2014 EM Report Card Coming Next Week

From The Central Line:

With the release of the 2014 ACEP Report Card on Emergency Medicine, the nation learns how well each state supports emergency medicine and your emergency department.

The Report Card is scheduled for release next Thursday, Jan. 16.

Study Challenges Paramedics’ Ability to Accurately Identify STEMI

From JEMS:

Discussion: This study presents lower paramedic accuracy rates than we are used to seeing in other articles; however, there are other variables at play. First, the researchers used previously transmitted prehospital ECGs that were then printed and given to the respondents in a static, non-clinical setting. Previously, studies have used computer generated ECGs or retrospective chart review, which may contribute to higher accuracy rates previously. The authors included the 10 ECGs that were presented to respondents in their research paper and, after significant discussion, there were quite a few tough ECGs that we didn’t agree were adequate representations as a group. Lastly, keep in mind that the medics in the study didn’t work in a system that allowed them to activate a cath lab in the field—all ECGs were transmitted to the receiving facility for review. That’s not a statement against the respondent paramedics; however, it leaves us to wonder if this study was designed around that knowledge. The authors feel that more training may be needed on identification of anterior and lateral STEMI identification within this group of paramedics.

Inappropriate antibiotic use in emergency rooms not decreasing in adults

Press Release:

n analysis of emergency room (ER)visits over a 10-year period finds that while inappropriate antibiotic use is decreasing in pediatric settings, it continues to remain a problem in adults, according to an article published ahead of print inAntimicrobial Agents and Chemotherapy.

In the study, the investigators mined data from the National Hospital Ambulatory Medical Care Survey for the years 2001-2010. During this time, acute respiratory tract infections accounted for 126 million visits to emergency departments in the US. In patients under the age of 19 they saw a decrease in the utilization of antibiotics for respiratory infections where they are not indicated. They saw no such reduction in adult patients.

“While emergency department antibiotic use for acute respiratory tract infections decreased in the past decade among children, we saw no decrease in antibiotic use for adults with acute respiratory tract infections,” says coauthor John Baddley, of the University of Alabama at Birmingham, an author on the study. “Given organized efforts to emphasize antibiotic stewardship, we expected to see a decrease in emergency department antibiotic use for such infections.”

That’s very unfortunate, Baddley says, because the ER’s see so many patients, since they are used not just for emergencies, but for primary care visits generally—especially among those who are uninsured or insured by Medicare. A major reduction in use of inappropriate antibiotics in the ER could have a big benefit just due to the large number of patients seen.

Acute respiratory tract infections, including rhinitis, sinusitis, and bronchitis, account for nearly one tenth of ambulatory care visits in the United States. While many of these infections are caused by viruses, clinicians still prescribe antibiotics for these conditions. Viruses are impervious to antibiotics, and inappropriate antibiotic use can lead to the development of antibiotic resistance.

“The observed lack of change in antibiotic utilization for adult acute respiratory tract infection patients, especially those with infections where antibiotics are not indicated, is concerning,” the investigators write in the study. “This may indicate that efforts to curtail inappropriate antibiotic use have not been effective or have not yet been implemented for this subset of patients.”

Complicating the picture, the investigators suggest that the lack of reduction in use of antibiotics in these cases may reflect, among other things, the difficulty of making definitive diagnoses, and the fact that patients frequently expect to receive an antibiotic, and pressure clinicians for them.

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A copy of the manuscript can be found online at http://bit.ly/asmtip0114c. The final version of the article is scheduled for the March 2014 issue of Antimicrobial Agents and Chemotherapy.

Antimicrobial Agents and Chemotherapy is a publication of the American Society for Microbiology (ASM). The ASM is the largest single life science society, composed of over 39,000 scientists and health professionals. Its mission is to advance the microbiological sciences as a vehicle for understanding life processes and to apply and communicate this knowledge for the improvement of health and environmental and economic well-being worldwide.

Emergency Rooms the Wrong Solution for the Mentally Ill

From Healthline:

Emergency rooms are for more than treating chest pains or closing wounds. The ER is also a place where people go for mental health emergencies, such as suicidal thoughts, an anxiety attack, or the urge to self-harm. The ER is still the go-to place for these behavioral health crises, but it doesn’t have to be, researchers say.

The Living Room, a program run by the Turning Point outpatient mental health center in Skokie, Ill., provides emergency treatment for emotional issues in a calm, home-like setting. And a recent study of this model shows that people deal better with mental health emergencies when they’re in this kind of supportive environment.