A New Positive-Pressure Device for Nasal Foreign Body Removal

From Pediatric Emergency Care:

Objectives: Nasal foreign bodies (FBs) are common causes of pediatric emergency consultations. The different methods for removing nasal FBs have varying levels of efficacy. The aim of this study was to evaluate the safety and efficacy of a new device for nasal FB removal in children.

Methods: A nasal occlusion device that uses modulated positive pressure to remove FBs was evaluated in a series of 18 patients ranging in age from 1 to 8 years diagnosed with a nasal FB during a period of 7 months.

Results: The device successfully removed FBs in 17 (94.4%) of the 18 patients. In 12 of the cases (66.7%), the FB was removed during the first attempt. None of the patients had complications or sequelae at the time of removal or at the follow-up visit.

Conclusions: The nasal occlusion device used in this study was found to be a promising, safe, effective, and easy to use tool for FB removal in a pediatric emergency room setting.

Emergency physician knowledge of reimbursement rates associated with emergency medical care

From the American Journal of Emergency Medicine:

Study Objective

We investigated emergency physician knowledge of the Centers for Medicare & Medicaid Services (CMS) reimbursement for common tests ordered and procedures performed in the emergency department (ED), determined the relative accuracy of their estimation, and reported the impact of perceived costs on physicians’ ordering and prescribing behavior.

Methods

We distributed an online survey to 189 emergency physicians in 11 EDs. The survey asked respondents to estimate reimbursement rates for a limited set of medical tests and procedures, rate their level of current cost knowledge, and determine the effect of health expenditures on their medical decision making. We calculated relative accuracy of cost knowledge as a percent difference of participant estimation of cost from the CMS reimbursement rate.

Results

Ninety-seven physicians participated in the study. The majority of respondents (65%) perceived their knowledge of costs as inadequate, and 39.3% indicated that beliefs about cost impacted their ordering behavior. Eighty percent of physicians surveyed were unable to estimate 25% of the costs within ±25% and no physicians estimated at least 50% of costs within 25% of the CMS reimbursement and only 17.3% of medical services were estimated correctly within ±25% by one or more physicians.

Conclusion

The majority of emergency physicians indicated they should consider cost in their decision-making but have a limited knowledge of cost estimates used by CMS to calculate reimbursement rates. Interventions that are easily accessible and applicable in the ED setting are needed to educate physicians about costs, reimbursement, and charges associated with the care they deliver.

Clinical implications for patients treated inappropriately for community-acquired pneumonia in the emergency department

From BMC Infectious Diseases:

Background

Community-acquired pneumonia (CAP) is one of the most common infections presenting to the emergency department (ED). Increasingly, antibiotic resistant bacteria have been identified as causative pathogens in patients treated for CAP, especially in patients with healthcare exposure risk factors.

Methods

We retrospectively identified adult subjects treated for CAP in the ED requiring hospital admission (January 2003-December 2011). Inappropriate antibiotic treatment, defined as an antibiotic regimen that lacked in vitro activity against the isolated pathogen, served as the primary end point. Information regarding demographics, severity of illness, comorbidities, and antibiotic treatment was recorded. Logistic regression was used to determine factors independently associated with inappropriate treatment.

Results

The initial cohort included 259 patients, 72 (27.8%) receiving inappropriate antibiotic treatment. There was no difference in hospital mortality between patients receiving inappropriate and appropriate treatment (8.3% vs. 7.0%; p = 0.702). Hospital length of stay (10.3 +/- 12.0 days vs. 7.0 +/- 8.9 days; p = 0.017) and 30-day readmission (23.6% vs. 12.3%; p = 0.024) were greater among patients receiving inappropriate treatment. Three variables were independently associated with inappropriate treatment: admission from long-term care (AOR, 9.05; 95% CI, 3.93-20.84), antibiotic exposure in the previous 30 days (AOR, 1.85; 95% CI, 1.35-2.52), and chronic obstructive pulmonary disease (AOR, 2.05; 95% CI, 1.52-2.78).

Conclusion

Inappropriate antibiotic treatment of presumed CAP in the ED negatively impacts patient outcome and readmission rate. Knowledge of risk factors associated with inappropriate antibiotic treatment of presumed CAP could advance the management of patients with pneumonia presenting to the ED and potentially improve patient outcomes.

Brazil emergency room robbed at gunpoint by gang

From THV11:

Patients at a hospital’s emergency room in Rio de Janeiro were victims of a gang robbery.

The suspects pointed guns at the patients in the waiting room and demanded their money and other valuables.

The suspects didn’t even wear masks or anything to obscure their faces.

No one was hurt but a nurse was almost got shot for not complying with the robbers’ demands.

Hill Plan Would Shift Medicare’s Doctor Payment System To Reward Quality

From Kasier Health News:

The bipartisan leadership of three Senate and House committees introduced legislation Thursday to overhaul the way Medicare pays physicians.

The package, which does not specify how it would be paid for, would repeal the current system, which sets Medicare physician payment rates through a 1997 formula based on economic growth and known as the “sustainable growth rate” (SGR).  Physicians would receive a 0.5 percent increase for each of the next five years as Medicare transitions to an alternative payment model designed toreward physicians based on the quality of care provided, rather than the quantity,  as the current payment formula does.