Optimising medical student education in the emergency department

From the BMJBMJ:

Aim To optimise the education of medical students in the emergency department (ED).

Methods Fourth year medical students, undertaking an emergency medicine rotation in a major trauma centre as part of an acute care programme, were prospectively surveyed over one year. Electronic questionnaire feedback provided a focus for interventions which were implemented as part of plan-do-study-act cycles. There were two interventions over three subsequent cohorts. Cohort A was our control group. Cohort B received a structured, formal induction to the ED. Cohort C were assigned a specialist emergency medicine trainee mentor. The project was led by a medical student undertaking an undergraduate BSc working in collaboration with an emergency medicine consultant and specialist trainee, all of whom passionate about leading improvement in medical education.

Results Thirty eight of 48 fourth year medical students gave feedback on their ED rotation during the 2016–2017 academic year. The number of students citing ‘a lack of knowledge of where to go within the department and what to do in each part’decreased from 7/15 (46.7%) in cohort A to 0/12 in cohort B. The number of students who were ‘unsure as who best to approach’decreased from 9/27 (33.3%) in cohort A and B combined, to 2/11 (18.2%) in cohort C. The number of students citing any problem in their ED rotation decreased from 13/15 (86.7%) in cohort A to 5/12 (41.7%) in cohort B and 5/11 (45.5%) in cohort C.

Conclusion Providing medical students in the ED with a structured, formal induction and by assigning ED mentors results in sustained improvement in feedback and can be used as a model to optimise medical education. The low-cost nature of the interventions and the ready availability of trainees, also wanting to contribute to their own teaching portfolios, makes this model easily replicable across all types of EDs.

Fentanyl Driving Surge in Fatal U.S. Opioid Overdoses

From Health Day:

Extremely powerful synthetic opioids, such as fentanyl or carfentanil, were directly responsible for more than half of thousands of opioid overdose deaths across many states in 2016, a new report finds.

Most often, fentanyl and even more potent “fentanyl analog” drugs — such as carfentanil — were mixed into the heroin that addicts were using, often without their knowledge, say researchers at the U.S Centers for Disease Control and Prevention.

The new report, based on data from 10 states, comes a day after President Donald Trump declared the opioid addiction epidemic a national public health emergency, potentially freeing up more funds to battle what he called a “scourge.”

Collaboration, Streamlined Process Improved ED Admit Times

From MedPage Today:

Patients facilitated into a pilot emergency department program meant to speed triage received care nearly twice as fast as other patients who presented at the ED, researchers said here.

University of Chicago Medicine researchers created and evaluated the “Dr. Admit” initiative, finding that its admitted patients received care an average of 192 minutes after arrival, versus 329 minutes for other patients. The median admission time for Dr. Admit patients was also lower (165 versus 271 minutes), said Tom Spiegel, MD, medical director at the hospital’s emergency department, at the American College of Emergency Physicians annual meeting.

The doctor of the future

From PoliticoPolitico:

Medicine increasingly looks like team sport, with duties and jobs that used to fall to a family doctor now executed by a team, from nurses who sit down with patients to discuss diet and exercise to clinical pharmacists who monitor a patient’s medication. The doctor, in this model, is a kind of quarterback, overseeing care plans, stepping in mostly for the toughest cases and most difficult decisions.

Under some models, the doctor may recede even further into the background, leaving advanced practice nurses or other highly qualified professionals in charge.

It’s no longer true “that you’re a sole cowboy out there, saving the patient on your own,” says Mark Earnest, head of internal medicine at the University of Colorado medical school.

EMS Physicians Laud Senate Passage of Bipartisan Bill Protecting Medical Treatment of Emergency Patients, Sponsored by Senators Bill Cassidy (Louisiana) and Michael Bennet (Colorado)

Press Release:

The National Association of EMS Physicians (NAEMSP) applauds the Senate’s passage of the Protecting Patient Access to Emergency Medications Act of 2017. The House of Representatives unanimously passed a similar version of the bill (H.R. 304) in January. The Senate-approved bill included minor technical changes from the House version requiring the House to approve the Senate version of the bill before it becomes law.

This bipartisan legislation ensures emergency medical service (EMS) care providers, such as paramedics, are able to continue administering the appropriate life-saving emergency medications to patients, without needing to obtain physician permission and potentially delay critical patient care. Additionally, the bill facilitates and strengthens the Drug Enforcement Agency’s (DEA) oversight of EMS.

“This bill will protect Americans and enable our medical first responders to do their utmost to care for patients in their most vulnerable moments,” said Dr. Brent Myers, President of NAEMSP. “We want to extend our deepest gratitude to the bill sponsors Senators Bill Cassidy, M.D. (R-LA) and Michael Bennet (D-CO) for their unwavering support.”

“EMS professionals work directly with physicians to respond to traumatic events,” said Senator Michael Bennet. “This bipartisan bill will allow them to continue this important work while creating safeguards to track controlled substances, such as opioids. The bill also improves access to innovative treatments for opioid addiction. Physicians and other practitioners should have multiple tools at their disposal to fight this epidemic.”

NAEMSP, a patient-centered organization of nearly 2,000 emergency medical professionals, led the industry response to the yet-pending federal regulations, working directly with the DEA and then members of Congress to put forward the Protecting Patient Access to Emergency Medications Act.

“The Protecting Patient Access to Emergency Medications Act is a testament to the value of tenacious advocacy, from NAEMSP and our partners the American College of Emergency Physicians and National Association of Emergency Medical Technicians, and of bipartisan leadership and collaboration,” said Dr. Ritu Sahni, Chair of NAEMSP’s Advocacy Committee. “We urge the House of Representatives and President Donald Trump to take immediate action to advance this bill.”

“Laws and regulations have prevented first responders from providing life-saving treatment to patients,” said Senator Bill Cassidy, M.D. (R-LA), winner of NAEMSP’s 2017 Friends of EMS Award. “This legislation gives EMS agencies the ability to administer emergency treatment and controlled substances to those in need.”

Standing orders, the authorization for medical professionals to autonomously perform certain emergency treatments, were put in question by developing DEA Controlled Substances Act (CSA) regulations. Along with preserving the ability to use standing orders, the legislation also provides a framework to enable the DEA to oversee EMS in a consistent manner across the nation and clarify protocols to follow in a uniform manner to prevent diversion.

About the National Association of Emergency Services Physicians (NAEMSP)

The National Association of EMS Physicians (NAEMSP) is an organization of physicians and other out-of-hospital emergency medical care professionals partnering to provide leadership and foster excellence in the subspecialty of Emergency Medical Services (EMS) medicine. NAEMSP also publishes the peer-reviewed and top-ranked Prehospital Emergency Care journal, as well as a blog and podcast on breaking issues and developments in the EMS field. (Website)

To learn more about NAEMSP’s advocacy on behalf of members and patients, please click here: http://www.naemsp.org/Pages/Advocacy.aspx

Narcan Is Now Available Over the Counter in 45 States

From Lifehacker:

Walgreens announced this week that they are now dispensing naloxone, the drug that can reverse an opioid overdose, over the counter in 46 states. (If you have a prescription, you can buy it in any state.) CVS offers it over the counter in 43 states.

 Which states, though? CVS has a list: you still need a prescription in Delaware, Hawaii, Maine, Michigan, Nebraska, Oklahoma, and Wyoming. According to a spokesperson, all of their stores stock it or can order it for the next business day.

Millennials Embrace Nursing Profession — Just In Time To Replace Baby Boomers

From Kaiser Health News:

The days are long past when the only career doors that readily opened to young women were those marked teacher, secretary or nurse. Yet young adults who are part of the millennial generation are nearly twice as likely as baby boomers were to choose the nursing profession, according to a recent study.

These young people, born between 1982 and 2000, are also 60 percent more likely to become registered nurses than the Gen X’ers who were born between 1965 and 1981.

Adults aren’t just big kids: What are liability risks for pediatricians who care for older patients in ED?

From the AAP:

It’s not uncommon for adult patients to be brought to pediatric EDs or for pediatric providers to work in a general ED to help their colleagues during times of high volume and/or acuity. Under the Emergency Medical Treatment and Labor Act of 1985 (EMTALA), a medical screening exam must be conducted.

What are the medical liability risks when pediatricians who are not trained in adult emergency medicine give care to adult patients in EDs or pediatric EDs? What if inadequate or suboptimal care is provided? Do Good Samaritan laws provide any protection to pediatric providers caring for adults? How do pediatricians comply with EMTALA without providing care beyond their training?

While these concerns might be raised in the ED, the potential risks extend to other settings.

Emergency rooms are providing nearly half of all medical care in the US — and that may be a problem

From Mic:

“I was stunned by the results,” Dr. David Marcozzi, an author of the study and an associate professor in the UMSOM Department of Emergency Medicine, said in a statement from the university. “This really helps us better understand health care in this country. This research underscores the fact that emergency departments are critical to our nation’s healthcare delivery system.”

According to Marcozzi, these findings mean that emergency rooms are providing vital care, especially for groups that face other barriers to accessing health care. “The data might suggest that emergency care provides the type of care that individuals actually want or need, 24 hours a day,” Marcozzi said.

Creating Positive Patient Experience in the Emergency Department

From Patient Engagement HIT:

Understanding patient values and expectations is key to ensuring a positive patient experience in the emergency department, according to a new research from patient experience consulting firm Press Ganey.

Performance Insights: Redesigning Healthcare Delivery looks at the ED as a case study for the healthcare industry as a whole. EDs host patients of all demographics and with varying health levels. As such, it serves as a “microcosm” of the healthcare system at large, the authors wrote.