Physicians Should Decline Facebook ‘Friend’ Appeals from Patients

From MedPage Today:

Physicians should avoid making or accepting “friend” requests through social networking websites with past or current patients, a new policy statement advises.

Instead, doctors should separate their professional and social lives online and direct patients to correct avenues of information if they contact doctors through social networks, according to the policy statement issued jointly on Thursday by the American College of Physicians (ACP) and the Federation of State Medical Boards (FSMB).

“There’s this notion of blurring of our identity, blurring of our persona,” David Fleming, MD, chair of ACP’s Ethics, Professionalism, and Human Rights Committee, which helped draft the guidelines, said here at the ACP’s annual meeting.

“With Facebook, where we get in trouble at times as professionals is when we start friending patients in ways that are perhaps inappropriate, or when patients start friending us,” Fleming said.

Increasing the role of nurse practitioners in the inpatient setting

From Kevin MD:

The doctor shortage will have a profound effect on every community attempting to receive adequate medical care. Using existing resources like NPs will bridge the healthcare gap, but this must be done wisely and carefully to assure patient care is not compromised.

Cost-Effectiveness of Helicopter Versus Ground Emergency Medical Services for Trauma Scene Transport in the United States

From the Annals of Emergency Medicine:

We determine the minimum mortality reduction that helicopter emergency medical services (EMS) should provide relative to ground EMS for the scene transport of trauma victims to offset higher costs, inherent transport risks, and inevitable overtriage of patients with minor injury.

Methods

We developed a decision-analytic model to compare the costs and outcomes of helicopter versus ground EMS transport to a trauma center from a societal perspective during a patient’s lifetime. We determined the mortality reduction needed to make helicopter transport cost less than $100,000 and $50,000 per quality-adjusted life-year gained compared with ground EMS. Model inputs were derived from the National Study on the Costs and Outcomes of Trauma, National Trauma Data Bank, Medicare reimbursements, and literature. We assessed robustness with probabilistic sensitivity analyses.

Results

Helicopter EMS must provide a minimum of a 17% relative risk reduction in mortality (1.6 lives saved/100 patients with the mean characteristics of the National Study on the Costs and Outcomes of Trauma cohort) to cost less than $100,000 per quality-adjusted life-year gained and a reduction of at least 33% (3.7 lives saved/100 patients) to cost less than $50,000 per quality-adjusted life-year. Helicopter EMS becomes more cost-effective with significant reductions in patients with minor injury who are triaged to air transport or if long-term disability outcomes are improved.

Conclusion

Helicopter EMS needs to provide at least a 17% mortality reduction or a measurable improvement in long-term disability to compare favorably with other interventions considered cost-effective. Given current evidence, it is not clear that helicopter EMS achieves this mortality or disability reduction. Reducing overtriage of patients with minor injury to helicopter EMS would improve its cost-effectiveness.