Two Midnights, One New Challenge

From EP Monthly:

A detailed break-down of CMS’s ‘Two-Midnight Rule’ and how it will impact emergency medicine.

Perhaps the surest way to drive someone crazy is to expect them to understand the rules and regulations related to coverage and payment by Medicare for hospital inpatient services (Part A), outpatient / observation services (Part B), and skilled nursing facility (SNF) services (also Part A). Medicare enrollees are faced with this challenge all the time, as are hospital financial, discharge planning, and utilization review staff and physicians providing hospital based care to these patients. The financial consequences of the decisions made in an effort to comply with these complicated and sometimes conflicting rules are significant; and emergency physicians (and our hospitalist colleagues) who practice at the nexus of the acute care continuum often find themselves buffeted by conflicting patient needs, hospital administrator expectations, RAC auditor threats, and their own financial interests.

When a “Fall” Isn’t a Fall: Screening for Elder Mistreatment

From EP Monthly:

Emergency physicians are at the front line to detect elder mistreatment, but they receive minimal training on this during residency. One in 10 older adults experiences abuse,1 and the majority of abuse/neglect cases are missed. In fact, victims of elder mistreatment visit the ED twice a year on average, and have over twice the relative risk of hospitalization.2,3 There are the obvious cases, such as Frank’s, where we know not to send someone back into a dangerous situation. But what about Mabel? Her humeral fracture does not require admission to the hospital. Does your hospital have a standardized medical work up for patients with concern for abuse or neglect? How would you and your ED social work team handle her situation? All too often in our busy EDs, Mabel would get an x-ray, a sling, and discharge paperwork without someone taking the extra time to discover her true situation. Once she reveals that her injury is not entirely accidental, are there other questions you should be asking?

Ambulance hijacked with crew, patient inside

From the Statesman:

An unidentified person hijacked an ambulance Sunday afternoon as Austin-Travis County Emergency Medical Services medics were assisting a patient in the back of the unit, EMS reported.

The patient and the medics were unharmed in the incident, EMS reported, and the hijacker has not been caught, according to Austin police.

EMS Capt. Rick Rutledge said a crew of first responders was in the back of the ambulance helping a patient on East Seventh Street just before 4 p.m. Sunday when someone jumped into the front of the vehicle and drove off.

Survey shows many unfamiliar with virtual health services

From the Journal:

Virtual care is a growing trend in health care, but few Iowans know about it, according to a University of Iowa Health Care survey conducted this year.

The survey of 528 Iowans from both urban and rural areas found that 54 percent of respondents were unfamiliar with the concept of care delivered via computer or smartphone.

Opening the Book on ED Metrics

From EP Monthly:

Often, I think docs are unaware of their own metrics, let alone how they compare to their colleagues. Emergency physicians are a competitive bunch and no one likes to be at the bottom of a list. Transparency of metrics encourages efforts to improve performance. I work for a very transparent group, so over the years I’ve become accustomed to working with providers who were either uncomfortable having their metrics displayed or wanted help to improve their performance.

Dogs Refuse to Leave Owner’s Side in Emergency Room

From ABC:

U.S. posts rules for addressing cyber bugs in medical devices

From Reuters:

The U.S. government on Tuesday issued rules for addressing cyber vulnerabilities in medical devices, providing manufacturers with guidelines for fixing security bugs in equipment, including pacemakers, insulin pumps and imaging systems.

“Cybersecurity threats are real, ever-present and continuously changing,” Suzanne Schwartz, a senior Food and Drug Administration official who helped draft the new rules, said in a blog post. “And as hackers become more sophisticated, these cybersecurity risks will evolve.”

The FDA released the 30-page guidance as the agency investigates claims from a short-selling firm and security researchers that heart devices from St. Jude Medical Inc are vulnerable to life-threatening hacks. The allegations, which surfaced in August, underscore the need for clear government rules on identifying and mitigating the impact of security vulnerabilities in medical equipment.

New rules give nursing home residents more power

From the Post:

About 1.4 million people living in nursing homes across the country can now be more involved in their care under the most wide-ranging revision of federal rules for such facilities in 25 years.

The changes reflect a shift toward more “person-centered care,” including requirements for speedy development of care plans, more flexibility and variety in meals and snacks, greater review of a resident’s drug regimen, better security, improved grievance procedures and scrutiny of involuntary discharges.

Physician sells rocks to fundraise $100k for Children’s Hospital of Wisconsin

From Becker’s:

When David Margolis, MD, learned Nordstrom sold out of $85 leather-wrapped rocks this year, he was inspired to start a fundraising campaign called “Rocks for a Reason.”

Dr. Margolis pledged to send every person who donated $85 to Milwaukee-based Children’s Hospital of Wisconsin — where he serves as director of the bone marrow transplant program — a rock in the mail.

“I figured if people were willing to pay $85 for rock that didn’t do anything, there must be some people out there who would be willing to pay $85 for a rock that would help bring joy to kids in the hospital,” Dr. Margolis said in a statement. The donations go toward medical care, community-based health initiatives and research, according to the hospital website, which proclaims, “And on top of that, you’ll still get a rock, and it’ll be sent to you by Dr. Margolis himself!”

Incidence of Pulmonary Embolism in the ED

From the International Fluid Academy:


  • PE was confirmed in 1/6 (17%) of adult patients hospitalised for a first episode of syncope, not on anticoagulant treatment
  • Although an even higher PE prevalence of 25% was noted in the subgroup with syncope of undetermined origin, also almost 13% of patients considered having another clinical explanation for the syncope had PE.
  • Syncope due to PE is thought to occur because of a sudden obstruction of the most proximal pulmonary arteries that lead to a transient depression in cardiac output. However, in approximately 40 % of the confirmed PE cases the vascular obstruction was “small” (<25% perfusion defect on VQ scan or most proximal location of embolus in (sub)segmental artery). This suggest there might be other associated mechanisms responsible for the syncope.