Patients value convenience of telemedicine

From Reuters:

Patients who have real-time video visits with their primary care providers instead of in-person exams are generally satisfied with the convenience and quality of their checkups, a new study suggests.

Reed and colleagues surveyed 1,274 patients at Kaiser in Northern California who had a scheduled video visit with a primary care provider in autumn 2015 to see how well the technology and the medical care worked for them.

Nearly all of the participants had some previous experience using video calling, although it might have been for personal or professional meetings and not for a medical checkup. Most of them also had undergraduate or advanced degrees and more than a third had household income of more than $100,000 a year.

19 emergency room staffers pregnant at the same time

From Live5:

Summer will bring 19 new babies to one Nebraska Medicine department.

This summer, Nebraska Medicine’s emergency department will seem more like the labor and delivery department.

Nurse after nurse after nurse announced baby news, and so did physicians and other emergency room staff.

The final total? The department is expecting 19 babies this summer. That includes those whose wives are expecting.


Cutbacks by some doctors halved new opioid prescriptions over 5 years

From Reuters:

The rate of first-time opioid prescriptions declined 54 percent between 2012 and 2017 in the U.S., largely because many doctors stopped prescribing the painkillers, according to a study of more than 86 million people covered by private insurance.

The number of prescriptions for three days’ worth of an opioid – the recommended amount for an initial prescription – fell 57 percent during those five-and-a-half years and there was a 68 percent decline in the number of prescriptions offering seven days of opioid therapy.

The decline came because the number of doctors willing to prescribe an opioid drug to a patient for the first time dropped 29 percent during that period, researchers report in the New England Journal of Medicine.

Parents bring newborns to ER for many non-urgent reasons

From Reuters:

One of the hardest things about being a new parent is figuring out when babies are so sick they need to go to the emergency room and when worrisome signs or symptoms might actually be perfectly normal, doctors say.

Anxious parents bring babies to the ER for all kinds of things that could go either way like goopy eyes, concerns about how the stump from the cut umbilical cord looks, vomiting, strange looking stool, irregular breathing, and jerky or unusual body movements, doctors write in the American Journal of Emergency Medicine.

“Differences between potentially dangerous pathology and normal infant behavior can be subtle,” said lead study author Dr. Zachary Drapkin of the University of Utah in Salt Lake City.

“It can be helpful if parents are counseled about what to expect over the first few days of life,” Drapkin said by email. “Many of these issues could very effectively be addressed with improved access to primary care.”

CMS unveils 3 payment models for state Medicaid programs

From Becker’s:

CMS discussed three models for states to consider:

1. Capitated Financial Alignment Model: Under this model, states and health plans would enter a joint contract with CMS to provide Medicare and Medicaid services for a capitated amount.

2. Managed Fee-for-Service Model: Under this model, states and CMS would partner to allow states to share in Medicare savings where services are covered on a fee-for-service basis.

3. State-Specific Models: Under this model, CMS would consider partnering with states to test new models that the state develops. States would propose the ideas to CMS through concept papers and proposals.

‘I’m just glad I was able to do a good deed’: Chicagoan pulled over to check out an accident scene and ended up delivering donated organs to Northwestern

From the Tribune:

Robert King was driving home from work Saturday evening — Lake Michigan dancing to the east, the skyline glistening to the north — when traffic on Lake Shore Drive slowed to a crawl.

A green-and-white van that sped past King moments earlier, lights and sirens blaring, sat along the roadside in a mangled heap. King pulled over to see if anyone needed help.

“I asked, ‘Hey, what’s going on? Everybody all right?’ ” King, 50, recalled. “This gentleman said, ‘Yeah, can you please help us? Can you get us to the hospital?’ I said, ‘Sure. No problem. Let me pull out of the way.’ ”

The gentleman, it turns out, was Kofi Atiemo, an organ transplant surgeon from Northwestern Memorial Hospital. The green-and-white vehicle, which had been T-boned while waiting at a stoplight, was an organ transplant vehicle on its way to Northwestern. A patient was prepped and waiting to be transplanted with its contents.

Homemade kits with tourniquets make gunshot first aid more available

From Reuters:

St. Louis doctors came up with some ingenious adaptations to lower the price of training kits used to teach people how to stop severe bleeding that can cost a life, and describe their inner-city focused training program and tools in JAMA Surgery.

Instead of the expensive limb model included in the commercial kits, Andrade and her colleagues constructed one out of foam rollers, in which they made cuts that were painted red to simulate wounds, to which trainees could practice applying a tourniquet.

“We used pool noodles to teach people how to apply pressure,” Andrade said. “If you apply it correctly the hole in the center completely closes.”

The trainers also taught participants to put together the bandages and other materials needed to stop bleeding themselves, so they could carry supplies with them.

Each training kit, including limb model, gauze, gloves and other supplies costs about $25, Andrade and her colleagues write in their report.

Burnout, Drop Out, Suicide: Physician Loss in Emergency Medicine, Part I

From eScholarship:

Each year more than 400 physicians take their lives, likely related to increasing depression and burnout. Burnout—a psychological syndrome featuring emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment—is a disturbingly and increasingly prevalent phenomenon in healthcare, and emergency medicine (EM) in particular. As self-care based solutions have proven unsuccessful, more system-based causes, beyond the control of the individual physicians, have been identified. Such system-based causes include limitations of the electronic health record, long work hours and substantial educational debt, all in a culture of “no mistakes allowed.” Blame and isolation in the face of medical errors and poor outcomes may lead to physician emotional injury, the so-called “second victim” syndrome, which is both a contributor to and consequence of burnout. In addition, emergency physicians (EP) are also particularly affected by the intensity of clinical practice, the higher risk of litigation, and the chronic fatigue of circadian rhythm disruption. Burnout has widespread consequences, including poor quality of care, increased medical errors, patient and provider dissatisfaction, and attrition from medical practice, exacerbating the shortage and maldistribution of EPs. Burned-out physicians are unlikely to seek professional treatment and may attempt to deal with substance abuse, depression and suicidal thoughts alone. This paper reviews the scope of burnout, contributors, and consequences both for medicine in general and for EM in particular.

Program reunites patients with emergency physicians

From Penn State News:

When Frederick heard about “See Me Now,” a program that reunites patients with their emergency department physicians, he didn’t hesitate to participate — and he brought a dozen family members and friends with him to the first reunion in February.

“I talked about what a hard time it was and that the only reason I made it through was because of their skills,” Frederick said. “There were tears all over the place. It was an important time for us to be able to express our thanks.”

The program, made available through a Penn State College of Medicine wellness mini-grant aimed at addressing physician burnout, was the brainchild of Dr. Jeff Lubin, vice chair for quality and patient safety outcomes at the Hershey Medical Center Department of Emergency Medicine, and Linda Gangai, program manager for quality and patient safety outcomes.

“In the emergency department, patients don’t have repeated contact with the doctors like they do in primary or specialty care because they are either going to the intensive care unit, the operating room or home,” Gangai said. “There’s no time to build that bond or relationship that can be so rewarding, and often doctors don’t know the outcomes.”

Numbers Say Emergency Care Is One of the Best Values in Health Care

From ACEP Now:

A recent study, reviewed in an EMRA+ PolicyRx Health Policy Journal Club article, provides an even more eye-popping perspective. The emergency department’s role in health care is quite large, impacting almost half of all hospital care, which is known to be the largest slice of the health care expenditure pie. As other clinicians continue to use the emergency department as an access point for their patients’ unscheduled acute care or as a rapid diagnostic center, our slice of the health care pie will inevitably increase. Ultimately, this will further magnify the attention on emergency care of those minding the national health care piggy banks. Instead of antagonizing the emergency medicine community, policymakers and payers should partner with us to identify solutions to bend the cost curve.