Jails and Emergency Rooms Are Our De Facto Mental Health Clinics

From the Pacific Standard:

This is not just a Cook County problem, nor just a Virginia, Oklahoma, or Nebraska problem. Research shows that jails across the country are crowded with the mental health patients who aren’t getting treatment elsewhere. And this has been true for decades. Dr. E. Fuller Torrey, a research psychiatrist who founded the Treatment Advocacy Center to push for better access to mental health care, has estimated that are three times more mentally ill people in jail and prisons than there are in hospitals in America (PDF). Some studies estimate that as many as 50 percent of all inmates of jails and prisons suffer from some kind of mental illness.

Salt Lake City firefighters work as a pit crew to save more heart attack victims

From the Salt Lake Tribune:

Salt Lake City firefighters credit a new strategy for saving more people from heart attacks.

According to the fire department, firefighters helped patients regain a pulse on 41 percent of their calls in 2013, up from 29 percent in 2011.

That’s thanks to a strategy called a “pit crew” response. Each of the four firefighters responding to a call of a heart attack has a specific job to do right away, much like a pit crew gets right to work on a race car, according to a fire department news release. Before, the team called out tasks for each firefighter to perform.

“Another major change for all cardiac arrest responses is to work on the patient where we find them instead of immediately loading the patient into an ambulance and taking them to a hospital while attempting to give them medical attention during transport,” said Scott Youngquist, the fire department medical director, in a statement. “It is difficult to perform good CPR on the patient in the back of a speeding ambulance and it puts the first responders and the driving public at risk of accident or injury.”

Development and validation of the Emergency Department Assessment of Chest pain Score and 2 h accelerated diagnostic protocol

From Emergency Medicine Australasia:

Risk scores and accelerated diagnostic protocols can identify chest pain patients with low risk of major adverse cardiac event who could be discharged early from the ED, saving time and costs. We aimed to derive and validate a chest pain score and accelerated diagnostic protocol (ADP) that could safely increase the proportion of patients suitable for early discharge.

Logistic regression identified statistical predictors for major adverse cardiac events in a derivation cohort. Statistical coefficients were converted to whole numbers to create a score. Clinician feedback was used to improve the clinical plausibility and the usability of the final score (Emergency Department Assessment of Chest pain Score [EDACS]). EDACS was combined with electrocardiogram results and troponin results at 0 and 2 h to develop an ADP (EDACS-ADP). The score and EDACS-ADP were validated and tested for reproducibility in separate cohorts of patients.

In the derivation (n = 1974) and validation (n = 608) cohorts, the EDACS-ADP classified 42.2% (sensitivity 99.0%, specificity 49.9%) and 51.3% (sensitivity 100.0%, specificity 59.0%) as low risk of major adverse cardiac events, respectively. The intra-class correlation coefficient for categorisation of patients as low risk was 0.87.

The EDACS-ADP identified approximately half of the patients presenting to the ED with possible cardiac chest pain as having low risk of short-term major adverse cardiac events, with high sensitivity. This is a significant improvement on similar, previously reported protocols. The EDACS-ADP is reproducible and has the potential to make considerable cost reductions to health systems.

The relationship between patient volume and mortality in American trauma centres

From Injury:


To synthesise published and unpublished findings examining the relationship between institutional trauma centre volume or trauma patient volume per surgeon and mortality.


Evidence on the relationship between patient volume and survival in trauma patients is inconclusive in the literature and remains controversial.


A literature search was performed to identify studies published between 1976 and 2013 via MEDLINE (Pubmed) and the Cumulative Index to Nursing and Allied Health Literature (EbscoHost) as well as footnote chasing. Abstracts from appropriate conferences and ProQuest Dissertations and Theses were also searched. Inclusion criteria required studies to be original research published in English that examined the relationship between mortality and either institutional or per surgeon volume in American trauma centres. We employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement checklist and flowchart. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was employed to rate the quality of the evidence.


Of 1392 studies reviewed, 19 studies met defined inclusion criteria; all studies were retrospective. The definition of volume was heterogeneous across the studies. Patient population and analysis methods also varied across the studies. Sixteen studies (84%) examined the relationship between institutional trauma centre volume and mortality. Of the 16 studies, 12 examined the volume of severely injured patients and eight examined overall trauma patient volume. High institutional volume was associated with at least somewhat improved mortality in ten of 16 studies (63%); however, nearly half of these studies found only some subpopulations experienced benefits. In the remaining six studies, volume was not associated with any benefits. Four studies (25%) analysed the impact of surgeon volume on mortality. High volume per surgeon was associated with improved mortality in only one of four studies (25%).


The studies were extremely heterogeneous, thus definitive conclusions cannot be drawn regarding optimal volume before a clear advantage in survival is observed. A prospective study defining volume as a continuous variable is warranted to support current admission criteria for American trauma patients.

CMS Extends Two-Midnight Partial Enforcement Delay for Additional Six Months

From the Ohio Hospital Association (hat tip: Jane Zachrich):

The Centers for Medicare & Medicaid Services (CMS) announced Friday that it will extend the two-midnight partial enforcement delay for an additional six months through Sept. 30, 2014.

Medicare Administrative Contractors (MACs) will continue to select claims for review with dates of admission from Oct. 1, 2013 through Sept. 30, 2014 for the Probe & Educate audits. MACs will continue to hold educational sessions with hospitals, as appropriate, through Sept. 30, 2014.

Recovery Auditors and other Medicare review contractors will not conduct post-payment patient status reviews of inpatient hospital claims with dates of admission on or after Oct. 1, 2013 through Sept. 30, 2014.

CMS also provided additional clarification of guidance on the physician order and physician certification requirements for hospital inpatient admissions.

New Rule Allows Patients Direct Access To Lab Results

From Kaiser Health News:

Calling your doctor to get lab results might be a thing of the past: a new federal rule will allow patients to have direct access to their completed laboratory reports.

The regulation was announced Monday by the Department of Health and Human Services. It amends privacy rules under the Health Insurance Portability and Accountability Act (HIPAA) and the Clinical Laboratory Improvement Amendments of 1988 (CLIA) that required patients to get their lab results from their physician, according to the announcement.

The final rule notes that some labs and physicians had raised concerns about the move when the administration issued a preliminary rule in June 2011. “Commenters expressed concern that patients might receive and act upon results that appear to be abnormal (showing false positives or false negatives, or results that are out of the normal range for the general population) but may be normal for that particular patient due to his or her medical conditions.”

Study Examines Different Therapeutic Hypothermia Cooling Temperatures

From JEMS:

There’ve been a lot of articles about therapeutic hypothermia lately. Cooling is primarily designed to protect the brain in an ever-evolving battle for full neurologic recovery. Published in November 2013 in the New England Journal of Medicine, this is a large, randomized, 939-patient, international trial comparing all-cause mortality and neurologic recovery at two different cooling temperatures.