Five questions on emergency room dental care

From the Asbury Park Press:

The Rutgers Center for State Health Policy has issued a report calling attention to the burgeoning use of emergency rooms for nontraumatic dental care.

The trend, researchers say, presents the state’s “health care policymakers with a challenge.”

Here are five questions about the report:

What does the report say?

Emergency room visits for oral care is higher in low-income areas, according to the report, issued by the Rutgers Center for State Health Policy. The report also shows that it is people between the ages of 19 and 34 who are the largest group using the emergency room for oral care.

“Consistent with findings in national data, use of EDs for oral care in New Jersey is overwhelmingly an issue among younger adults (19-34) and even more so for younger adults living in low-income regions,” the report says.

– See more at:

Healthcare spending growth highest in a decade

From Fierce Healthcare:

The growth, a 10-year high, is driven in large part by $8 billion more in hospital revenue, which was more than the prior four quarters combined, according to USA Today. As a result, the U.S. Commerce Department revised overall fourth-quarter economic growth upwards to 2.6 percent.

The healthcare spending makeup also changed since past decades, according to an analysis by the Wall Street Journal. Nursing care accounted for only 5 percent of health spending in 1960, but represented 13 percent in 2012. Hospital spending, however, is down, accounting for about 30 percent of spending in 2012 compared to 1980, when it peaked at 40 percent. Spending on physician services also declined, accounting for about 23 percent of spending in 2012 compared to 25 percent in 1990, according to a breakdown of the analysis by McGuireWoods LLP.

“How to Avoid Going Broke After an ER Visit”

From Fox Business:

The terrifying experience of visiting the emergency room often continues when you receive the bill. 

Medical costs can be high and one trip to the emergency room can have a serious (and often disastrous) impact on your finances. Here are four tips to avoid going broke from a medical emergency. 

Rural residents confront higher health care costs

From TwinCities:

Health care has always been more expensive in far-flung communities, where actuarial insurance data show fewer doctors, specialists and hospitals, as well as older residents in need of more health care services. But the rural-urban cost divide has been exacerbated by the Affordable Care Act.

“We’ve gone from letting the insurance companies use a pre-existing medical condition to jack up rates to having a pre-existing zip code being the reason health insurance is unaffordable,” Fales said. “It’s just wrong.”

Geography is one of only three determinants insurance companies are allowed to use to set premiums under the federal health care law, along with age and tobacco use. Insurance officials say they need such controls to remain viable.

Daylight saving impacts the timing of heart attacks

From the University of Michigan:

It seems moving the clock forward or backward may alter the timing of when heart attacks occur in the week following these time changes, according to data compiled by the University of Michigan Frankel Cardiovascular Center from Michigan’s BMC2 database.

The largest study of its kind in the U.S. reveals a 25 percent jump in the number of heart attacks occurring the Monday after we “spring forward” compared to other Mondays during the year – a trend that remained even after accounting for seasonal variations in these events.  The study was presented Saturday at the American College of Cardiology’s 63rd Annual Scientific Session.

But the study showed the opposite effect is also true. Researchers found a 21 percent drop in the number of heart attacks on the Tuesday after returning to standard time in the fall when we gain an hour back.

An ED scribe program is able to improve throughput time and patient satisfaction

From the American Journal of Emergency Medicine:


At our institution, we previously described the detrimental effect of computerized physician order entry (CPOE) on throughput time and patient satisfaction (Ann of Emer Med, Vol 56, P S83-S84). To address these quality metrics, we conducted a pilot program using scribes in the emergency department (ED).


We conducted a before-and-after study of ED throughput at our 320-bed suburban community hospital with a census of 70000 annual visits. Our primary outcome measure was the effect of scribes on ED throughput as measured by the effect on (1) door-to-room time; (2) room-to-doc time; (3) door-to-doc time; (4) doc-to-dispo time; and (5) length of stay for discharged/admitted patients, between pre-CPOE and post-CPOE cohorts. Our secondary outcome measure was patient satisfaction as provided by Press Ganey surveys. Data were analyzed using descriptive statistics, and means were compared using a standard t test.


Patient data from a total of 11729 patients in the before cohort were compared with data from 12609 patients in the after cohort. Despite a 7.5 % increase in volume between the post-CPOE and post-scribe cohorts, all throughput metrics improved in the post-scribe cohort. This process improved the overall door-to-doc time to 61 minutes in the after cohort from 74 minutes in the before cohort. Furthermore, patient and physician satisfaction was improved from the 58th and 62nd percentile to 75th and 92nd percentile, respectively.

Head Injury Showdown: PECARN Wins!

From (the consistently excellent) Emergency Medicine Literature of Note:

Ultimately, the management of “intermediate risk” is the key to this instrument’s role in reducing resource utilization.  In many settings, such as this one, if the “intermediate risk” group predominantly undergoes CT rather than observation, resource utilization will increase, rather than decrease.

EPR, Emergency Preservation and Resuscitation

From ABC:

“The standard of care at that point is to intubate them, give them fluids and blood and open up the chest,” said Tisherman. “If you quickly find something you can fix in there, like a source of bleeding that you can stop, then there’s a chance of survival. But if you don’t, that’s when we’ll switch to EPR.”

EPR, or Emergency Preservation and Resuscitation, will swap what little blood the patient has left for cold saltwater, dropping their temperature to 50 degrees and putting vital cellular functions on ice.

Test Accurately Rules out Heart Attacks in the ER

From ABC:

A simple test appears very good at ruling out heart attacks in people who go to emergency rooms with chest pain, a big public health issue and a huge worry for patients.

A large study in Sweden found that the blood test plus the usual electrocardiogram of the heartbeat were 99 percent accurate at showing which patients could safely be sent home rather than be admitted for observation and more diagnostics.

Of nearly 9,000 patients judged low risk by the blood test and with normal electrocardiograms, only 15 went on to suffer a heart attack in the next month, and not a single one died.

Nitroglycerin, a Staple of Emergency Rooms, Is in Short Supply

From the NY Times:

The drug nitroglycerin has long been an emergency room staple, a front-line drug that is often the first thing doctors try when a patient shows up with a heart attack.

So when Baxter International, the country’s only manufacturer of injectable nitroglycerin, recently told hospitals that it was sharply cutting shipments of the drug, the news sent pharmacists and emergency room doctors into a panic. Hospitals have been struggling for years with intermittent shortages of the drug, but with the latest news, doctors worried they could
actually run out. 

Assurances by Baxter and the Food and Drug Administration on Tuesday that they were taking steps to ease the shortage offered small comfort.