Diary of a Concussion

From the Verge:

I opened my eyes to see a clear blue sky and two men leaning over me to put a brace around my neck. I don’t know if I was already on the stretcher or if I was still on the pavement, but there are plenty of things I don’t remember. As I would later find out, I had a brain injury.

Was I badly hurt, I asked. I felt as though someone had smashed a two-by-four across the entire left half of my face. The two men on either side of me carefully lifted my upper body to finish with the brace, giving me a view of my legs. I wiggled my left toes, which were more obliging than my lips. It couldn’t be that bad, I decided. My spinal cord still worked.

 

1 in 5 Americans say they’ve experienced a medical error

From Becker’s:

More than 20 percent of Americans say they have experienced a medical error, according to a recent survey.

The independent research organization NORC at the University of Chicago conducted the survey in partnership with the IHI/NPSF Lucian Leape Institute and with funding from Medtronic. For the survey, NORC polled a nationally representative sample of 2,536 adults between May 12 and June 26 about their experience with medical errors.

New law helps California doctors treat mental health emergencies

From the Reporter News:

Emergency medicine just got a little easier for physicians dealing with patients suffering from a mental health crisis or are unable to provide consent, allowing doctors to make informed decisions before treatment begins.

“This new law gives emergency physicians access to critical medical records, including a patient’s previous diagnoses and prescription history, allowing us to provide better care for patients with mental health needs who come to the ER,” said Dr. Aimee Moulin, president of the California Chapter American College of Emergency Physicians. “The more I know about a patient’s medical history, the better care I can give them when they need it most,”

 

 

How Telemedicine Can Help Reduce Rural Hospital Closures And Provide Easier Access To Care

From Health IT Outcomes:

Rural hospitals can use different forms of telemedicine to improve the outcomes for their patients and reduce their own patient churn:

  1. Remote specialist consultations allow patients to connect with the nearest urban hospital and their physicians for specialized care. This saves the patients and their families’ travel costs and hours of driving time, while still retaining the patient in the local rural health system.
  2. Outsourced diagnostics provide the ability for patients to receive regular specialty lab work without traveling for hours.
  3. Regular monitoring of a patient with a chronic illness often means weekly trips to see a specialist, by being able to see and talk with the patient while they remain at home removes barriers for patients with added limitations.

Nearly 46 million US residents who reside in rural areas are facing the challenge that they may lose out on having access to high-quality emergency care and specialized services from their local hospital. Many rural hospitals are already rising to the challenge and providing direct-to-consumer telemedicine. While it isn’t an easy button, virtual care can help these organizations overcome staffing shortages, heightened readmission rates, low patient census, and patient churn.

Don’t worry about ‘tongue swallowing’ in cardiac arrest victims

From Reuters:

If someone in cardiac arrest needs cardiopulmonary resuscitation (CPR), don’t waste time trying to move the person’s tongue out of the way, experts say.

Attempts to prevent “tongue swallowing” are a major barrier to successful bystander resuscitation of people with cardiac arrest, they warn.

In many cases of cardiac arrests in athletes in recent years, teammates, coaches and fans have tried to clear the athlete’s throat before starting resuscitation because they mistakenly believed there was a danger of tongue swallowing. This practice “is a real obstacle” to lifesaving CPR, researchers wrote in the journal Heart Rhythm.

“There is a gap between what the medical community knows and practices regarding CPR and what is common in society,” study coauthor Dana Viskin of Tel Aviv University in Israel told Reuters Health by email.

Patients Visiting Multiple Emergency Departments: Patterns, Costs and Risk Factors

From Academic Emergency Medicine:

OBJECTIVE:

We sought to characterize the population of patients seeking care at multiple EDs and to quantify the proportion of all ED visits and costs accounted for by these patients.

METHODS:

We performed a retrospective, cohort study of de-identified insurance claims for privately insured patients with ≥ 1 ED visit between 2010 and 2016. We measured the number of EDs visited by each patient and determined the overall proportion of all ED visits and ED costs accounted for by patients who visit multiple EDs. We identified factors associated with visiting multiple EDs.

RESULTS:

8,651,716 patients made 16,390,676 ED visits over the study period, accounting for $26,102,831,740 in ED costs. A significant minority (20.5%) of patients visited more than one ED over the study period. However, these patients accounted for a disproportionate amount of all ED visits (41.4%) and all ED costs (39.2%). A small proportion (0.4%) of patients visited 5 of more EDs but accounted for 2.8% of ED visits and costs. Among patients with two ED visits within 30-days, 32% were to different EDs. Having at least one ED visit for mental health or substance abuse related diagnosis was associated with increased odds of visiting multiple EDs.

CONCLUSIONS:

A substantial minority of patients visit multiple EDs, but account for a disproportionate burden of overall ED utilization and costs. Future work should evaluate the impact of visiting multiple EDs on care utilization and outcomes and explore systems for improving access to patient records across care centers. This article is protected by copyright. All rights reserved.

Study finds gender, racial, and ethnic disparities among academic emergency medicine physicians

From News Medical:

Gender, racial, and ethnic disparities, with regard to academic rank and compensation, continue to exist among academic emergency medicine physicians in spite of a move by leading organizations of emergency medicine to prioritize increasing diversity. That is the primary finding of a study to be published in the October 2017 issue of Academic Emergency Medicine (AEM), a journal of the Society for Academic Emergency Medicine (SAEM).

The study by Madsen, et al, found that women earned less than men regardless of rank, clinical hours, or training and that failure to advance or to receive promotion to leadership roles may be a be a factor in why women leave careers in academic medicine. The study proposes that future research is needed to delineate the issues of retention and advancement.

Additionally, the study found that underrepresented minorities (URM) comprise a small proportion of the academic medicine workforce and are less likely to hold senior positions, and are less likely to be promoted at all levels, regardless of gender, tenure status, degree, or NIH award status.

Looking beyond technology to shape the emergency department of the future

From STAT:

The concept of physicians writing prescriptions for healthy food, pioneered by Dr. H. Jack Geiger in Mound Bayou, Miss., in the 1960s, was once thought of as the purview of social justice warriors. Today, emergency departments like ours and clinics all over the country are partnering with community-supported agriculture cooperatives and farmers markets to do just that. It’s a way to use the health care system to overcome the food desert phenomenon common to patients in the urban areas as well as in rural Mississippi.

Our health care system doesn’t serve everyone well. Technology may be part of the fix, but it alone doesn’t hold the answers. We must find ways of using technology to improve the care of our patients, but we can’t let it lead us. Understanding the social forces that influence our patients’ health and disease, and pushing back on these forces with the same kind of thoughtfulness and care that we apply to selecting the right medication or performing the right procedure, must also be part of the future of emergency medicine.

Larger-dose opioid prescriptions not coming from emergency departments, study shows

Mayo Press Release:

Opioid prescriptions from the emergency department (ED) are written for a shorter duration and smaller dose than those written elsewhere, shows new research led by Mayo Clinic. The study, published today in the Annals of Emergency Medicine, also demonstrates that patients who receive an opioid prescription in the ED are less likely to progress to long-term use.

This challenges common perceptions about the ED as the main source of opioid prescriptions, researchers say.

“There are a few things that many people assume about opioids, and one is that, in the ED, they give them out like candy,” says lead author Molly Jeffery, Ph.D., scientific director, Mayo Clinic Division of Emergency Medicine Research. “This idea didn’t really fit with the clinical experience of the ED physicians at Mayo Clinic, but there wasn’t much information out there to know what’s going on nationally.”

To study 5.2 million opioid prescriptions written for acute – or new-onset – pain across the U.S. between 2009 and 2015, the researchers used the OptumLabs Data Warehouse, a database of de-identified, linked clinical and administrative claims information. None of the patients in the study had received an opioid prescription for the previous six months. This made it easier to compare doses by eliminating patients who built up a tolerance to the drugs.

Researchers found prescriptions for commercially insured patients from the ED were 44 percent less likely to exceed a three-day supply than those written elsewhere. Those patients were also 38 percent less likely to exceed a daily dose of 50 milligrams of morphine equivalent, which is almost seven pills of five-milligram oxycodone per day. And they were 46 percent less likely to progress to long-term opioid use. An opioid prescribing guideline from the Centers for Disease Control and Prevention (CDC) issued in 2016 cautions against exceeding a three-day supply or 50 milligrams of morphine equivalent per day for acute pain.

The results were similar for Medicare patients.

“As an emergency physician, it was a good surprise to see the results of the study,” says senior author M. Fernanda Bellolio, M.D., research chair of the Mayo Clinic Department of Emergency Medicine.

Also unexpected, the researchers say, were the number of prescriptions that exceeded 50 milligrams of morphine equivalent per day. One in 5 commercially insured patients in a non-ED setting received a dose exceeding this guideline. People receiving prescriptions exceeding CDC recommendations – regardless of where they were written – were three times more likely to progress to long-term use.

“Patients and physicians should be aware of the risk of long-term use when they’re deciding on the best treatment for acute pain,” Dr. Bellolio says.

The researchers hope this study will help combat what the CDC calls an opioid epidemic by working toward an ideal prescription to match each patient’s need.

“There is a large amount of variability across patient populations in the amount of opioids people receive for acute pain, depending on where they receive their prescription,” Dr. Jeffery says. “When we see variability on such a large scale, we should worry that some people are not getting the best, most appropriate treatment.”

In the last 15 years, the number of Americans receiving an opioid prescription and the number of deaths involving overdoses have roughly quadrupled, according to the CDC. More than 41 people per day died from a prescription opioid overdose in 2015.

The researchers also note a positive trend: The proportion of prescriptions progressing to long-term use dropped over the study’s period.

The team now is studying what’s driving the differences between ED prescriptions and other practice settings. They hope shedding light on why there’s a difference will reduce the variation in prescriptions and help health care providers determine the best treatment for each individual.

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The Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery funded the research. The center works within the medical practice, gathering and analyzing data with the goal of making broad-based quality and efficiency improvements in patient care at Mayo and beyond.

Dr. Jeffery is a health care practice and policy researcher in the Mayo Clinic Kern Center for the Science of Health Care Delivery, and Dr. Bellolio is a Kern Health Care Delivery Scholars Program alumna.

Their co-authors are:

  • Michael Hooten, M.D., Mayo Clinic
  • Erik Hess, M.D., Mayo Clinic
  • Ellen Meara, Ph.D., Dartmouth College
  • Joseph Ross, M.D., Yale University School of Medicine
  • Henry Henk, Ph.D., OptumLabs
  • Bjug Borgundvaag, M.D., Ph.D., Mount Sinai Hospital, Toronto
  • Nilay Shah, Ph.D., Mayo Clinic

About OptumLabs

OptumLabs is a collaborative center for research and innovation co-founded by Optum and Mayo Clinic, and focused on improving patient care and patient value. The OptumLabs Data Warehouse is a comprehensive, longitudinal, real-world data asset with de-identified administrative claims data, including medical claims and eligibility information from a large national U.S. health insurance plan, as well as de-identified electronic health record data from a nationwide network of provider groups. The Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, which leads the relationship with OptumLabs for Mayo Clinic, has published a number of studies identifying areas for potential improvements in health care delivery using the OptumLabs Data Warehouse.

About Mayo Clinic

Mayo Clinic is a nonprofit organization committed to clinical practice, education and research, providing expert, comprehensive care to everyone who needs healing. For more information, visit mayoclinic.org/about-mayo-clinic or newsnetwork.mayoclinic.org.

 

Study: Emergency departments are prescribing opioids the right way

From MPR:

New Mayo Clinic research has found that that emergency departments are doing a good job of appropriately prescribing opioids.

Investigators scrutinized more than five million opioid prescriptions dispensed between 2009 and 2015 across the U.S. They found emergency department patients were 44 percent less likely to be prescribed opioids for more than three days than patients elsewhere.

Mayo researcher Molly Jeffrey said the study contradicts assumptions that emergency departments hand out pain killers like candy.

“They’re doing something right in the emergency department,” Jeffrey said.