Talks with families tied to fewer hospitalizations from nursing homes

From Reuters:

Nursing homes that send fewer residents to the hospital at the end of life might do a better job of communicating with families about the pitfalls of aggressive interventions than other facilities, a recent U.S. study suggests.

At the end of life, hospital stays for seriously injured or ill nursing home residents typically offer little hope of improving quality of life or changing outcomes for the better, researchers note in JAMA Internal Medicine.

“We found that nursing home staff at all facilities encountered the same barriers to avoiding potentially burdensome hospitalizations, but that staff at low-hospitalizing facilities did two things very differently from those at high-hospitalizing ones,” said lead study author Dr. Andrew Cohen of Yale University in New Haven, Connecticut.

Post-Mortem Delivery by EM Resident

From ABC30:

DeNolf had just started her shift when the second-year resident at Kaweah Delta found herself at a familiar operating table – only this time, she was carrying out a procedure she’d only practiced before.

“I’ve only had two simulations,” she explained. “And the third time was the real deal.”

DeNolf didn’t know the mother had been shot twice in the head, but she did know she had just seconds to take the baby out and that perimortem C-sections like this one are rarely successful.

“I got my scalpel out,” she said. “We, as emergency physicians, also carry a 10 blade and an 11 blade. My attendant said, ‘Cut,’ so I cut.”

The baby came out barely moving, not breathing but after a few tense seconds, they found a pulse.

Physician Practices in Rural Areas Being Acquired by Hospitals at Dramatic Rate

From the AJMC:

Within the past 3 years, hospital employment and hospital ownership of physician practices has increased in both urban and rural areas, but growth in the number of rural practices owned by hospitals has significantly outpaced that in the urban setting (102.6% growth among rural practices vs 77.8% growth for urban practices), according to an October 2016 report, “Physician Practice Acquisition Study: National and Regional Employment Changes,” written through a partnership between Avalere and the Physicians Advocacy Institute (PAI). The partnership is examining trends in physician employment and practice ownership in hospitals and health systems.

Increasingly, physicians practice in the context of employment arrangements with health systems and hospitals, according to the report. There has been continued growth in hospital and health system acquisitions of physician practices, typically involving multiple physicians and acquisition of the practice’s physical building/equipment; and sustained increases in the number of individual physicians entering into employment arrangements with hospitals and health systems.

Why is the mental health burden in EDs rising?

From MDEdge:

The mounting impact of mental illness on patients and the American health care system has been of growing concern, especially in recent years. As such, now more than ever, it is important to understand the mental health burden and investigate the factors contributing to the elevated use of emergency departments to treat patients with psychiatric illness.

Emergency Department: Guide Helps Kids Understand

From Mass General:

With the help of her mother, Wooden wrote “You Are Here: Wendy’s Welcome to the ED,” a guide for what fellow pediatric patients can expect during an emergency room visit and how to help reduce anxiety and foster communication between their parents and providers.

“We’ve learned a lot over the years from the compassionate care we’ve received from Wendy’s team of doctors, nurses and other staff members,” says Wendy’s mother, Darcy Daniels, who has become an advocate for family-centered care on the MGHfC Family Advisory Council and other subcommittees.

“We wanted to share those lessons so other patients and families can get the best care possible while cutting down on stress and worry. Thanks to the Family Advisory Council, we had a forum where we could go and have our ideas not only heard, but connect us to the right people in the hospital to make the project happen.”

Goodbye SGR, Hello MACRA

From Emergency Physicians Monthly:

What will the new payment system look like for emergency physicians? Much remains to be sorted out in the coming years, but several aspects are clear and written into law. Physicians payments will follow the new Merit-based Incentive Payment System (MIPS), which replaces three previous physician payment programs into one that ties a bonus or penalty each year to physician performance on 4 key areas of clinical transformation: quality, cost efficiency, use of electronic health records and practice improvement activities. (Figure 1) Unlike the Physician Quality Reporting System (PQRS) program that over 60% of emergency physicians participated in last year—MIPS is mandatory for nearly all physicians and raises the stakes from 1–2% of payments per year to a +/- 9% payment adjustment by 2022. Unlike older programs, the MIPS allows eligible clinicians (emergency physicians or advanced practice providers such as PA and APRNS) to report as an individual or as a group (defined by Tax Identification Number [TIN]), thereby enabling quality measures to better match the team-based care models in emergency medicine.

Short turnaround between shifts may increase sick leave

From Reuters:

Workers who get less than 11 hours of rest between shifts may be more likely to take sick leave, a Norwegian study suggests.

“Quick returns,” defined as breaks shorter than 11 hours between the end of one shift and the beginning of another, were tied to a 21 percent increase in the odds of nurses taking sick leave the following month.

“Recent studies suggest these rapid changeovers can be associated with equal or even worse effects on sleep and fatigue than night work,” said lead study author Oystein Vedaa of the University of Bergen.