Antibiotic Stewardship Programs Feasible in Smaller Hospitals

From MedPage Today:

Antimicrobial restriction/preauthorization and post-prescription audit and review are two strategies recommended by the Infectious Diseases Society of America as antibiotic stewardship strategies. But these recommendations emerged from studies in large tertiary care hospitals, Anderson and colleagues pointed out, whereas most healthcare is provided in community hospitals. These facilities show the highest rates of antibiotic use in the U.S.

“Community hospitals typically have limited or no resources and no trained staff dedicated to [antibiotic stewardship],” the authors noted. “Therefore, understanding which of the core strategies is most feasible in this practice setting would assist in appropriate allocation of limited resources.”

Post opioid-overdose interventions emerge in US

From Science Daily:

Opioid-related deaths continue to take the lives of thousands in the US each year, with non-fatal opioid overdoses as a significant risk factor for a subsequent fatal overdose. Post-overdose interventions are emerging in affected communities, using what support systems are available to assist in the program design.

Inappropriateness of Repeated Laboratory and Radiological Tests for Transferred Emergency Department Patients

From the Journal of Clinical Medicine:

Background: Laboratory and radiographic tests are often repeated during inter-hospital transfers from secondary to tertiary emergency departments (ED), despite available data from the sending structure. The aim of this study was to identify the proportion of repeated tests in patients transferred to a tertiary care ED, and to estimate their inappropriateness and their costs.

Methods: A retrospective chart review of all adult patients transferred from one secondary care ED to a tertiary care ED during the year 2016 was carried out. The primary outcome was the redundancy (proportion of procedure repeated in the 8 h following the transfer, despite the availability of the previous results). Factors predicting the repetition of procedures were identified through a logistic regression analysis. Two authors independently assessed inappropriateness.

Results: In 2016, 432 patients were transferred from the secondary to the tertiary ED, and 251 procedures were repeated: 179 patients (77.2%) had a repeated laboratory test, 34 (14.7%) a repeated radiological procedure and 19 (8.2%) both. Repeated procedures were judged as inappropriate for 197 (99.5%) laboratory tests and for 39 (73.6%) radiological procedures.

Conclusion: Over half of the patients transferred from another emergency department had a repeated procedure. In most cases, these repeated procedures were considered inappropriate.

Civil Monetary Penalties Resulting From Violations of the Emergency Medical Treatment and Labor Act (EMTALA) Involving Psychiatric Emergencies, 2002 to 2018

From SAEM:


The objective was to describe characteristics of civil monetary penalties levied by the Office of the Inspector General (OIG) related to violations of the Emergency Medical Treatment and Labor Act (EMTALA) involving psychiatric emergencies.


Descriptions of EMTALA‐related civil monetary penalty settlements from 2002 to 2018 were obtained from the OIG. Cases related to psychiatric emergencies were identified by inclusion of key words in settlement descriptions. Characteristics of settlements involving EMTALA violations related to psychiatric emergencies including date, amount, and nature of the allegation were described and compared with settlements not involving psychiatric emergencies.


Of 230 civil monetary penalty settlements related to EMTALA during the study period, 44 (19%) were related to psychiatric emergencies. The average settlement for psychiatric‐related cases was $85,488, compared with $32,004 for non–psychiatric‐related cases (p < 0.001). Five (83%) of the six largest settlements during the study period were related to cases involving psychiatric emergencies. The most commonly cited deficiencies for settlements involving psychiatric patients were failure to provide appropriate medical screening examination (84%) or stabilizing treatment (68%) or arrange appropriate transfer (30%). Failure to provide stabilizing treatment was more common among cases involving psychiatric emergencies (68% vs. 51%, p = 0.041). Among psychiatric‐related settlements, 18 (41%) occurred in CMS Region IV (Southeast) and nine (20%) in Region VII (Central).


Nearly one in five civil monetary penalty settlements related to EMTALA violations involved psychiatric emergencies. Settlements related to psychiatric emergencies were more costly and more often associated with failure to stabilize than for nonpsychiatric emergencies. Administrators should evaluate and strengthen policies and procedures related to psychiatric screening examinations, stabilizing care of psychiatric patients boarding in EDs, and transfer policies. Recent large, notable settlements related to EMTALA violations suggest that there is considerable room to improve access to and quality of care for patients with psychiatric emergencies.

High percentage of radiology malpractice claims originate in emergency department

From Radiology Business:

Nearly half of all radiology malpractice claims involve patients treated in the emergency department (ED), according to a new study published in the Journal of the American College of Radiology.

“Diagnostic errors are the primary source of liability risk in radiology,” wrote Jeffrey D. Robinson, MD, MBA, department of radiology at the University of Washington in Seattle, and colleagues. “Radiologists are in the midrange of subspecialists with respect to both the frequency of claims and the cost of settlements. Even so, the average radiologist is involved with the medicolegal system for a substantial portion of her career.”

On the Virtues of Telemedicine

From Inside Sources:

RURAL CARE: Telemedicine can bring constant, reliable care to rural areas facing chronic shortages of primary care physicians and specialists. Teledoctors can deliver care to a rural community without relocating there or even visiting with any frequency.

Blood test detects concussion and subconcussive injuries in children and adults

From Science Daily:

Subconcussive injuries often show no symptoms or immediate effects, but can cause wear and tear on the brain over time with repeated injuries. The latest study, published in the journal BMJ Paediatrics Open, includes more than 700 emergency room patients — children and adults. The study gets us closer to developing a standard blood test to spot these injuries as early as possible.

“A unique feature of this study is that it includes patients who hit their heads but have no symptoms,” said Linda Papa, MD, lead author of the study and emergency medicine doctor at Orlando Health. “This group is rarely — if ever — included in biomarker studies.”

The blood test looks for two proteins (GFAP and UCH-L1) found in our brains and released into blood after an injury — higher levels of which could indicate a concussion or subconcussive injury. Dr. Papa has been studying these biomarkers for more than a decade. Some of her previous studies have focused on athletes, but now she’s expanding her research on subconcussive injuries to the general population and all age groups.

To boost workforce, medical schools try to sell rural life

From the AP:

The Quillen College of Medicine at East Tennessee State University is among a small group of medical schools across the U.S. with programs dedicated to bolstering the number of primary care doctors in rural communities.

The schools send students to live in small towns and train with rural doctors. Like Quillen, some also organize outings and cultural experiences to try to sell students on living there after they graduate.

Schools have taken students to a ranch to brand cattle, brought in an Appalachian story teller and catered local delicacies to show students who may have never lived without the convenience of a Starbucks or Target what rural life offers.

“It’s a little sense of what the fun part of rural life can be,” said Dr. Dana King, chair of the family medicine department at West Virginia University School of Medicine, where students in the rural track go to a ski resort, visit a coal mine and go whitewater rafting.

CMS to update hospital validation survey processes

From Becker’s:

CMS is seeking to simplify the process for validating hospital accreditation surveys, according to an Aug. 22 blog post from The Joint Commission.

Historically, state agencies conducted a separate survey within 60 days of an accreditation survey to ensure the accrediting organization performed a thorough evaluation.

The new process would eliminate the need for a second survey, instead allowing the state survey team to observe the accreditation survey in real time.

Alarms in emergency rooms rarely important, which can desensitize staff

From Reuters:

Walk into any emergency room in the U.S. and you’ll hear a regular din of beeping alarms going off from machines connected to patients. But a new study found only a tiny fraction of the alarms signals a condition important enough to require a change in the patient’s care.

And that creates a problem: the nearly constant din tends to desensitize hospital staff to the sounds, a phenomenon dubbed “alarm fatigue,” which can result in real emergencies being missed, researchers warn in The American Journal of Emergency Medicine.