“EMS Loyalty Program” Slashes Emergency Room Trips, Saves Millions

From Dallas/Fort Worth Healthcare Daily:

In July 2009, MedStar began a community health program using paramedics to treat and counsel these high ED utilizers. It discovered that 21 people who called 911 as often as twice a week comprised more than 1 percent of its total call volume, at a cost of nearly $1 million.

Patients who have graduated from the CHP reduced their emergency department use by nearly 85 percent in the year after graduation, saving more than $7.4 million in ED charges. MedStar works with the patient and local healthcare providers to reduce the incidence of preventable ambulance responses. CHP now has 264 graduates.

The comparison of heparinized insulin syringes and safety-engineered blood gas syringes used in arterial blood gas sampling in the emergency department setting

From the American Journal of Emergency Medicine:

Introduction

The arterial blood gas measurement process is a painful and invasive procedure, often uncomfortable for both the patient and the physician. Since the patient related factors that determine the difficulty of the process cannot be controlled, the physician related factors and blood gas measurement techniques are a modifiable area of improvement that ought to be considered. Many hospitals use insulin syringes or syringes washed with heparin for the purpose of blood gas measurement because they do not have blood gas specific syringes. In this prospective cross-sectional study we aimed to compare safety-engineered blood gas syringes and conventional heparinized syringes used during the arterial blood gas extraction process in terms of ease of operation, the physician-patient satisfaction, laboratory appropriateness and complications.

Methods

Our study included patients whose arterial blood gas needed to be measured in the emergency room and who agreed to participate in the study. Patients were randomly divided into two groups. The arterial blood gas of the patients from the first group was measured by using conventional heparinized syringes, while safety-engineered blood gas syringes were used to measure the arterial blood gas of the patients from the second group. The groups were compared in terms of demographic data, the number of attempts, the physician and patient satisfaction, early and late term complications and laboratory appropriateness of the taken sample.

Results

A total of 550 patients were included into our study in a two-month study period. There were not significant differences between patients in terms of gender, age, weight, height, body mass index and wrist circumference. In addition, the number of attempts (p=0.489), patients’ pain level during the procedure (p=0.145), the degree of difficulty of the procedure according to the patient (p=0.109) and physician (p=0.554) were not significantly different between the groups. After arterial blood gas extraction procedure 115 patients (20.9%) developed complications. In the conventional heparinized syringe group the complication rate (n=69, 25.1%) was significantly higher compared to the group that used safety-engineered blood gas syringes (n=46, 16%) (p=0.0211). Localized pain, which is one of the most common early complications, was more frequent in the conventional heparinized syringe group (19.3%). Complications in women (p=0.003) and local pain (p=0.01) developed lesser in the second group that used safety-engineered blood gas syringes and the patient-physician satisfaction was higher in that group as well. In the evaluation 48 hours after the procedure, the ratios of infection and local hematoma were higher in the conventional heparinized syringe group (p=0.0213 and p <0.0001).

Conclusion

In this study we did not find any significant differences between the conventional heparinized syringes and safety-engineered blood gas syringes in terms of ease of operation, physician and patient satisfaction, and appropriateness of the taken sample. However, patients whose arterial blood gas was extracted by using safety-engineered blood gas syringes felt less pain and experienced fewer infections and hematomas at their puncture site.

Telemedicine Bolsters ICU Care In Rural Maryland Hospitals

From Kaiser Health News:

Studies have shown that patients do better and leave sooner from ICUs managed by intensivists, another term for critical care doctors. But intensivists are in short supply nationwide, and small community hospitals like Atlantic General have a difficult time recruiting and retaining them, let alone paying their salaries. Connecting intensivists to small ICUs via telemedicine, proponents say, is the next best thing to hiring them.

Telemedicine, the exchange of medical information between sites via electronic communications, is being used not only by ICUs but also by other hospital departments, home health agencies and private doctors’ offices. But skeptics suggest that small ICUs might be able to improve care with less expensive measures. Telemedicine now costs hospitals roughly $40,000 to $50,000 a year for each covered bed. Initially, adaptation of telemedicine in ICUs nationwide was rapid, but a new study suggests it is slowing.

Rural California Plans New Trauma Centers

From the California Health Report via Kaiser Health News:

Over the past two years, communities long without trauma centers began to fill the void – designating regional hospitals as resources for those suffering from traumatic injuries.

In 2012, San Luis Obispo County officials picked Sierra Vista Regional Medical Center to be a level-three trauma center. Late last year, Monterey County followed suit, beginning negotiations with its own hospital, Natividad Medical Center, to change staffing in order to qualify as a level-two trauma center.

“The real crisis in America’s ERs”…Dental Pain

From CNN:

If you doubt there’s a dental health crisis in America, walk into any emergency room. Every day, thousands of people without access to a dentist are looking for dental care in our ERs, most of which cannot provide the care these patients need.

Nationally, more than 2.1 million people, the vast majority of them adults, showed up in ERs with dental pain in 2010, double the number just a decade prior, according to the National Hospital Ambulatory Medical Care Survey.

Those ER visits for largely preventable issues cost the health system more than $2 billion that year. And the majority of dental ER visits, nearly 80%, were for common and preventable conditions like abscesses and cavities.

Man crashes into hospital, treated at hospital’s ER

From the Telegraph:

A man suffered apparent minor injuries Tuesday morning when his compact car left the road and hit Alton Memorial Hospital’s 3-year-old Duncan Wing, damaging a brick wall.

“The man said he blacked out” as he drove his Toyota Yaris, going over the curb and traveling until his the car hit the hospital wall, about 100 feet north of the emergency room, said Rusty Ingram, manager of marketing and communications at the hospital, 1 Memorial Drive.

Long drive, big problems for medical emergencies in rural Georgia

From the Telegraph:

In large areas along a stretch of the state from Macon to Milledgeville and on to Augusta, it can be a long drive for people having a heart attack to get to an emergency room. And pregnant mothers living far from a hospital correlates with higher rates of premature births.

Rural residents are more likely to die of heart attacks that could be stabilized or stopped in the right kind of facility. And unless a would-be mother drives as much as an hour or more, she will not get regular prenatal care either, part of what leads to risky early births, health officials said.

But rural health care is not generally a money-spinner. Rural populations tend to be poorer, older and sicker than residents in more metropolitan areas, meaning they are less likely to be able to pay for the care they get.

Those are issues that are starting to get attention.