FDA tells hospitals that 3M surgical warming blanket is OK for use

From the Star Tribune:

The Food and Drug Administration on Wednesday recommended that hospitals and doctors continue using 3M’s forced-air warming blankets in surgery, despite thousands of lawsuits that allege the devices increase the risk of serious surgical infections.

The Bair Hugger Forced Air Warming Device, manufactured by Maplewood-based 3M Co., is a widely used system that is supposed to promote post-surgical healing and cut down on infections by maintaining a patient’s body temperature in surgery.

Avoidable emergency department visits: a starting point

From the International Journal for Quality in Health Care:

Objective: To better characterize and understand the nature of a very conservative definition of ‘avoidable’ emergency department (ED) visits in the United States to provide policymakers insight into what interventions can target non-urgent ED visits.
Design/setting: We performed a retrospective analysis of a very conservative definition of ‘avoidable’ ED visits using data from the National Hospital Ambulatory Medical Care Survey from 2005 to 2011.
Participants: We examined a total of 115 081 records, representing 424 million ED visits made by patients aged 18–64 years who were seen in the ED and discharged home.
Main outcome measures: We defined ‘avoidable’ as ED visits that did not require any diagnostic or screening services, procedures or medications, and were discharged home.
Results: In total, 3.3% (95% CI: 3.0–3.7) of all ED visits were ‘avoidable.’ The top five chief complaints included toothache, back pain, headache, other symptoms/problems related to psychosis and throat soreness. Alcohol abuse, dental disorders and depressive disorders were among the top three ICD-9 discharge diagnoses. Alcohol-related disorders and mood disorders accounted for 6.8% (95% CI: 5.7–8.0) of avoidable visits, and dental disorders accounted for 3.9% (95% CI: 3.0–4.8) of CCS-grouped discharge diagnoses.
Conclusions: A significant number of ‘avoidable’ ED visits were for mental health and dental conditions, which the ED is not fully equipped to treat. Our findings provide a better understanding of what policy initiatives could potentially reduce these ‘avoidable’ ED visits to address the gaps in our healthcare system, such as increased access to mental health and dental care.

Only 3% of emergency room visits may truly be avoidable, study suggests

From Fierce Healthcare:

Though many emergency rooms are overcrowded and some patients may not have urgent needs, just a fraction of visits are truly “avoidable,” according to a new study.

Researchers examined data from the National Hospital Ambulatory Medical Care Survey from 2005 to 2011 that included more than 115,000 records representing 424 million emergency department visits, and found that only 3.3% were avoidable. The study team defined avoidable visits as those that did not require diagnostic tests, screenings, procedures or medications.

A number of these avoidable visits were for concerns that the ER is not equipped to treat, like dental or mental health issues, according to the study. Of the avoidable visits, 6.8% were for alcohol- or mood-related disorders, like depression or anxiety, while 3.9% were for dental conditions.

The findings, published in the International Journal for Quality in Health Care, challenge the commonly held belief that many people visit the ER needlessly, said Rebecca Parker, M.D., president of the American College of Emergency Physicians, in an announcement.

Low health literacy is associated with preventable emergency department visits

Press Release:

Low health literacy is a risk factor for potentially preventable emergency department (ED) visits, particularly those that result in hospital admission. That is the primary finding of a study to be published in the September 2017 issue of Academic Emergency Medicine (AEM), a journal of the Society for Academic Emergency Medicine.

The study, by Balakrishnan, et al, found that patients with limited health literacy are less inclined to access high-quality outpatient care compared to individuals with adequate health literacy. The study further suggests that until the underlying reasons for this disparity are identified and addressed, dissuading individuals from accessing emergency medical services for potentially preventable emergency department visits will likely be unsuccessful, even harmful.

The lead author of the study is Meenakshi P. Balakrishnan MPH, PhD, Clinical Research Manager in the Department of Emergency Medicine at the University of Florida, Gainesville. Balakrishnan’s study proposes that the emergency department may be an important testing ground for literacy-sensitive precautions and interventions that have the potential to reduce preventable ED visits that contribute to high costs and inefficiency within the U.S. healthcare system.

Harrison Alter, MD, MS, FACEP, Associate Chair for Research in the Department of Emergency Medicine at Highland Hospital and Executive Director of the Andrew Levitt Center for Social Emergency Medicine commented:

“One of the key principles of social emergency medicine is that there are concrete things emergency physicians can do at the bedside when we are faced with social needs. Of all of the social determinants of health, health literacy–the ability of patients to grasp the words we use to describe our care–is one that we can practically reach out and touch. It is at the foundation of our compact with our patients. Dr. Balakrishnan’s paper demonstrates this principle clearly and forcefully, suggesting that patients with low health literacy are twice as likely to use the emergency department for potentially avoidable visits.”


The Society for Academic Emergency Medicine (SAEM) is a 501(c)(3) not-for-profit organization dedicated to the improvement of care of the acutely ill and injured patient by leading the advancement of academic emergency medicine through education and research, advocacy, and professional development. To learn more, visit saem.org.

A qualitative study exploring the factors influencing admission to hospital from the emergency department

From the BMJ:

Objective The number of emergency admissions to hospital in England and Wales has risen sharply in recent years and is a matter of concern to clinicians, policy makers and patients alike. However, the factors that influence this decision are poorly understood. We aimed to ascertain how non-clinical factors can affect hospital admission rates.

Method We conducted semistructured interviews with 21 participants from three acute hospital trusts. Participants included 11 emergency department (ED) doctors, 3 ED nurses, 3 managers and 4 inpatient doctors. A range of seniority was represented among these roles. Interview questions were developed from key themes identified in a theoretical framework developed by the authors to explain admission decision-making. Interviews were recorded, transcribed and analysed by two independent researchers using framework analysis.

Findings Departmental factors such as busyness, time of day and levels of senior support were identified as non-clinical influences on a decision to admit rather than discharge patients. The 4-hour waiting time target, while overall seen as positive, was described as influencing decisions around patient admission, independent of clinical need. Factors external to the hospital such as a patient’s social support and community follow-up were universally considered powerful influences on admission. Lastly, the culture within the ED was described as having a strong influence (either negatively or positively) on the decision to admit patients.

Conclusion Multiple factors were identified which go some way to explaining marked variation in admission rates observed between different EDs. Many of these factors require further inquiry through quantitative research in order to understand their influence further.

Impact of an emergency department electronic sepsis surveillance system on patient mortality and length of stay


Objective: The purpose of this study was to determine whether an electronic health record–based sepsis alert system could improve quality of care and clinical outcomes for patients with sepsis.

Materials and Methods: We performed a patient-level interrupted time series study of emergency department patients with severe sepsis or septic shock between January 2013 and April 2015. The intervention, introduced in February 2014, was a system of interruptive sepsis alerts triggered by abnormal vital signs or laboratory results. Primary outcomes were length of stay (LOS) and in-hospital mortality; other outcomes included time to first lactate and blood cultures prior to antibiotics. We also assessed sensitivity, positive predictive value (PPV), and clinician response to the alerts.

Results: Mean LOS for patients with sepsis decreased from 10.1 to 8.6 days (P < .001) following alert introduction. In adjusted time series analysis, the intervention was associated with a decreased LOS of 16% (95% CI, 5%-25%; P = .007, with significance of α = 0.006) and no change thereafter (0%; 95% CI, −2%, 2%). The sepsis alert system had no effect on mortality or other clinical or process measures. The intervention had a sensitivity of 80.4% and a PPV of 14.6%.

Discussion: Alerting based on simple laboratory and vital sign criteria was insufficient to improve sepsis outcomes. Alert fatigue due to the low PPV is likely the primary contributor to these results.

Conclusion: A more sophisticated algorithm for sepsis identification is needed to improve outcomes.

60 Critical Access Hospital CEOs to Know | 2017

From Becker’s:

ACUTE CARE is honored to be affiliated with four hospitals led by individuals on the list:

Mike Donlin. Administrator of Floyd Valley Healthcare (Le Mars, Iowa). Mr. Donlin began his career as an orderly in a small Onamia, Minn.-based hospital before being commissioned to the National Naval Medical Center in 1975

Dale Hustedt. President and CEO of Avera Holy Family Hospital (Estherville, Iowa). Mr. Hustedt was named CEO of Avera Holy Family Hospital in 2014

Tammy Loosbrock. Senior Director of Sanford Luverne (Minn.) Medical Center. Ms. Loosbrock served as the manager of rehabilitation services, ancillary service director and COO of Sanford Luverne Medical Center before becoming CEO.

Roger J. Reamer. Administrator and CEO of Memorial Health Care Systems (Seward, Neb.). Mr. Reamer heads Memorial Health Care Systems, a critical access hospital that opened in 1950

Forgo supplemental oxygen in adequately perfused patients with acute MI, study suggests

From MD Edge:

Supplemental oxygen did not prevent mortality or rehospitalization among patients with suspected myocardial infarction whose oxygen saturation on room air exceeded 90%, investigators reported.

Elder abuse: ERs learn how to protect a vulnerable population

From 12News:

Because visits to the emergency room may be the only time an older adult leaves the house, staff in the ER can be a first line of defense, said Tony Rosen, founder and lead investigator of the Vulnerable Elder Protection Team (VEPT), a program launched in April at the New York-Presbyterian Hospital/Weill Cornell Medical Center ER.

The most common kinds of elder abuse are emotional and financial, Rosen said, and usually when one form of abuse exists, so do others. According to a New York study, as few as 1 in 24 cases of abuse against residents ages 60 and older were reported to authorities.

The VEPT program — initially funded by a small grant from The John A. Hartford Foundation (a Kaiser Health News funder) and now fully funded by the Fan Fox and Leslie R. Samuels Foundation — includes Presbyterian Hospital emergency physicians Tony Rosen, Mary Mulcare and Michael Stern. These three doctors and two social workers take turns being on call to respond to signs of elder abuse. Also available when needed are psychiatrists, legal and ethical advisers, radiologists, geriatricians and security and patient-services personnel.

Four reasons to choose emergency medicine

From Kevin MD:

4. Style. The prospect of putting on a tie and going to the same eight-to-four clinic job made me want to vomit as a med student. Not to downplay the importance of properly managed hypertension, but spending all day seeing six-month rechecks to control cholesterol and blood pressure in a clinic had no appeal. I wanted variety, flexibility and portability. A career in emergency medicine ticked all those boxes.

Lifestyle must be part of the decision-making process for every physician. Few specialties exist that include no call, no pager, scheduled shifts and the flexibility to work less than full time.