Rural Hospital Bill Portends Larger Changes for N.C. Hospitals

From North Carolina Health News:

Last week, Gov. Pat McCrory put his pen to paper and signed into law Senate Bill 698, a bill that will help several struggling hospitals in their attempts to reopen.

Tucked into the bill, is a single line repealing two laws written in the 1990s, when Asheville’s Mission Hospital asked for permission to merge with St. Joseph’s Hospital.

That 1995 merger would have created a virtual health care monopoly in Asheville, and so the state approved a “certificate of public advantage.” The COPA allowed the merger to proceed while protecting Mission from anti-trust litigation that may have come because of its new size.

Decreasing Mental Health Services Increases Mental Health Emergencies

Press Release:

Countywide reductions in psychiatric services – both inpatient and outpatient – led to more than triple the number of emergency psychiatric consults and 55 percent increases in lengths of stay for psychiatric patients in the emergency department.  The before and after study of the impact of decreasing county mental health services was published online Friday in Annals of Emergency Medicine (“Impact of Decreasing County Mental Health Services on the Emergency Medicine”).

“As is often the case, the emergency department catches everyone who falls through the cracks in the health care system,” said lead study author Arica Nesper, MD, MAS of the University of California Davis School of Medicine in Sacramento.  “People with mental illness did not stop needing care simply because the resources dried up. Potentially serious complaints increased after reductions in mental health services, likely representing not only worse care of patients’ psychiatric issues but also the medical issues of patients with psychiatric problems.”

After Sacramento County in California decreased its inpatient psychiatric beds from 100 to 50 and closed its outpatient unit, the average number of daily psychiatry consults in the emergency department increased from 1.3 to 4.4. The average length of stay for patients requiring psychiatric consults in the emergency department increased by 55 percent, from 14.1 hours to 21.9 hours.  Three hundred and fifty patients (out of a total of 1,392 patients undergoing psychiatric evaluation) were held in the emergency department longer than 24 hours.  The study period was 16 months: eight months before the cuts and eight months after.

“Between 2009 and 2011, $587 million was cut from mental health services in California,” said Dr. Nesper. “These cuts affect individual patients as well as communities and facilities like emergency departments that step in to care for patients who have nowhere else to turn. Ultimately, these cuts led to a five-fold increase in daily emergency department bed hours for psychiatric patients.  That additional burden on emergency departments has ripple effects for all other patients and the community.”

Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, the national medical society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information, visit www.acep.org.

Man accused of choking ER doctor

From the Statesman:

Witnesses told police that Edelen had been walking near the emergency room desk and said he had a question for his doctor, according to the affidavit.

Edelen then spoke to the doctor, it said, while the doctor was sitting down completing paperwork. The doctor later told police that Edelen got behind him, wrapped his arm around him and began choking him, the affidavit said.

Doctor-patient relationship is key to reducing CT scan overuse

From Yale News:

One in every three CT scans performed on patients with minor head injury is not medically necessary. The American College of Emergency Physicians has identified CT overuse as the top priority for minimizing wasteful and unnecessary tests in the emergency department. A Yale-led study has found that among other factors, strengthening the doctor-patient relationship can reduce unwarranted scans and their growing cost.

The study published early online in Academic Emergency Medicine.

Emergency providers have guidelines, such as the Canadian CT Head Rule, to help determine when a patient’s minor head injury should lead to a CT scan and further intervention. While the guidelines have been tested and validated, they are often ignored. For example, CT scans may be performed on patients with signs of concussion — even though CT does not help diagnose concussion but rather other risks such as bleeding.

Critical Access Hospital Closure Approval Likely

From the Times:

It’s considered a “long shot” that a state agency would reject the application to close Streator’s St. Mary’s Hospital.

On Tuesday, the Illinois Health Facilities and Services Review Board is expected to vote on the application by St. Mary’s owner, Springfield-based HSHS, to close the hospital on Monday, Jan. 4.

MercyRockford’s mobile emergency docs to roam northern Illinois

From RRStar:

MercyRockford Health System today launched an expansion into northern Illinois of its MD-1 Physician Response program that can put an emergency room doctor in the field to assist first responders during medical emergencies.

Doctors take an MD-1 response vehicle to emergency scenes such as shootings, multiple-victim car crashes and natural disasters with advanced equipment not typically aboard an ambulance.

They can’t replace emergency responders. But MD-1 is billed as a way to help paramedics in the field save lives by cutting the time it takes for a severely injured or ill patient from a rural area to reach a doctor’s care, MercyRockford EMS Medical Director Jay MacNeal said.

Lowering Body Temperature May Help Cardiac Arrest Patients

From HealthDay:

Lowering the body temperature after someone’s heart has stopped beating may improve the odds of surviving with good brain function, a new study suggests.

In fact, patients whose body temperatures were lowered (therapeutic hypothermia) were nearly three times more likely to survive cardiac arrest, the study found. Those treated with the cold therapy were also 3.5 times more likely to have better mental function than those who didn’t receive the therapy, the researchers said.

“Our findings provide support for the idea that all unconscious post-arrest patients should receive aggressive care with therapeutic hypothermia,” said lead researcher Dr. David Gaieski, an associate professor of emergency medicine at the School of Medicine at Thomas Jefferson University in Philadelphia.

“Withholding [this treatment] does not make sense given these data and other data from other studies at many institutions around the world,” he said.

The report was published Nov. 16 online in the journal Circulation.