ENA Applauds Introduction of ED Suicide Screening Legislation in Congress

Press Release:

Amid a marked increase in suicide rates across the United States and its own research that shows more can be done to assess patients for suicidality in the emergency department, the Emergency Nurses Association on Tuesday offered strong support for new legislation introduced in Congress to improve suicide risk protocols that can help save lives.

The Effective Suicide Screening and Assessment in the Emergency Department Act would create a grant program within the Department of Health and Human Services that is focused on assisting EDs develop ways to better identify, assess and treat patients with signs of suicidality. The bill was introduced Monday by Reps. Gus Bilirakis, R-Fla., and Eliot Engel, D-N.Y.

“Emergency departments are often the place where patients at risk for suicide go within our health care system,” said ENA President Patti Kunz Howard, PhD, RN, CEN, CPEN, TCRN, NE-BC, FAEN, FAAN. “Suicide screening is an essential component of ensuring patient safety. This legislation would create opportunities for more emergency departments to effectively screen, assess and treat high-risk patients.

“We thank Representatives Bilirakis and Engel for recognizing the urgent need to enhance the capabilities of emergency departments to address this growing national crisis,” Howard offered.

According to Centers for Disease Control and Prevention statistics cited by the National Institute for Mental Health, suicide is now the 10th leading cause of death in the United States, claiming approximately 47,000 American lives each year. From 2001 to 2017, the U.S. suicide rate increased 31 percent.

In a 2018 study published in the Journal of Emergency Nursing, ENA researchers identified a need for improvement in the identification of at-risk patients and that additional efforts to enhance suicide-risk assessment should include screening tools that are used continuously during a patients’ ED visit.

“These staggering statistics make it clear that we need improved methods for identifying and assessing the suicide risks of emergency department patients,” Bilirakis said. “As part of my long-term commitment to fixing our broken mental health care system, I want to be sure that we enhance the procedures surrounding the discharge of patients who have attempted suicide or exhibit suicidal ideation to maximize the likelihood that they obtain appropriate follow-up care.

“Our bill is the first step in making that happen. I appreciate the hard work of the Emergency Nurses Association on this important patient care issue and their support for this legislation,” he added.

The funding provided under this grant program can be used by hospitals to:

  • Provide training to emergency health care providers on identifying and treating high-risk patients
  • Establish policies and best practices for emergency departments to improve the identification, assessment and treatment of individuals who are at high risk of suicide, as well as developing best practices for coordination of care and discharge procedures for those patients
  • Hire behavioral health professionals who specialize in treatment of patients with suicidal ideation
  • Improve access to care for those at risk for suicide using telehealth and developing other approaches to reduce the boarding of patients in the ED

Emergency Room Hallway Breeds Delirium

From MedPage Today:

Patients parked for long periods in emergency department (ED) hallways are at high risk for developing in-hospital delirium, researchers reported here.

Among more than 2,000 patients who developed delirium during hospital stays that began with ED visits, half their time in the ED was spent in a hallway bed, versus 30% for patients without a record of in-hospital delirium following admission from the ED (P<0.001), according to Thomas Perera, MD, of Zucker School of Medicine/North Shore University Hospital/Hofstra University, Manhasset, New York.

Research participants’ privacy threat

From Axios:

Technology has advanced to the point where research study participants can be identified by their MRI scans even after all other identifying information has been stripped, according to an experiment detailed yesterday in the New England Journal of Medicine and reported on by the New York Times.

Why it matters: If stored medical data were leaked, it could potentially be used to identify study participants for marketing, scams or even stalking.

Female and minority health professionals face discrimination from rural colleagues

From Reuters:

Even as rural America struggles to attract enough healthcare providers, women and minority health professionals are sometimes driven out of rural communities by the discrimination and harassment from colleagues, a new study finds.

In interviews for the study, many of the healthcare professionals who were female, nonwhite, and of certain sexual orientation and gender identity minority groups described burnout from bias, harassment and hostility from their colleagues, researchers report in JAMA Network Open.

“We’re trying very hard to bring healthcare providers to underserved rural communities,” said study leader Dr. Michelle Ko from the University of California, Davis. “But we have to be very cognizant of how bias, harassment and institutional discrimination can be barriers to that. These issues affect not only the wellbeing of the health professionals but also patients’ access to care.”

Working Americans Are Getting Less Sleep, Especially Those Who Save Our Lives

From NPR (hat tip: Dr. Butts):

If you often hit that midafternoon slump and feel drowsy at your desk, you’re not alone. The number of working Americans who get less than seven hours of sleep a night is on the rise.

And the people hardest hit when it comes to sleep deprivation are those we depend on the most for our health and safety: police and health care workers, along with those in the transportation field, such as truck drivers.

In a recent study, researchers from Ball State University in Muncie, Ind., analyzed data from the National Health Interview Survey. They looked at self-reports of sleep duration among 150,000 adults working in different occupations from 2010 to 2018. Researchers found the prevalence of inadequate sleep, defined as seven hours or less, increased from 30.9% in 2010 to 35.6% in 2018.

Emergency Departments save 25,000 lives, $55 million. Here’s how.

From the AMA:

Emergency departments across the nation are delivering better care for patients with sepsis and chest pain, improving opioid prescribing and ordering fewer unnecessary imaging tests.

Under the initiative, the American College of Emergency Physicians created the Emergency Quality Network (E-QUAL) to:

  • Improve sepsis patients’ outcomes.
  • Improve the value of ED evaluation for low-risk chest pain by reducing avoidable testing and hospital admissions.
  • Reduce opioid-associated harm through safer prescribing and evidence-based interventions.
  • Reduce avoidable imaging in low-risk patients by implementing Choosing Wisely recommendations for advanced imaging for low-back pain, minor health injuries, pulmonary embolus, renal colic, and syncope.

Study finds that half of nurses, physicians are burned out

From Becker’s:

Between 35 percent and 54 percent of U.S. nurses and physicians are burned out, a situation that won’t improve until healthcare organizations, educational institutions and the government all make systemic changes, according to a new report from the National Academy of Medicine.

Defined by emotional exhaustion, detachment and a low sense of personal achievement, burnout can jeopardize patient care and cause clinicians to leave their jobs, the report found. Burnout is attributed to overwhelming job demands and inadequate resources, not individual mental health diagnoses. With high individual costs, such as occupational injury, alcohol abuse and suicide risk, burnout also has high social and economic costs for organizations and society.

Cutting opioid prescriptions may be as easy as asking patients how many they’ll need

From Becker’s:

Asking patients to be involved in deciding how many opioids they need could help lower opioid prescribing rates, according to a study published in The Green Journal.

Researchers from Ann Arbor-based Michigan Medicine designed a shared decision-making intervention to help educate patients about postoperative pain management and their options. Patients were shown a pain management-focused visual aid after surgery and physicians discussed the typical number of opioids required to help manage pain as well as the risks and side effects of opioid use.

Physicians also told patients the maximum number of opioids that may be prescribed. Patients were then asked to choose how many they think they would need, with reassurance that the prescription could be altered if necessary.

Is the stethoscope dying? High-tech rivals pose a threat

From the AP:

 Two centuries after its invention, the stethoscope — the very symbol of the medical profession — is facing an uncertain prognosis.

It is threatened by hand-held devices that are also pressed against the chest but rely on ultrasound technology, artificial intelligence and smartphone apps instead of doctors’ ears to help detect leaks, murmurs, abnormal rhythms and other problems in the heart, lungs and elsewhere. Some of these instruments can yield images of the beating heart or create electrocardiogram graphs.

Dr. Eric Topol, a world-renowned cardiologist, considers the stethoscope obsolete, nothing more than a pair of “rubber tubes.”

What if you call 911 and no one comes? Inside the collapse of America’s emergency medical services.

From NBC:

There is no hospital in Hebron. In fact, when someone calls 911, there isn’t even a law that requires anyone in Hebron to answer the phone. Like so many other low-income, rural communities across the country, the small town’s ambulance runs on altruism alone.

And those ambulance services are closing in record numbers, putting around 60 million Americans at risk of being stranded in a medical emergency. Because so many emergency medical services (EMS) agencies have been struggling financially, some states are stepping in with funding. But emergency medical experts say it’s not enough to cure the dire situation.