Did a New York Times column unfairly attack ER doctors?

From WhiteCoat, writing for Kevin MD:

 …the assertions that a colleague of yours made while discussing emergency physicians in the New York Times. In her column, Dr. Rita Redberg stated,

… fortunately, we can reduce the rate of medical imaging by simply avoiding unnecessary scans and minimizing the radiation from appropriate ones. For example, emergency room physicians routinely order multiple CT scans even before meeting a patient. Such practices, for which there is little or no evidence of benefit, should be eliminated.

Factors contributing to emergency department care within 30 days of hospital discharge and potential ways to prevent it: Differences in perspectives of patients, caregivers, and emergency physicians

From the Journal of Hospital Medicine:

BACKGROUND

Identifying needs in patients who utilize the emergency department (ED) soon after being discharged from inpatient care is essential for planning appropriate care-transition interventions.

OBJECTIVE

To examine differences in stakeholder perspectives on reasons for ED care soon after hospital discharge and interventions that could be useful to prevent these ED visits.

DESIGN AND MEASUREMENTS

A convenience sample of 135 patients who presented to an urban teaching hospital ED <30 days after last hospital discharge, their caregivers (when present), and emergency physicians were administered identical structured surveys. Concordance and agreement rates between patient-physician and patient-caregiver dyads were calculated.

RESULTS

Concordances between stakeholders were poor, with weighted kappas ranging from 0.02 to 0.34 for patient-physician dyads and 0.03 to 0.68 for patient-caregiver dyads. Emergency physicians and caregivers identified factors between 1% and 42% of the time the patients did not. Less than half of any stakeholder could identify an intervention to potentially prevent the ED visit.

CONCLUSIONS

Our findings suggest the difficulty in forming unified definitions for root cause of ED visits soon after hospital discharge and support the use of multiple stakeholders in identifying appropriate targets for care-transition interventions.

The Clinical Significance of a Failed Initial Intubation Attempt During Emergency Department Resuscitation of Out-of-Hospital Cardiac Arrest Patients

From Resuscitation:

Objective

Advanced airway management is one of the fundamental skills of advanced cardiac life support (ACLS). A failed initial intubation attempt (FIIA) is common and has shown to be associated with adverse events. We analysed the association between FIIA and the overall effectiveness of ACLS.

Methods

Using emergency department (ED) Out-of-hospital cardiac arrest (OHCA) registry data from 2008 to 2012, non-traumatic ED-resuscitated adult OHCA patients on whom endotracheal intubation was initially tried were identified. Prehospital and demographic factors and patient outcomes were retrieved from the registry. The presence of a FIIA was determined by reviewing nurse-documented CPR records. The primary outcome was achieving a return of spontaneous circulation (ROSC). The secondary outcomes were time to ROSC and the ROSC rate during the first 30minutes of ED resuscitation.

Results

The study population (n=512) was divided into two groups based on the presence of a FIIA (N=77). Both groups were comparable without significant differences in demographic or prehospital factors. In the FIIA group, the unadjusted and adjusted odds ratios (ORs) for achieving a ROSC were 0.50 (95% confidence interval [CI], 0.31-0.81) and 0.40 (95% CI, 0.23-0.71), respectively. Multivariable median regression analysis revealed that FIIA was associated with an average delay of 3minutes in the time to ROSC (3.08; 95% CI, 0.08-5.80). Competing risk regression analysis revealed a significantly slower ROSC rate during the first 15minutes (adjusted subhazard ratio, 0.52; 95% CI, 0.35-0.79) in the FIIA group.

Conclusion

FIIA is an independent risk factor for the decreased effectiveness of ACLS.

Hospital spends $1.2M to expand emergency department and isolate intoxicated, mentally ill

From the Daily Sun:

A street alcoholic drinks too much and passes out in front of a business. 

A concerned resident calls 911. An officer responds, a fire truck responds with a medic, and an ambulance takes the drunk person to the Flagstaff Medical Center Emergency Department to be treated.

While there, the street alcoholic is combative with the nurses and staff and starts to yell.

A child being treated for a broken arm watches a drunk person throw up and use foul language.

Quality of patient care — all patients — was the driving force in creating a specialized space in the emergency department where chronic public alcoholics and the mentally ill can be taken and treated. 

Rapid Response: Mobile Stroke Unit

From WWLP:

University of Texas Health has unveiled the nation’s first mobile stroke unit with a CT scanner on board.

The mobile stroke unit is specifically designed to treat stroke patients.

According to Dr. James Grotta, director of Stroke Research at UT Health, the ambulance is “designed specifically to take the emergency room to the patient.