. The application was received October 31 and has the support of Wyoming Medical Center.

The application for a variance in emergency services is under review by the state. It is the first such application to be received under new rules governing such actions. Laura Hudspeth of the State Health Department said she didn’t know how long it would take to complete review of the application. The rule change basically says that if another emergency room is located within 10 miles a variance can be approved.

Value Based Purchasing of Emergency Care – Part 2 Recommendations for Providers

From ACEP’s The Central Line:

This is Part 2, outlining suggested strategies (dos and don’ts) for providers of emergency care who want to prepare for value based purchasing under health reform.  It is primarily aimed at emergency physicians and other hospital-based providers, but also applies to specialists providing on-call backup services to ER patients.

• Don”t assume that because your hospital’s business model is predicated on exploiting the fee-for-service payment system, and avoiding at all costs going ‘at risk’ for the care of managed care enrollees; you should avoid talking to your hospital CEO about future payment models predicated on value based purchasing of hospital and physician services.  They all know it’s coming, and they will appreciate that you are thinking about it as well.

Do consider doing your homework, reading up on VBP and payment reform and how it may affect hospital-based providers, and anticipating how you and your group will respond when your hospital begins to align its business model (and its medical staff) to the new reimbursement paradigm.