More people might survive cardiac arrest if more bystanders tried hands-only CPR

From Reuters:

More lives could be saved after cardiac arrest if bystanders applied cardiopulmonary resuscitation (CPR), even if it’s just the hands-only version, a new study suggests.

With hands-only CPR emerging as an alternative to the traditional method – chest compressions coupled with mouth-to-mouth rescue breaths – Swedish researchers decided to investigate the impact of the simpler method.

They found that when rates of either type of CPR increased, the chances of surviving a sudden cardiac arrest doubled.

No ED is Immune from Psychiatric Patient Boarding

From Emergency Medicine News:

The increase in ED wait times for psychiatric patients can be traced to a number of factors, but perhaps the most significant is the decline in the number of inpatient psychiatric beds available nationwide. Those dropped 35 percent between 1998 and 2013. (JAMA 2016;316[24]:2591; And the drop wasn’t just confined to the late 1990s and early aughts; a June 2016 report from the Treatment Advocacy Center, a national nonprofit focused on making treatment available for severe mental illness, found that the United States had 37,679 state psychiatric beds in 2016, down about 13 percent from 2010. ( That comes out to an average of 11.7 psychiatric beds for every 100,000 people, a number far below the 40-60 beds per 100,000 people the center recommends.

At the same time, the number of patients presenting to the emergency department with psychiatric emergency conditions significantly increased, said Dr. Zeller. “We’ve seen an approximately 55 percent increase in the number of ED patients who have psychiatric emergency complaints as their primary presenting condition, and over a 400 percent increase in people presenting to EDs for reasons related to suicide.”

Some interventions aimed at this growing crisis have briefly shown promise, only to revert back to the mean over time. That was the case at Yale New Haven Hospital, which in December 2013 added a locked, 12-bed observation psychiatric unit to reduce boarding and improve ED throughput of psychiatric patients. The psychiatric observation unit shares coverage with the psychiatric emergency department, which is staffed 24 hours a day by a board-certified psychiatrist, advanced practice providers, nurses, and social workers. The psychiatric observation unit provides rapid psychiatric assessment, treatment, and referrals for adults experiencing a psychiatric emergency.

Depression in Emergency Department Patients and Association with Healthcare Utilization

From SAEM:


Depression is one of the most common illnesses in the U.S., with increased prevalence among people with lower socioeconomic status and chronic mental illness who often seek care in the Emergency Department (ED). We sought to estimate the rate and severity of major depressive disorder (MDD) in a non‐psychiatric emergency department (ED) population and its association with subsequent ED visits and hospitalizations.


This prospective cohort study enrolled a convenience sample of English‐speaking adults presenting to an urban academic medical center ED without psychiatric complaints between January 1, 2015 and September 21, 2015. Patients completed a computerized adaptive depression diagnostic screen (CAD‐MDD) and dimensional depression severity measurement test (CAT‐DI) via tablet computer. Primary outcomes included number of ED visits and hospitalizations assessed from index visit until January 1, 2016. Negative binomial regression modeling was performed to assess associations between depression, depression severity, clinical covariates, and utilization outcomes.


Of 999 enrolled patients, 27% screened positive for MDD. The presence of MDD conveyed a 61% increase in the rate of ED visits (IRR=1.61, 95% CI: 1.27‐2.03) and a 49% increase in the rate of hospitalizations (IRR=1.49, 95% CI: 1.06‐2.09). For each 10% increase in MDD severity, there was a 10% increase in the relative rate of subsequent ED visits (incident rate ratio, IRR=1.10, 95% CI: 1.04‐1.16) and hospitalizations (IRR=1.10, 95% CI: 1.02‐1.18). Across the range of the severity scale there was over a 2.5‐fold increase in the rate of ED visits and hospitalization rates.


Rates of depression were high among a convenience sample of English‐speaking adult ED patients presenting with non‐psychiatric complaints and independently associated with increased risk of subsequent ED utilization and hospitalization. Standardized assessment tools that provide rapid, accurate and precise classification of MDD severity have the potential to play an important role in identifying ED patients in need of urgent psychiatric resource referral.

ER shift can require 4,000 EHR clicks

From Becker’s:

Depending on the EHR system physicians use, they can spend significant time clicking on their computer screen, 62 clicks specifically just to order Tylenol, according to Fox News.

For physicians working a full shift in the emergency room, more than 4,000 clicks are required throughout the day. With all that clicking, comes mistakes.