Another reason to worry about overcrowded emergency rooms

From Reuters:

Patients are more likely to be misdiagnosed or experience treatment delays when emergency rooms are so crowded that they receive care in a hallway, a survey of physicians suggests.

Privacy and confidentiality are vital in emergency care, particularly for patients who may be reluctant to undress or divulge sensitive personal information in front of companions in an exam room or strangers in a hallway, researchers note in the Emergency Medicine Journal.

Convert hospitals into ERs? Proposal would make it easier.

From Crain’s:

A proposed bill that shakes up the way Illinois hospitals get Medicaid dollars contains a plan that would allow any medical center in the state to essentially close and become a free-standing emergency center.

As part of the makeover, state lawmakers plan to create a pool of potentially hundreds of millions of dollars to help hospitals convert. Becoming a free-standing ER is one way to use the extra funds.

Under current state law, free-standing ERs only can operate in a community with 50,000 or fewer residents. They must be within 50 miles of a hospital that owns or controls the ER. The Illinois Health Facilities & Services Review Board, which determines the fate of health care projects in the state to prevent duplicating services, must approve stand-alone ERs.

Currently there are six stand-alone ERs operating in a geographic area that stretches from downstate Streator (about an hour northeast of Peoria) to north suburban Lindenhurst near the Wisconsin border, according to the Illinois Department of Public Health.

As part of the new assessment program, free-standing ERs wouldn’t be limited by population restrictions, and they could bypass the facilities board. Instead, a state committee that oversees the pool of money to help hospitals convert would approve ERs, then the state Healthcare & Family Services Department would sign off.

But first, state lawmakers must pass a bill to overhaul the assessment program, then get federal approval before the existing program expires on July 1.

US News ranks 10 best, worst states for healthcare

From Becker’s:

The publication evaluated all 50 states using 77 metrics across eight categories, including healthcare. To rank states in healthcare, U.S. News examined healthcare access, public health and healthcare quality metrics.

The 10 best states for healthcare are:

1. Hawaii

2. Washington

3. Iowa

4. Connecticut

5. Massachusetts

6. Vermont

7. Minnesota

Southern Illinois hospitals celebrate beating national averages for treating heart attack patients

From the The Southern:

“The national guidelines recommend 120 minutes, but we have kept ourselves within 90 minutes,” Panchamukhi said.

The program boasts impressive door-to-balloon numbers, from referring hospitals as far as 46 miles from Memorial Hospital of Carbondale. Those hospitals include Pinckneyville Community Hospital, Marshall Browning Hospital of Du Quoin, Franklin Hospital in Benton, Ferrell Hospital in Eldorado, Harrisburg Medical Center, VA Medical Center in Marion, Herrin Hospital, St. Joseph Memorial Hospital in Murphysboro and Union County Hospital.

Collide or collaborate? Community health centers and hospitals work through their overlap

From Modern Healthcare (free subscription required):

Despite humble beginnings, federally qualified health centers, known as FQHCs, have become a sleeping giant in the healthcare industry. Amid this transformation, hospitals—particularly in rural or otherwise underserved areas—find themselves stepping carefully in an uneasy dance with primary-care focused health centers.

Emergency Department Frequent Users for Acute Alcohol Intoxication

From eScholarship:

Introduction: A subset of frequent users of emergency services are those who use the emergency department (ED) for acute alcohol intoxication. This population and their ED encounters have not been previously described.

Methods: This was a retrospective, observational, cohort study of patients presenting to the ED for acute alcohol intoxication between 2012 and 2016. We collected all data from the electronic medical record. Frequent users for alcohol intoxication were defined as those with greater than 20 visits for acute intoxication without additional medical chief complaints in the previous 12 months. We used descriptive statistics to evaluate characteristics of frequent users for alcohol intoxication, as well as their ED encounters.

Results: We identified 32,121 patient encounters. Of those, 325 patients were defined as frequent users for alcohol intoxication, comprising 11,370 of the encounters during the study period. The median maximum number of encounters per person for alcohol intoxication in a one-year period was 47 encounters (range 20 to 169). Frequent users were older (47 years vs. 39 years), and more commonly male (86% vs. 71%). Frequent users for alcohol intoxication had higher rates of medical and psychiatric comorbidities including liver disease, chronic kidney disease, ischemic vascular disease, dementia, chronic obstructive pulmonary disease, history of traumatic brain injury, schizophrenia, and bipolar disorder.

Conclusion: In this study, we identified a group of ED frequent users who use the ED for acute alcohol intoxication. This population had higher rates of medical and psychiatric comorbidities compared to non-frequent users.

Bystander defibrillator use tied to better cardiac arrest outcomes

From Reuters:

Cardiac arrest patients may be more likely to survive and avoid permanent disabilities when bystanders use a defibrillator to treat them before an ambulance arrives, a new study suggests.

The study focused on 2,500 cardiac arrests that happened in a public place and were considered “shockable,” or possible to treat with an automated external defibrillator (AED). Overall, a bystander used a defibrillator to aid patients in just 19 percent of these cases, the study found.

But when bystanders did intervene, cardiac arrest patients had more than double the survival odds and were also more than twice as likely to leave the hospital able to walk and manage daily tasks with little or no assistance

‘Is there a doctor on board?’ A guide to managing in-flight medical emergencies

Press Release:

A new article in CMAJ (Canadian Medical Association Journal) practical tips for physicians on airplanes who may step in to help in a medical emergency.

“Hearing the call go out for a doctor onboard at 36 000 feet can be anxiety-provoking for any physician,” says Dr. Alun Ackery, an emergency physician at St. Michael’s Hospital and the University of Toronto. “If the health professional offers their expertise, they may have to manage an unfamiliar clinical scenario, in a foreign and limited environment without knowledge of the available resources. This article provides practical tips to inform physicians about what to expect if they are in this situation.”

The article reviews the policies and procedures of Canada’s two major airlines, Air Canada and WestJet Airlines Ltd. and literally unpacks the medical equipment found onboard these carriers in a video to help health care professionals understand what they might encounter during an in-flight medical emergency and what resources are available to help with treatment.

An estimated 2.75 billion passengers worldwide fly each year on commercial airlines, with 133.4 million fliers in Canada in 2015, a 27% increase over 2009. The increased number of passengers is one reason for an increase in in-flight medical emergencies. Another reason is longer flights, which subject people to stressors, such as lower oxygen humidity levels, for a longer period of time.

There are no standardized methods for identifying in-flight emergencies making it difficult to find reliable incidence rates. Estimates range from one medical emergency per every 604 flights (16 events per one million passengers) to one per 7700 passengers. The top five causes of medical emergencies are lightheadedness/loss of consciousness (37.4%), respiratory symptoms (12.1%), nausea or vomiting (9.5%), cardiac symptoms (7.7%) and seizures (5.8%).

Physicians are the primary responders in 40% to 50% of in-flight emergencies, nurses and paramedics in 5% to 25% and flight attendants alone in almost half (45%) of incidents. The authors suggest that in complex medical situations, a team-based approach, assigning clear roles and responsibilities to use the skills of other health care professionals, is valuable. Flight attendants should be involved as key resources who know the aircraft, emergency procedures and can liaise with the cockpit and ground communications staff for telemedicine support and potential emergency landings.

“The incidence of in-flight medical emergencies continues to rise and it is likely that many physicians will hear a call to attend to a fellow passenger. Knowing what to expect may help physicians be better prepared the next time that fateful call goes out at 36 000 feet,” says Dr. Ackery.

Watch the authors unpack in-flight medical kits from Air Canada and WestJet Airlines Ltd. in a video https://youtu.be/h5iKxHO5oVY.

Researchers from St. Michael’s Hospital, the University of Toronto, Air Canada, WestJet Airlines Ltd. and ORNGE Air Ambulance collaborated on the article.

“”Is there a doctor on board?”: Practical recommendations for management of in-flight medical emergencies” is published February 26, 2018.

Video link pre-embargo: https://youtu.be/h5iKxHO5oVY

Wanted: Psychiatrists — lots of them

From Axios:

If you like to start your Mondays on a depressing note — and who doesn’t? — Forbes’ Bruce Japsen is here to help. He noted an important but alarming development this weekend: psychiatrists are now in urgent demand — thanks to issues ranging from opioid addiction to mass shootings, depression and suicide.

TV trauma cases don’t look much like real life

From Reuters:

To see how much TV scenarios differ from reality, Weinberg and colleagues compared what happened to 290 fictional trauma patients on “Grey’s Anatomy” with outcomes for real life injuries sustained by 4,812 patients in a national registry of trauma cases.

They found the death rate was three times higher on TV: 22 percent of trauma patients died on the show compared with 7 percent in real life.

Survivors did better on TV, too.

Half of the seriously injured patients on TV spent less than a week in the hospital, while only 20 percent of real patients had such brief stays.