Canadian Emergency Department physicians call on government to set standards of care for patients

From 680 News:

Emergency room doctors are calling on the federal and provincial governments to set standards for patient treatment, including the maximum travel time to an emergency department.

The Canadian Association of Emergency Physicians says Ontario is dealing with the problem in many hospitals by keeping emergency rooms open with the help of temporary doctors.

Other provinces have started staffing their emergency rooms overnight with nurses and paramedics.

Prehospital administration of intranasal fentanyl deemed safe

From MedPage Today:

Out-of-hospital administration of intranasal fentanyl by ambulance workers was safe and effective at reducing pain, researchers found.

A Danish study of children and adults with an orthopedic condition, abdominal pain, or acute coronary syndrome and who were not effectively treated with nitroglycerin spray showed treatment with intranasal fentanyl was associated with mild adverse events in 4% of patients, according to Morten Hansen, MD, of Copenhagen University Hospital in Denmark, and colleagues.

Some 79% of participants had clinically relevant pain reduction scores of two or greater, they wrote online in the journal Annals of Emergency Medicine.


Use of Expired Auto-Injectors OK’d by FDA

From MedPage Today:

The FDA cautioned emergency medical staff to retain nearly and recently expired auto-injectors by Meridian Medical Technologies and to use them in emergencies if no other product is available. The action arises because of a supply chain disruption.

The auto-injectors involved include atropine (Atropen) and atropine/pralidoxime chloride (DuoDote), as well as morphine sulfate, pralidoxime chloride, and diazepam auto-injectors from the company “that are nearing or beyond the labeled expiration date” until the agency is able “to provide additional information regarding the continued use of these products,” the FDA said in a statement on its website.

The FDA issued a communication on Sept. 5, 2013 regarding supply issues with the DuoDote auto-injector, stating that certain lots of DuoDote can be used for another year beyond the original expiration date given by the manufacturer.

Iowa Man Accused Of Drunk Driving, Fighting Police While Naked in the ED

From Deadspin:

Police said while in the emergency room lobby, Roberts took off his pants and “caused a scene.” Later, when he was discharged from the hospital, Roberts refused to get dressed and started two fights with the deputy while he was still naked.

“Mr. Roberts was uncooperative the entire time,” the complaint states.

Effectiveness of written hospitalist sign-outs in answering overnight inquiries

From the Journal of Hospital Medicine via Today’s Hospitalist (hat tip: Dr. Menadue):


Hospitalists are key providers of care to medical inpatients, and sign-out is an integral part of providing safe, high-quality inpatient care. There is little known about hospitalist-to-hospitalist sign-out.


To evaluate the quality of hospitalist/physician-extender sign-outs by assessing how well the sign-out prepares the night team for overnight events and to determine attributes of effective sign-out.


Analysis of a written-only sign-out protocol on a nonteaching hospitalist service using prospective data collected by an attending physician survey during overnight shifts.


Yale–New Haven Hospital, a 966-bed, urban, academic medical center in New Haven, Connecticut with approximately 13,700 hospitalist discharges annually.


We recorded 124 inquiries about 96 patients during 6 days of data collection in 2012. Hospitalists referenced the sign-out for 89 (74%) inquiries, and the sign-out was considered sufficient in isolation to respond to 27 (30%) of these inquiries. Hospitalists physically saw the patient for 14 (12%) of inquiries. Nurses were the originator for most inquiries (102 [82%]). The most common inquiry topics were medications (55 [45%]), plan of care (26 [21%]), and clinical changes (26 [21%]). Ninety-five (77%) inquiries were considered to be “somewhat” or “very” clinically important by the hospitalist.


Overall, we found that attending hospitalists rely heavily on written sign-out to address overnight inquiries, but that those sign-outs are not reliably effective. Future work to better understand the roles of written and verbal components in sign-out is needed to help improve the safety of overnight care

EDPMA Advocacy on OPPS Rule a Success

From the Emergency Department Practice Management Association (EDPMA):

Yesterday, CMS finalized the 2014 update to the Outpatient Prospective Payment System (OPPS). The final rule is available here.

On September 6, 2013, EDPMA urged CMS to delay its proposal to collapse the ED facility codes until stakeholders have had a chance to better understand the impact of this significant change. We are happy to report that the final rule delays the proposal while CMS reevaluates the most appropriate structure for ED facility codes. CMS will maintain the current coding structure consisting of five visit levels for 2014 while the agency considers alternatives. Our consultants apologize for reporting otherwise in the rush to distribute the rule to you last night.

The pressure is constant for ER’s ‘traffic controller’

From the Globe and Mail:

It’s not just about managing space. Resources are also in short supply. The department only has two rooms with the equipment to resuscitate patients. If both are in use – often a daily occurrence – there is nowhere for a new patient to go. And at any given moment, an ambulance may arrive with a gravely ill patient, or the trauma team could be called into action to save the life of a critically injured individual.

For Thorne, the critical challenge is flow: ensuring patients move through her department and into the right spot so staff can continue seeing incoming people. When the department is full and the hospital has no spare beds, the emergency department starts to back up very quickly.