Docs call for proactive use of Narcan

From the Herald:

Suspected opioid overdoses among young children should be treated more often with the life-saving reversal agent Narcan, and prevented with a cap on doses for potentially deadly prescriptions, local doctors are urging.

“Certainly in the era that we are currently in, in terms of prevalence of prescriptions of illicit opioids in the state of Massachusetts, I think opioid intoxication should be on the list of potential diagnoses for pediatric patients,” said Dr. Lauren Allister, pediatric emergency doctor at Massachusetts General Hospital.

“And given potential lethal effects of an opioid overdose,” she added, “the benefits of giving Narcan greatly outweigh the risks of missing an opioid intoxication.”


ACUTE CARE, INC. Supports Amanda the Panda

Amanda the Panda

Learn more about the program here.

Rural hospitals keep closing. What can be done?

From Healthcare Dive:

Since 2010, 71 hospitals have closed, fueled by congressional spending measures that cut Medicare payments and by the ACA, which favors hospitals that do a high-volume of business. One of the latest closings came this month in Ellington, MO. The pace is escalating: Last year, the rate of closures was six times greater than in 2010.

According to the National Rural Health Association, another 683 rural hospitals are at risk of closing — taking with them, should that occur, 700,000 patient encounters, 36,000 healthcare jobs, 50,000 community jobs and $10.6 billion in U.S. revenues. Overall, 35% of rural hospitals operate at a financial loss.

Cuts in reimbursement for bad debt have been particularly hard on rural hospitals, which often operate at the narrowest of margins, said Maggie Elehwany, vice president of government relations at the NRHA. Not only do rural hospitals experience lower volume of patients than their urban counterparts, their patients tend to be older, poorer, and sicker. Elehwany said it’s probably not coincidental that most of the closures have occurred in states that have not expanded their Medicaid programs.

FBI: Hospice nurses told to overdose patients to speed death

From Modern Healthcare:

The owner of a Dallas-area hospice ordered nurses to increase drug dosages for patients to speed their deaths and maximize profits, according to an FBI affidavit.

A copy of the affidavit for a search warrant obtained by KXAS-TV in Dallas-Fort Worth alleges Brad Harris ordered higher dosages for at least four patients at Novus Health Services in Frisco. It’s unclear whether any deaths resulted from overdoses of drugs like morphine.

Harris has not been charged. The FBI on Wednesday declined to say whether an investigation is ongoing.

ACEP Cautions San Diego County Emergency Patients

Press Release:

The American College of Emergency Physicians (ACEP) along with its California Chapter today voiced concerns about warning people not to seek emergency care unless it’s a “true” emergency.

“Emergency physicians educate patients on the best places to seek the care they need,” said Jay Kaplan, MD, FACEP, president of ACEP.  We never tell people ‘not to go,’ to the emergency department because it’s not always possible for them to know when symptoms reflect a ‘true’ emergency.   For example, is my leg broken, or is it severely strained?  It’s not always possible for a patient to know unless he or she gets a medical examination. In addition, some patients, with conditions such as shortness of breath or indigestion, make the mistake of delaying seeking medical care when they are truly having an emergency. San Diego’srecent campaign may discourage some people from visiting the emergency department who really should be there and that would be tragic.”

Dr. Kaplan said emergency physicians have long advocated for making the determination of whether or not emergency care is appropriate should be based on patient symptoms, not the final diagnosis. The California ACEP Chapter sponsored legislation which was signed into law in California in 1994 protecting patients’ right to access the emergency department whenever they felt they were having an emergency.  The national prudent layperson standard was enacted by Congress in 1997 and is part of the Patient Protection and Affordable Care Act (ACA).

In addition, many people still do not have access to patient-centered medical homes and as a consequence, turn to the emergency department for care. Nearly three-quarters (71 percent) of emergency physicians responding to a poll in 2015 said they treated patients every day who ended up in the ER after first seeking help in an urgent care that was not equipped to care for them. More than half (54 percent) of emergency physicians say urgent care centers are marketing themselves as alternatives to the emergency department.

“Despite the ACA and the expansion of Medi-Cal, many patients are having trouble finding physicians willing to take their insurance,” said Dr. Kaplan.  “Emergency visits will continue to increase for many reasons including the nation’s growing elderly population and primary care physician shortages. The emergency department is the only place people can get help any time of day or night.  It’s an incredibly valuable service that we all need to support.”

California ACEP president, Dr. Marc Futernick, a practicing emergency physician in Los Angeles agreed. “I treat patients in the emergency department every shift who couldn’t access a primary care physician and had no choice but to come to the emergency department for treatment because their condition worsened dramatically.”

According to a report from the Center for Studying Health System Change (HCS), many assessments of “unnecessary” use of emergency care incorrectly look at patients’ diagnoses, instead of patients’ symptoms and why they are choosing to seek emergency care.  A study conducted by HSC in 2012 found that most emergency visits by Medicaid patients were for urgent or more serious symptoms. A study published in the Journal of the American Medical Association (JAMA) in 2013 found that most patients with so-called “primary care treatable” diagnoses come to the emergency department with identical symptoms to patients with true emergencies.

ACEP is the national medical specialty 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.

Happy Doctors’ Day

We appreciate our physician partners’ contribution to our patients’ health and their families’ welfare.


This Company is Making an Epi-Pen That Fits in a Wallet

From Gizmodo:


AdrenaCard is meant to help people who are both unfortunate enough to need an epinephrine injection for serious allergic reactions—and human enough that they regularly forget their “epi-pen” when they’re going out. It’s a small epinephrine injector that fits inside a wallet.

New Jersey hospital emergency room becomes first in U.S. to end use of opioid painkillers

From Pix 11:

St. Joseph’s Regional Medical Center announced it has become the first hospital in the country to implement a program that will manage patients’ pain in the emergency room without the use of opioid painkillers.

Painkillers most frequently used in the emergency room in the past were oxycodone, vicodin and percocet, according to Dr. Mark Rosenberg, the Emergency Department chair.

“Our job here together is to look at the whole equation and understand how we can stop people from going from a prescription, to an addiction,” he said.

Teleophthalmology May Expand Coverage in Emergency Eye Care

From Medscape:

Teleophthalmology may play a role in reducing coverage gaps in emergency department eye care, particularly in rural areas, a new study suggests.

Lauren Wedekind, from the Veterans Affairs Palo Alto Health Care System in California, and colleagues published the results of their study online March 24 in JAMA Ophthalmology.

“Surveyed emergency department nurse managers and physicians indicated moderately high interest and perceived value for a teleophthalmology solution for remote triage and consultation,” the authors write.

Why hackers are going after health-care providers

From the Post:

Washington is reeling from the news of a hack at MedStar, one of the largest medical providers in the area. A computer virus infecting the organization’s computer systems forced MedStar to shut down much of its online operations Monday.

The exact nature of the attack is not yet known, but MedStar is just the latest victim in a string of cyberattacks that have hit the health-care industry hard. Here’s what you need to know about how health-care providers became the latest digital battleground.