Arizona Hospital and Healthcare Association loses three members

From the AZCentral:

Arizona’s three largest hospital systems are leaving a statewide hospital lobbying group over concerns about how the group represents the large hospitals on legislative and regulatory issues.

Abrazo Health Care, Banner Health and Dignity Health on Friday informed the Arizona Hospital and Healthcare Association that their membership will end effective March 1.

The pullout by the three hospital systems that represent more than 20 metro Phoenix hospitals comes as larger urban hospitals have faced rising numbers of uninsured patients seeking free or reduced-cost care in hospital emergency rooms. The hospitals say the rise in uninsured patients follows the Legislature’s cuts to the state’s Medicaid program and Arizona’s tepid economic recovery.

Physicians Adapting Smartphone Use to Patient Care

From JEMS:

Physicians are also texting information and photographs to each other using smartphones. What are the ramifications for patient privacy? It’s hospital policy that health care providers separate personally identifiable information from, for example, images, or X-rays of the patient when emailing, texting, or videoconferencing.

Amar Patel, Director of WakeMed’s Center for Innovative Learning investigated and designed the video conferencing pilot study. Patel said that while he understands that there are concerns about patient privacy, he thinks virtual face-to-face video conferencing is more private than telephone conferences.

Hospital reorganization gives doctors more control

From the Des Moines Register:

Mercy Medical Center Des Moines is reorganizing its administrative structure effective on Feb. 1 to give physicians more control, responsibility and accountability.

“The current structure is very hospital-centric and less physician-centric,” said Mercy chief executive David Vellinga.

The new structure places seven physicians in lead roles where they will partner with non-medical administrators to develop strategy and ensure proper delivery of medical care and services at the hospital.

Telemedicine: Now It’s A Must

From H&HN:

Driven by a desire to improve the quality of and access to care, health systems both large and small are tapping into the power of telemedicine at a feverish pace.

But clinical considerations aren’t the only market forces driving adoption. Supply-and-demand economics, the utility and reliability of new wireless devices and cost pressures are also significant factors.

Optimal patient communication in the ED taught via simulation

From MedicalXPress:

Principal investigator and lead author Lynn Sweeney, M.D., an emergency medicine physician at Rhode Island Hospital, is a member of the hospital’s Simulation Center. Sweeney and her colleagues developed Project CLEAR! (Communication Leading to Excellence and Ameliorating Risk) to give structure and consistency to the manner in which staff communicate with each other and with patients. “This is the first program that we know of its kind to combine traditional teamwork training with simulation-based customer service training,” Sweeney says.

“Excellence in health care is no longer defined merely by the quality of clinical care offered, but also by the superiority of service provided to those who seek care. The importance of patient satisfaction has grown over the past decade,” she adds. “To be recognized as a top-quality organization, we have to not only provide exceptional care, but our patients and their families have to truly feel how much we care about them.”

Project CLEAR! has provided training for a staff of nearly 400, including nurses, physicians, medical assistants and secretaries in one of the busiest emergency departments in the country. The CLEAR! training day includes a 7-hour interactive experience that features three medical simulation scenarios using both standardized patients and high-fidelity manikans, to teach both Crew Resource Management concepts and customer-service. The simulation scenarios are used to elicit specific teaching points that will impact quality of care, safety and service.

Switching from the Endotracheal to Laryrnygeal tube

From Anaesthesist via PubMed:

Implementation of the laryngeal tube for prehospital airway management : Training of 1,069 emergency physicians and paramedics

OBJECTIVE: The European Resuscitation Council recommends that only rescuers experienced and well-trained in airway management should perform endotracheal intubation. Less trained rescuers should use alternative airway devices instead. Therefore, a concept to train almost 1,100 emergency physicians (EP) and emergency medical technicians (EMT) in prehospital airway management using the disposable laryngeal tube suction (LTS-D) is presented.

METHODS: In five operational areas of emergency medicine services in Germany and Switzerland all EPs and EMTs were trained in the use of the LTS-D by means of a standardized curriculum in the years 2006 and 2007. The main focus of the training was on different insertion techniques and LTS-D use in children and infants. Subsequently, all prehospital LTS-D applications from 2008 to 2010’were prospectively recorded.

RESULTS: None of the 762 participating EMTs and less than 20% of the EPs had previous clinical experience with the LTS-D. After the theoretical (practical) part of the training, the participants self-assessed their personal familiarity in using the LTS-D with a median value of 8 (8) and a range of 2-10 (range 1-10) of 10 points (1: worst, 10: best). Within the 3-year follow-up period the LTS-D was used in 303 prehospital cases of which 296 were successfully managed with the device. During the first year the LTS-D was used as primary airway in more than half of the cases, i.e. without previous attempts of endotracheal intubation. In the following years such cases decreased to 40% without reaching statistical significance. However, the mean number of intubation attempts which failed before the LTS-D was used as a rescue device decreased significantly during the study period (2008: 2.2 ± 0.3; 2009: 1.6 ± 0.4; 2010: 1.7 ± 0.3).

CONCLUSION: A standardized training concept enabled almost 1,100 rescuers to be trained in the use of an alternative airway device and to successfully implement the LTS-D into the prehospital airway management algorithm. Because the LTS-D recently became an accepted alternative to endotracheal intubation in difficult airway scenarios, the number of intubation attempts before considering an alternative airway device is steadily decreasing.

Doctor Says Air Ambulance’s Design Is too Risky for Patients

From JEMS:

Ed. This is an AW 139, not ORNGE’s exact ship.

ORNGE’s top doctor has checked out the medical interior of the air ambulance’s multimillion-dollar helicopters and found a disaster waiting to happen.

Dr. Bruce Sawadsky, in a report written Monday, calls the cramped interior of the brand new AW 139 helicopter a “high risk environment.”

His findings? Tough to do CPR. Hard to prop up a patient who is having difficulty breathing. Takes too long to load and unload a patient. Risky, too. Many equipment malfunctions.