The 3 top healthcare industry staffing challenges–and how to solve them

From Fierce Healthcare:

1. The need for primary care and emergency department physicians
As the industry shifts to outpatient services, patient-centered medical homes and preventive care in response to healthcare reform, hospitals will need to add primary care practitioners to their medical staffs.

But the primary care physician shortage, already acute, will worsen, says Bill Fera, M.D., chief medical officer for Ernst & Young’s Health Advisory Group, in Pittsburgh, Pa.

In addition, Lynch says there will be a corresponding shortage in physicians specializing in emergency medicine, as the influx of newly insured patients will be more likely to present to emergency departments than before, even for routine care, because they don’t have a regular physician. “Health reform is really making the shortage [of these physicians] come to light,” Lynch says.

Solution: Employ more physicians; use more mid-level staff. Some hospitals are filling the gaps by moving to an employment model for the specialties they need, buying physician practices and employing physicians on a full-time basis.

Hospitals should also consider hiring more mid-level professionals. Allied clinicians, such as nurse practitioners and certified registered nurse anesthetists, are a lower-cost alternative to physicians for staffing healthcare services, such as urgent care centers and telehealth programs. “Care extenders can deal with a lot of short fall and fill in gaps. They’ll be picking up the slack when there aren’t enough physicians,” says Fera.

Hospital Emergency Room Visits per 1,000 Population

Hospital Emergency Room Visits per 1,000 Population

Kaiser Foundation State Health Facts

Patients Can Pay A High Price For ER Convenience

From NPR, via Kaiser Health News:

Medical entrepreneurs are remaking the emergency room experience. They’re pulling the emergency room out of the hospital and planting it in the strip mall.

It’s called a “free-standing ER,” and some 400 of them have opened across the country in the past four years.

The trend is hot around Houston, where there are already 41 free-standing ERs and 10 more in the works.

“I think these emergency medical centers are springing up like Texas wildflowers in the springtime,” says Vivian Ho, a health economist at Rice University in Houston. “It’s really amazing.”

Some of the new facilities are owned by hospitals, but the majority are owned by for-profit companies. Ho says they may offer excellent care, but they’re also chasing profits.

D.C. Ambulance in Presidential Motorcade Runs Out of Gas

From JEMS:

As President Obama travels to and from the White House in his motorcade, the number one concern is keeping him safe. A critical constant is a DC Fire and EMS ambulance, typically Medic 1, that trails behind in the event of a medical emergency.

But on August 8, as the President and First Lady were leaving the White House to celebrate Mr. Obama’s 52nd birthday at the restaurant Rasika in West End, Medic 1 ran out of gas.

Lifelong Learning and Self-assessment Is Relevant to Emergency Physician

From the Journal of Emergency Medicine:

Background

The Lifelong Learning and Self-assessment (LLSA) component of the American Board of Emergency Medicine (ABEM) Maintenance of Certification (MOC) program is a self-assessment exercise for physicians. Beginning in 2011, an optional continuing medical education (CME) activity was added.

Objectives

As a part of a CME activity option for the LLSA, a survey was used to determine the relevancy of the LLSA readings and the degree to which medical knowledge garnered by the LLSA activity would modify clinical care.

Methods

Survey results from the 2011 LLSA CME activity were reviewed. This survey was composed of seven items, including questions about the relevancy of the readings and the impact on the physician’s clinical practice. The questions used a 5-point Likert scale and data underwent descriptive analyses.

Results

There were 2841 physicians who took the LLSA test during the study period, of whom 1354 (47.7%) opted to participate in the 2011 LLSA CME activity. All participants completed surveys. The LLSA readings were reported to be relevant to the overall clinical practice of Emergency Medicine (69.6% strongly relevant, 28.1% some relevance, and 2.3% little or no relevance), and provided information that would likely help them change their clinical practices (high likelihood 38.8%, some likelihood 53.0%, little or no change 8.2%).

Conclusions

The LLSA component of the ABEM MOC program is relevant to the clinical practice of Emergency Medicine. Through this program, physicians gain new knowledge about the practice of Emergency Medicine, some of which is reported to change physicians’ clinical practices.

Comparison of Bag-Valve-Mask Hand-Sealing Techniques in a Simulated Model

From the Annals of Emergency Medicine:

Study objective

Bag-valve-mask ventilation remains an essential component of airway management. Rescuers continue to use both traditional 1- or 2-handed mask-face sealing techniques, as well as a newer modified 2-handed technique. We compare the efficacy of 1-handed, 2-handed, and modified 2-handed bag-valve-mask technique.

Methods

In this prospective, crossover study, health care providers performed 1-handed, 2-handed, and modified 2-handed bag-valve-mask ventilation on a standardized ventilation model. Subjects performed each technique for 5 minutes, with 3 minutes’ rest between techniques. The primary outcome was expired tidal volume, defined as percentage of total possible expired tidal volume during a 5-minute bout. A specialized inline monitor measured expired tidal volume. We compared 2-handed versus modified 2-handed and 2-handed versus 1-handed techniques.

Results

We enrolled 52 subjects: 28 (54%) men, 32 (62%) with greater than or equal to 5 actual emergency bag-valve-mask situations. Median expired tidal volume percentage for 1-handed technique was 31% (95% confidence interval [CI] 17% to 51%); for 2-handed technique, 85% (95% CI 78% to 91%); and for modified 2-handed technique, 85% (95% CI 82% to 90%). Both 2-handed (median difference 47%; 95% CI 34% to 62%) and modified 2-handed technique (median difference 56%; 95% CI 29% to 65%) resulted in significantly higher median expired tidal volume percentages compared with 1-handed technique. The median expired tidal volume percentages between 2-handed and modified 2-handed techniques did not significantly differ from each other (median difference 0; 95% CI –2% to 2%).

Conclusion

In a simulated model, both 2-handed mask-face sealing techniques resulted in higher ventilatory tidal volumes than 1-handed technique. Tidal volumes from 2-handed and modified 2-handed techniques did not differ. Rescuers should perform bag-valve-mask ventilation with 2-handed techniques.

Equipment to prevent, diagnose, and treat hypothermia

From the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine:

Introduction

Hypothermia is associated with increased morbidity and mortality in trauma patients and poses a challenge in pre-hospital treatment. The aim of this study was to identify equipment to prevent, diagnose, and treat hypothermia in Norwegian pre-hospital services.

Method

In the period of April-August 2011, we conducted a survey of 42 respondents representing a total of 543 pre-hospital units, which included all the national ground ambulance services, the fixed wing and helicopter air ambulance service, and the national search and rescue service. The survey explored available insulation materials, active warming devices, and the presence of protocols describing wrapping methods, temperature monitoring, and the use of warm i.v. fluids.

Results

Throughout the services, hospital duvets, cotton blankets and plastic “bubble-wrap” were the most common insulation materials. Active warming devices were to a small degree available in vehicle ambulances (14%) and the fixed wing ambulance service (44%) but were more common in the helicopter services (58-70%). Suitable thermometers for diagnosing hypothermia were lacking in the vehicle ambulance services (12%). Protocols describing how to insulate patients were present for 73% of vehicle ambulances and 70% of Search and Rescue helicopters. The minority of Helicopter Emergency Medical Services (42%) and Fixed Wing (22%) units was reported to have such protocols.

Conclusion

The most common equipment types to treat and prevent hypothermia in Norwegian pre-hospital services are duvets, plastic “bubble wrap”, and cotton blankets. Active external heating devices and suitable thermometers are not available in most vehicle ambulance units.