Not urgent? Expect to sit up in the ER

From WRAL:

Hospital officials say the reason the ER often runs out of beds is because the general population is growing and aging. But beds are becoming less important in some hospitals.

“Rather than being in a stretcher, they can treat you in a chair that is sectioned off,” said UNC Rex’s Dr. Linda Butler. “They can start their treatment plan and get (the patient) out.”

The different style of treatment is called vertical care, and it’s used for non-urgent patients. Hospital officials say it’s more efficient.

“Instead of a patient waiting in a bed for all of their tests, they can get their tests, go to a chair, wait for results (and) have another patient go into that bed,” Butler said.

The vertical care allows doctors to use more of their space.

West Virginia hospital to charge upfront co-pays for non-emergency ER visits

From Beckers:

Thomas Memorial Hospital in Charleston, W.Va, in about a month, will begin charging upfront co-pays to patients who visit the hospital’s emergency room for non-emergency care, according to the Charleston Gazette-Mail.

Upon entry into the ER, patients will be screened to determine if they require emergency care. If they come to the ER for a non-emergency reason, they will be informed of the co-pay and be able to decide to stay and pay the upfront co-pay or visit another provider.

Efficacy of Prescription Guidelines on Opioid Prescriptions in the ED

From Urgent Matters:

As described in a previous Urgent Matters blog post, opioid prescriptions in the emergency department (ED) have the potential to cause long-term opioid use (defined as 180 days or more of opioids within 12 months of the index ED visit). Further, prescription opioids continue to be the number one cause of drug overdose deaths in the US. These trends indicate a dire need for effective interventions to curb unnecessary opioid prescriptions and prevent opioid abuse by patients.

A recent study in the Annals of Emergency Medicine examines the effects of one such intervention: opioid prescribing guidelines. Specifically, the study examined opioid prescription rates by ED physicians in Ohio, comparing pre and post guideline data.  The goal was to determine whether the implementation of Ohio’s April 2012 opioid prescription guidelines for ED physicians reduced the number of opioid prescriptions by ED physicians.

Blue Earth, MN CEO’s Take on the Senate Health Care Bill

From Minnesota Public Radio:

The Congressional Budget Office is expected to release its analysis of Senate Republicans’ health care plan later Monday.

It’s not much different from the plan House Republicans passed last month, which the CBO estimated would lower the federal deficit over the next decade while also leaving millions more people uninsured.

The deepest cuts Republicans are proposing are to Medicaid, which provides health care to low-income Americans. If passed, rural hospitals would be among those hardest hit because their patients tend to be older and poorer.

MPR’s Cathy Wurzer spoke with Rick Ash, the CEO of a rural hospital in southern Minnesota, United Hospital District in Blue Earth.

Video recording in the emergency department: a pathway to success

From the BMJ:

At the Royal Infirmary of Edinburgh in Scotland, we video record all patients who are admitted into the ED resuscitation rooms as part of our continuous video audit system. Since installation in late 2015, numerous EDs from across the UK and abroad have repeatedly asked us the same questions: how did you do this; how did you ‘get past ethics’; how do you get consent.

The consistent problem for EDs wishing to integrate video is not the lack of supportive studies reporting video use; video-based studies have assessed the full spectrum of ED care, including communication during consultations, family–staff interactions and time-critical resuscitations. The problem is that there is scarce guidance on how EDs can navigate the processes that will allow them to progress with their own programme of work.

Here, we report on our experience of the practical issues associated with video implementation, such as legality, ethics, data protection and staff acceptance, as these are the issues that are regularly cited as reasons why video is not used.5 6 By focusing on these, we can start to answer the questions above that are pertinent to all EDs that pursue video audit and move towards video becoming an essential part of care delivery.

Returns After Observation Admissions

From Reuters:

When elderly patients stay in U.S. hospitals for “observation” but aren’t officially admitted, there’s a high likelihood they’ll soon be back for more hospital care, a new study shows.

One in five patients covered by Medicare, the federal insurance program for people over age 65, who were observed in a hospital but not admitted returned for a repeat visit within a month, researchers found.

Financial incentives and disincentives have led to an increase in the number of Medicare patients who spend up to 48 hours being observed in the hospital without being admitted. Today, 1.5 million Medicare beneficiaries are observed in hospitals each year, according to Dr. Kumar Dharmarajan, who led the study.

The new findings suggest that clinicians might need to focus more attention on caring for patients once they return home after being observed in the hospital, said Dharmarajan, a geriatrician and cardiologist at Yale School of Medicine in New Haven, Connecticut.

House Seeks To Cap Malpractice Awards As Part Of Health Care Update

From Kaiser Health News:

Last week, a jury awarded a Pennsylvania man $620,000 for pain and suffering in a medical malpractice lawsuit he filed against a surgeon who mistakenly removed his healthy testicle, leaving the painful, atrophied one intact.

However, if a bill before the House of Representatives passes, the maximum he would be able to receive for such “non-economic” damages would be $250,000.

Out-of-hospital cardiac arrests fell under the Affordable Care Act

From Reuters:

In Oregon, the rate of cardiac arrests happening outside of hospitals fell significantly after implementation of the Affordable Care Act and its expansion of health insurance coverage, researchers report.

“The degree of benefit was most surprising: a 17 percent reduction in risk of cardiac arrest (a life-threatening condition where the heart stops pumping) among the middle-aged population for whom health insurance was expanded,” lead author Dr. Eric C. Stecker from Oregon Health and Science University (OHSU) in Portland said by email.

Cardiac Testing After Emergency Department Evaluation for Chest Pain. Time for a Paradigm Shift?

From JAMA:

Cardiovascular disease is the leading worldwide cause of mortality and morbidity. The evaluation of chest pain for suspected acute coronary syndrome (ACS) typically occurs in an emergency department (ED). Chest pain is the second most common reason for an ED visit and accounts for 7 million annual encounters in the United States. Identifying the minority of patients who have ACS is challenging with high stakes, as timely treatment can prevent future cardiac events.1 Missed ACS is also the top reason for malpractice claims against emergency physicians. Consequently, most emergency physicians are unwilling to accept an ACS “miss” rate of less than 1%.2 Thus, the current ED approach to suspected ACS is to err on the side of more testing and more admissions, and results in more than $3 billion in annual hospital costs.3

Deep cuts to Medicaid put rural hospitals in the crosshairs

From CNN (hat tip: Dr. Menadue):

For the hundreds of rural U.S. hospitals struggling to stay in business, health policy decisions made in Washington, D.C., this summer could make survival a lot tougher.

Since 2010, at least 79 rural hospitals have closed across the country, and nearly 700 more are at risk of closing. These hospitals serve a largely older, poorer and sicker population than most hospitals, making them particularly vulnerable to changes made to Medicaid funding.

“A lot of hospitals like [ours] could get hurt,” says Kerry Noble, CEO of Pemiscot Memorial Health Systems, which runs the public hospital in Pemiscot County, one of the poorest in Missouri.