Some success for ER effort to boost primary-care follow up

From Modern Physician:

An effort to connect non-emergent ER patients with a primary-care provider showed some success in increasing primary-care follow-up over the next year, a new study finds.

The study is published on the Annals of Emergency Medicine’s website. In the study of 965 ER patients, conducted at Bellevue Hospital Center, New York, people working as patient navigators tried to identify patients to be transferred to an on-site primary-care clinic, with the idea that patients assigned to a primary-care physician and given care in the clinic would be more likely to make follow-up visits to the clinic. The researchers found that to be the case: After a year, a higher share (9.3% more) of the patients directed to the primary-care clinic had made follow-up visits to the clinic. There was no statistically significant decrease in ER use for this group, however.

Rural hospitals band together to lure physicians

From H&HN:

Earlier this year, the Sunflower Health Network in Salina hired a full-time recruiter for its members. Participating hospitals pay a monthly fee of $125 to seek a midlevel practitioner, and $250 for doctors, along with a $10,000 to $15,000 placement fee if a match is found.

Sunflower’s members already had been collaborating — on everything from joint purchasing to group health insurance — since the mid-1990s, when the network was formed, and it made sense to add recruiting to the mix, says Heather Fuller, Sunflower’s executive director. Members even share a radiologist to help fill in when one goes on vacation.

“It’s so expensive, just like anything else, for the critical access hospitals that don’t have a lot of money,” Fuller says. “They were being charged huge amounts from outside agencies and recruitment firms to get these doctors. So they thought, ‘Why can’t we work together on this, as we have on some of our other ventures and programs in the past?'”

Intravenous Line Placement in the Prehospital Setting

From Prehospital Emergency Care:

Background. Intravenous (IV) line placement is an important prehospital advanced life support skill, but IV success rates are variable among providers. Little is known about what factors are associated with successful IV placement, limiting the ability to develop benchmarks for skill maintenance, such as requiring a specific number of IV placements per year.

Objective. We aimed to identify whether first-pass IV success was associated with the number of attempted or successful previous IV attempts. We hypothesized that IV success is associated with the number of successful IV placements in the preceding year.

Methods. We retrospectively studied 800 consecutive charts with an IV attempt from 11 suburban and rural emergency medical services (EMS) agencies over a one-month period. Cases involving pediatric patients (age <18 years) and those with incomplete data were excluded. Success of the first IV attempt was identified. Potential predictor variables were collected and analyzed by univariate logistic regression, including patient age, systolic blood pressure, history of IV drug abuse or renal disease, traumatic event, catheter size, and location of IV attempt, as well as the individual provider’s numbers of total and successful IV attempts in the preceding year. Variables significantly associated with IV success at the p < 0.10 level were included in a multivariate regression model using a p-value of 0.05.

Results. Of 602 cases meeting the study criteria, 469 (77.9%) had a successful first-pass IV placement. Significantly associated with IV success in the univariate regression were patient age (p = 0.054), trauma (p = 0.074), IV catheter size (p < 0.001), IV location (p = 0.056), and the number of previous successful IV attempts (p = 0.039), whereas the number of total previous IV attempts was not significantly associated (p = 0.871). In the multivariate logistic regression model, only IV catheter size had a significant association (p < 0.001), with a larger-bore IV catheter size associated with higher success.

Conclusion. In this retrospective study, larger IV catheter size, but not the prehospital providers’ previous year’s experience, was associated with successful IV placement in adult patients. These data fail to support requirements for a minimum number of yearly IV placements by full-time paramedics to improve success rates.