Nursing shortage will pressure hospital margins for years

From Becker’s:

U.S. nonprofit hospital margins will be negatively affected by an extreme nursing shortage for at least the next three to four years, according to a new report from Moody’s Investors Service.

“Labor is the largest hospital expense and is increasing faster than total expense growth while outpacing revenue growth,” Safat Hannan, a Moody’s analyst, said. “The lack of qualified nurses will compound these expense pressures and negatively affect hospital margins.”

Code Help: Can This Unique State Regulatory Intervention Improve Emergency Department Crowding?

From eScholarship:

Introduction: Emergency department (ED) crowding adversely affects multiple facets of high-quality care. The Commonwealth of Massachusetts mandates specific, hospital action plans to reduce ED boarding via a mechanism termed “Code Help.” Because implementation appears inconsistent even when hospital conditions should have triggered its activation, we hypothesized that compliance with the Code Help policy would be associated with reduction in ED boarding time and total ED length of stay (LOS) for admitted patients, compared to patients seen when the Code Help policy was not followed.

Methods: This was a retrospective analysis of data collected from electronic, patient-care, timestamp events and from a prospective Code Help registry for consecutive adult patients admitted from the ED at a single academic center during a 15-month period. For each patient, we determined whether the concurrent hospital status complied with the Code Help policy or violated it at the time of admission decision. We then compared ED boarding time and overall ED LOS for patients cared for during periods of Code Help policy compliance and during periods of Code Help policy violation, both with reference to patients cared for during normal operations.

Results: Of 89,587 adult patients who presented to the ED during the study period, 24,017 (26.8%) were admitted to an acute care or critical care bed. Boarding time ranged from zero to 67 hours 30 minutes (median 4 hours 31 minutes). Total ED LOS for admitted patients ranged from 11 minutes to 85 hours 25 minutes (median nine hours). Patients admitted during periods of Code Help policy violation experienced significantly longer boarding times (median 20 minutes longer) and total ED LOS (median 46 minutes longer), compared to patients admitted under normal operations. However, patients admitted during Code Help policy compliance did not experience a significant increase in either metric, compared to normal operations.

Conclusion: In this single-center experience, implementation of the Massachusetts Code Help regulation was associated with reduced ED boarding time and ED LOS when the policy was consistently followed, but there were adverse effects on both metrics during violations of the policy.

Opioids no better than NSAIDs for chronic back or arthritis pain

From Reuters:

Acetaminophen, ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) are better than opioids at easing the intensity of chronic pain in the back, knees or hips, a U.S. experiment suggests.

And opioids are no better than these other drugs at reducing how much pain interferes with daily activities like walking, working, sleeping or enjoying life, researchers report in JAMA, online March 6.

“We already knew opioids were more dangerous than other treatment options, because they put people at risk for accidental death and addiction,” said lead study author Dr. Erin Krebs of the Minneapolis VA Health Care System and the University of Minnesota.

Experts offer advice for anaphylaxis

From Reuters:

Parents and caregivers should know what to do when an extreme allergic reaction known as anaphylaxis occurs, according to a new resource published in the medical journal JAMA.

The content of the page, accessible for free (, is based on recommendations given by the Centers for Disease Control and Prevention. The resource emphasizes the symptoms and treatment of anaphylaxis caused by foods, medications or insect bites.

The primer was published alongside a summary of guidelines for physicians for preventing and treating peanut allergy, which afflicts 2 percent of children and 1 percent of adults in the U.S., and is the number one cause of death due to food-related reactions.