Barriers and Facilitators to CPR Training and Performing CPR in an, Older Population Most Likely to Witness Cardiac Arrest: A National Survey

From Resuscitation:

Background

Bystander CPR rates are lowest at home, where 85% of out-of-hospital cardiac arrests occur. We sought to identify barriers and facilitators to CPR training and performing CPR among older individuals most likely to witness cardiac arrest.

Methods

We selected independent-living Canadians aged ≥55 using random-digit-dial telephone calls. Respondents were randomly assigned to answer 1 of 2 surveys eliciting barriers and facilitators potentially influencing either CPR training or performance. We developed survey instruments using the Theory of Planned Behavior, measuring salient attitudes, social influences, and control beliefs.

Results

Demographics for the 412 respondents (76.4% national response rate): Mean age 66, 58.7% female, 54.9% married, 58.0% CPR trained (half >10 years ago). Mean intentions to take CPR training in the next 6 months or to perform CPR on a victim were relatively high (3.6 and 4.1 out of 5). Attitudinal beliefs were most predictive of respondents’ intentions to receive training or perform CPR (Adjusted OR; 95%CI were 1.81; 1.41-2.32 and 1.63; 1.26-2.04 respectively). Respondents who believed CPR could save a life, were employed, and had seen CPR advertised had the highest intention to receive CPR training. Those who believed CPR should be initiated before EMS arrival, were proactive in a group, and felt confident in their CPR skills had the highest intention to perform CPR.Interpretation: Attitudinal beliefs were most predictive of respondents’ intention to complete CPR training or perform CPR on a real victim. Behavioural change techniques targeting these specific beliefs are most likely to make an impact.

Can elderly patients without risk factors be discharged home when presenting to the emergency department with syncope?

From the Archives of Gerontology and Geriatrics:

Age is often a predictor for morbidity and mortality. Although we previously proposed risk factors for adverse outcome in syncope, after accounting for the presence of these risk factors, it is unclear whether age is an independent risk factor for adverse outcomes in syncope. Our objective was to determine whether age is an independent risk factor for adverse outcome following a syncopal episode. We conducted a prospective, observational study enrolling consecutive patients with syncope. Adverse outcome/critical intervention included hemorrhage, myocardial infarction/percutaneous coronary intervention, dysrhythmia, antidysrhythmic alteration, pacemaker/defibrillator placement, sepsis, stroke, death, pulmonary embolus or carotid stenosis. Outcomes were identified by chart review and 30-day follow-up. We found that of 575 patients, adverse events occurred in 24%. Overall, 35% with risk factors had adverse outcomes compared to 1.6% without risks. Age65 were more likely to have adverse outcomes: 34.5% versus 9.3%, p<0.001. Similarly, among patients with risk factors, elderly patients had more adverse outcomes: 43%; 36–50% versus 22%; 16–30%, p<0.001. However, among patients with no predefined risks, there were no statistical differences: 3.6%; 0.28–13% versus 1%; 0.04–3.8%. This was confirmed in a regression model accounting for the interaction between age>65 and risk factors. Although the elderly with syncope are at greater risk for adverse outcomes overall and in patients with risk factors, age65 alone was not a predictor of adverse outcome in syncopal patients without risk factors. Based on this data, it may be safe to discharge home from the ED patients with syncope, but without risk factors, regardless of age.

NY doctors now required to check drug database

From the Wall Street Journal, via Kaiser Health News:

New York doctors, physician assistants and nurse practitioners are now required to check the new statewide drug database before prescribing painkillers, with pharmacists responsible for recording the related prescriptions they fill.

The law was enacted last year and took effect Tuesday. It’s meant to help practitioners review patients’ drug histories through the state health department’s online registry.

Rates of Emergency Department Visits Due to Pneumonia in the United States, July 2006–June 2009

From Academic Emergency Medicine:

Objectives

Pneumonia hospitalization rates are frequently reported as a measure of pneumonia disease burden in the United States. However, a detailed understanding of pneumonia burden in all health care settings, including the emergency department (ED), is essential for measuring the full effect of this disease on the population and planning and evaluating interventions to reduce pneumonia-related morbidity. The aim of this study was to quantify pneumonia-attributable ED visits in the United States among children and adults during the 3-year period July 2006 through June 2009.

Methods

Rates of pneumonia ED visits were calculated using the Nationwide Emergency Department Sample (NEDS), the largest source of U.S. ED data. Pneumonia ED visits were identified using International Classification of Diseases (ICD) codes within NEDS. A pneumonia ED visit was defined by a primary (first-listed) pneumonia discharge diagnosis or a secondary pneumonia diagnosis with an accompanying primary diagnosis of respiratory failure, shock, septicemia, a sign or symptom consistent with pneumonia, another acute respiratory infection, or an acute exacerbation of a chronic pulmonary disease. Population-based annual rates of pneumonia ED visits stratified by age group and geographic region from July 2006 through June 2009 were calculated. The percentages of pneumonia ED visits resulting in treat-and-release outpatient ED visits were also calculated within each age stratum.

Results

During the study period, 6,917,025 ED visits for pneumonia were identified, representing 2.2% of all U.S. ED visits. During the 3 study years, defined as July through June of 2006–2007, 2007–2008, and 2008–2009, pneumonia ED visit rates per 1,000 person-years were 7.4 (95% confidence interval [CI] = 7.0 to 7.8), 7.8 (95% CI = 7.3 to 8.2), and 7.6 (95% CI = 7.1 to 8.0), respectively. Annual rates were stable over the 3 years within each age group and geographic region. Overall, 39.3% of pneumonia ED visits, including 74.5% of pediatric and 28.1% of adult visits, were managed as treat-and-release outpatient visits.

Conclusions

Pneumonia accounts for 2.2% of ED visits in the United States and results in approximately seven to eight ED visits per 1000 persons per year. A substantial proportion of pneumonia cases diagnosed in the ED are managed in treat-and-release ED outpatient visits, highlighting that enumeration of ED visit rates provides important complementary information to hospitalization rates for the assessment of pneumonia burden.

Interhospital Transfers from U.S. Emergency Departments: Implications for Resource Utilization, Patient Safety, and Regionalization

From Academic Emergency Medicine:

Objectives

The authors sought to describe the demographic and clinical characteristics of interhospital transfers from U.S. emergency departments (EDs) along with the primary reasons for transfers.

Methods

This was a retrospective, cross-sectional analysis of the 1997 through 2009 National Hospital Ambulatory Medical Care Survey (NHAMCS). Visit-level characteristics were compared for patients who were transferred, admitted, or discharged. Additionally, data on primary reason for transfer for available years (2005 through 2008) were reviewed. Weighted analyses produced nationally representative estimates.

Results

During this time period, 1.8% (95% confidence interval [CI] = 1.7% to 2.0%) of ED patients were transferred to other hospitals. Compared to visits resulting in admission, those resulting in transfer were more likely to involve patients who were <18 years old (18% vs. 7.9%), male (53% vs. 46%), with Medicaid (22% vs. 16%) or self-payment (15% vs. 8.2%) as a primary expected source of payment, having a visit related to injury (40% vs. 19%), and from a nonurban ED (29% vs. 15%). Among transferred patients, 28% (95% CI = 27% to 30%) received four to six diagnostic tests, and 31% (95% CI = 29% to 34%) received more than six diagnostic tests prior to transfer; 52% (95% CI = 50% to 54%) had diagnostic imaging, and 17% (95% CI = 16% to 19%) had cross-sectional imaging. Of the patients transferred from 2005 through 2008, 47% (95% CI = 43% to 53%) were transferred for a higher level of care, and 29% (95% CI = 26% to 35%) were transferred for psychiatric care.

Conclusions

Transfer of ED patients was relatively rare, but was more common among specific, potentially high-risk populations. Diagnostic testing, including advanced imaging, was common prior to transfer. A majority of transfers were for reasons indicating limited resources or expertise at the referring facility.

A placebo of kindness

A placebo of kindness

From Indexed

Residents can’t admit patients?

From Fierce Healthcare:

While the final rule issued Aug. 2 by the Centers for Medicare & Medicaid Services clarifies when a patient should be admitted to the hospital, the finalized Hospital Inpatient Prospective Payment System (IPPS) unintentionally prevents medical residents from admitting patients, Bloomberg BNA reported.

As stated, the IPPS final rule requires the order to admit a patient must be written by a practitioner “who has admitting privileges at the hospital”–something few residents have, the Association of American Medical Colleges (AAMC) told CMS last week in a letter.