Some hospitals are taking a different approach to reducing the use of emergency departments for minor health problems: charging patients who show up for what the hospital considers to be a non- urgent situation with an up-front fee. In 2004, a Houston-area hospital was the first member of the HCA system to charge an up-front ED fee for nonurgent care, according to HCA spokesperson Ed Fishbough. Since then, similar policies have been implemented at 76 of 163 HCA hospitals.
When a patient with a sore throat, earache or other minor ailment heads to the emergency department for a cure, there are a raft of consequences every hospital is familiar with: longer waits for patients with more serious conditions, higher costs for the patient and the hospital, and the challenge of treating a patient in a less-than-ideal care setting. While hospitals are required by EMTALA to take care of all comers, leaders at Presbyterian Healthcare Services in New Mexico have been testing an innovative strategy for dealing with non-emergencies in the ED — they screen patients for more serious problems before sending them on their way to a primary care appointment arranged by the hospital.
The first question that comes to mind, of course, is how a program that sends patients out of the ED complies with EMTALA, but hospital leaders say the ED fulfills the screening requirements required by federal law before deciding whether a patient should be directed to primary care.
“We asked all of those questions right off the bat,” Jim Hinton, president and CEO of Presbyterian Healthcare Services, says. “We’re more than satisfied our program meets the letter and spirit of EMTALA.”
From the Journal of Emergency Medicine:
BACKGROUND: Emergency physicians and nurses are frequently dissatisfied professionally when treating alcohol-intoxicated patients, and have negative attitudes towards this patient population and alcohol rehabilitation.
STUDY OBJECTIVES: The goal of this study is to examine differences in attitudes between emergency physicians and nurses towards alcohol-intoxicated patients.
METHODS: This single-site survey study evaluated emergency physicians’ and nurses’: 1) attitudes of personal professional satisfaction and dissatisfaction when caring for intoxicated patients; 2) attitudes towards the difficulty in caring for alcohol-intoxicated patients; 3) attitudes towards respect of the alcohol-intoxicated patient; 4) attitudes towards the adequacy of training in caring for intoxicated patients; 5) attitudes towards rehabilitation and counseling of alcohol-intoxicated patients.
RESULTS: Physicians were less satisfied and more dissatisfied than nurses when caring for alcohol-intoxicated patients. Physicians found treating alcohol-intoxicated patients more difficult than nurses did. Physicians were more likely to agree that alcohol-intoxicated patients should be treated with respect. Physicians felt more adequately trained than nurses in caring for alcohol-intoxicated patients. Nurses were more likely to believe that alcohol-related rehabilitation is ineffective compared with physicians. Both nurses and physicians refer alcohol-intoxicated patients to rehabilitation to a similar extent.
CONCLUSIONS: Emergency physicians and nurses have similar attitudes but significant differences in the extent of these attitudes towards the care of the alcohol-intoxicated patient.
From EurekAlert (press release):
Contrary to what many trauma teams believe, the presence of family members does not impede the care of injured children in the emergency department, according to a study to be presented Saturday, April 28, at the Pediatric Academic Societies (PAS) annual meeting in Boston.
Professional medical societies, including the American Academy of Pediatrics and the American College of Emergency Physicians, support family presence during resuscitations and invasive procedures. The degree of family member involvement ranges from observation to participation, depending on the comfort level of families and health care providers.
“Despite the many documented family and patient benefits and previous studies that highlight the safe practice of family presence, trauma providers remain hesitant to adopt this practice,” said lead author Karen O’Connell, MD, FAAP, a pediatric emergency medicine attending physician at Children’s National Medical Center in Washington, D.C. “A common concern among medical providers is that this practice may hinder patient care, either because parents will actually interfere with treatment or their presence will increase staff stress and thus decrease procedure performance.”