CMS revives Obama-era critical-access hospital rule

From Modern Healthcare:

The CMS plans to release a finalized version of an Obama-era rulemaking that outlines new standards that critical-access hospitals must comply with to continue billing under Medicare.

The federal agency released the proposed version of the rule in June 2016 and it was not finalized before the Trump administration started in January 2017. The CMS plans to release a final version of the rule some time over the next 17 months, according to a Jan. 12 Federal Register notice, which outlined a list of forthcoming rulemakings.

The wide-ranging rule represented the most major change to standards for critical-access hospitals since 1997. It included a requirement that hospitals must have infection prevention and antibiotic stewardship programs for healthcare-related infections and for the proper use of antibiotics. In addition, the CMS proposed that hospitals adopt nondiscrimination policies that expand protections based on gender identity and sexual orientation. The rule also had several provisions meant to hasten patients’ access to their healthcare records.

In all, the CMS estimated that implementing the rule would cost the industry $773 million to $1.1 billion.

FDA expects IV fluid shortage to improve in coming weeks, months

From Reuters:

The U.S. Food and Drug Administration said on Tuesday it expects a shortage of intravenous saline fluids for hospitals due to damage to key manufacturing facilities in Puerto Rico to improve over the coming weeks and months.

FDA Commissioner Scott Gottlieb said that the FDA has approved IV saline products from more companies, which is expected to boost U.S. supply. He said the tight supply of saline products had been exacerbated by increased demand as a result of a worse-than-normal flu season.

Where patients get prescription opioids: It’s not where you might think

From USC News:

…the share of opioids prescribed from emergency departments was small and declined during that 17-year period, from 7.4 percent to 4.4 percent. The share of opioids prescribed from doctor’s offices was much larger and actually increased during that period, to 83 percent from 71 percent.

Pediatric emergency department triage-based pain guideline utilizing intranasal fentanyl: Effect of implementation

From the American Journal of Emergency Medicine:


Pain management guidelines in the emergency department (ED) may reduce time to analgesia administration (TTA). Intranasal fentanyl (INF) is a safe and effective alternative to intravenous opiates. The effect of an ED pain management guideline providing standing orders for nurse-initiated administration of intranasal fentanyl (INF) is not known. The objective of this study was to determine the impact of a pediatric ED triage-based pain protocol utilizing intranasal fentanyl (INF) on time to analgesia administration (TTA) and patient and parent satisfaction.


This was a prospective study of patients 3–17 years with an isolated orthopedic injury presenting to a pediatric ED before and after instituting a triage-based pain guideline allowing for administration of INF by triage nurses. Our primary outcome was median TTA and secondary outcomes included the proportion of patients who received INF for pain, had unnecessary IV placement, and patient and parent satisfaction.


We enrolled 132 patients; 72 pre-guideline, 60 post-guideline. Demographics were similar between groups. Median TTA was not different between groups (34.5 min vs. 33 min, p = .7). Utilization of INF increased from 41% pre-guideline to 60% post-guideline (p = .01) and unnecessary IV placement decreased from 24% to 0% (p = .002). Patients and parents preferred the IN route for analgesia administration.


A triage-based pain protocol utilizing INF did not reduce TTA, but did result in increased INF use, decreased unnecessary IV placement, and was preferred by patients and parents to IV medication. INF is a viable analgesia alternative for children with isolated extremity injuries.

First responders are getting their radio network — from AT&T

From Axios:

Police and firefighters are finally getting the priority communications network they were promised in the wake of the September 11, 2001, terrorist attacks. In exchange for building it, AT&T gets $6.5 billion in government funds over the next five years and access to a large chunk of valuable airwaves for 25 years.

Examining 30-day COPD readmissions through the Emergency Department

From MDLinx:

In this work, researchers aimed to better understand COPD readmission through the Emergency Department (ED), ascertain factors associated with 30-day readmission through the ED, and identify subgroups of patients with COPD for readmission reduction interventions. As practically all patients with COPD who re-present to the ED within 30 days are readmitted to the hospital and for a variety of clinical complaints, they recommended intensive outpatient monitoring, evaluation, and follow-up after discharge to help prevent re-presentation to the ED. Improved decision support algorithms and alternative management strategies were required among COPD patients who presented with breathing difficulty to identify and intervene on the subgroup of patients who required <48-hour length of stay.

Emergency department telehealth program reduces wait time by 6 minutes

From Clinical Innovation and Technology:

Patients in rural hospitals using telehealth services were seen by a provider six minutes faster than patients without telehealth, according to a study conducted by the University of Iowa.

In this study, researchers evaluated the impact an emergency department (ED)-based telemedicine program could have on ED wait times in rural hospitals. Factors of door-to-provider time, ED length-of-stay and time-to-transfer were included.