Resources: 2019 Novel Coronavirus

From the CDC:

Healthcare Personnel Preparedness Checklist for 2019-nCoV pdf icon[PDF]

Front-line healthcare personnel in the United States should be prepared to evaluate patients for novel coronavirus (2019-nCoV). The following checklist highlights key steps for healthcare personnel in preparation for transport and arrival of patients potentially infected with 2019-nCoV.

□ Stay up to date on the latest information about signs and symptoms, diagnostic testing, and case definitions for 2019-nCoV disease.

□ Review your infection prevention and control policies and CDC infection control recommendations for 2019-nCoV for:

□ Assessment and triage of patients with acute respiratory symptoms

□ Patient placement

□ Implementation of Standard, Contact, and Airborne Precautions, including the use of eye protection

□ Visitor management and exclusion

□ Source control measures for patients (e.g., put facemask on suspect patients)

□ Requirements for performing aerosol generating procedures

□ Be alert for patients who meet the persons under investigation (PUI) definition

□ Know how to report a potential 2019-nCoV case or exposure to facility infection control leads and public health officials

□ Know who, when, and how to seek evaluation by occupational health following an unprotected exposure (i.e., not wearing recommended PPE) to a suspected or confirmed nCoV patient

□ Remain at home, and notify occupational health services, if you are ill

□ Know how to contact and receive information from your state or local public health agency

From the Iowa Department of Public Health:

Iowa Healthcare Providers
Please review the following information and share it widely with all healthcare  providers within your healthcare facilities and networks.

States ranked by ER visit rate

From Becker’s:

The District of Columbia has the highest rate of emergency room visits in the U.S., according to the most recently available data from the Kaiser Family Foundation.

Here are (Ed. selections from) ER visit per 1,000 population in all 50 states and the District of Columbia in 2017 (the most recent data available):

25. Iowa: 436

28. Wisconsin: 429

31. Nebraska: 420

39. Minnesota: 372

Study identifies solution for physicians’ unprofessional behavior

From Becker’s:

Professional development programs can help stop some physician unprofessional behavior, according to a study published in The Joint Commission Journal on Quality and Patient Safety.

Researchers conducted a 35-item, web-based survey that helped determine the effectiveness of a professional development program. In total, 28 physicians completed the survey before and after attending a program focused to replace unprofessional behavior with professional behavior, promoting peer accountability and support and developing effective leadership skills.

An accompanying editorial describes unprofessional and disruptive workplace behaviors among physicians, such as using language that is profane, disrespectful, insulting, demeaning, insensitive or abusive; verbal intimidation; inappropriate arguments with patients, family members or colleagues; boundary violations; outbursts of anger; among others.

Hours physicians work each week, by generation

From Becker’s:

Nearly a quarter of physicians overall don’t have a work week longer than 40 hours, no matter their generation, according to a new Medscape report.

The Inpatient Discharge Lounge as a Potential Mechanism to Mitigate Emergency Department Boarding and Crowding

From Annals:

Delayed access to inpatient beds for admitted patients contributes significantly to emergency department (ED) boarding and crowding, which have been associated with deleterious patient safety effects. To expedite inpatient bed availability, some hospitals have implemented discharge lounges, allowing discharged patients to depart their inpatient rooms while awaiting completion of the discharge process or transportation. This conceptual article synthesizes the evidence related to discharge lounge implementation practices and outcomes. Using a conceptual synthesis approach, we reviewed the medical and gray literature related to discharge lounges by querying PubMed, Google Scholar, and Google and undertaking backward reference searching. We screened for articles either providing detailed accounts of discharge lounge implementations or offering conceptual analysis on the subject. Most of the evidence we identified was in the gray literature, with only 3 peer-reviewed articles focusing on discharge lounge implementations. Articles generally encompassed single-site descriptive case studies or expert opinions. Significant heterogeneity exists in discharge lounge objectives, features, and apparent influence on patient flow. Although common barriers to discharge lounge performance have been documented, including underuse and care team objections, limited generalizable solutions are offered. Overall, discharge lounges are widely endorsed as a mechanism to accelerate access to inpatient beds, yet the limited available evidence indicates wide variation in design and performance. Further rigorous investigation is required to identify the circumstances under which discharge lounges should be deployed, and how discharge lounges should be designed to maximize their effect on hospitalwide patient flow, ED boarding and crowding, and other targeted outcomes.

Potential Changes to Non-Physician Supervision and Reimbursement Policies Coming to Medicare

From ACEP (hat tip: Dr. Menadue):

You may have heard that the Centers for Medicare & Medicaid Services (CMS) is considering changing existing Medicare regs around non-physician supervision requirements and reimbursement—in other words, what services non-physicians like nurse practitioners and physician practitioners can perform unsupervised, and how much they can get paid.

As background, CMS recently released a request for information asking for feedback on a certain section of President Trump’s Executive Order (EO), “Protecting and Improving Medicare for Our Nation’s Seniors.” The EO directs the Secretary of the Department of Health and Human Services (HHS) to propose specific reforms to the Medicare program, including ones that eliminate supervision and licensure requirements that are more stringent than other federal or state laws. CMS therefore requested help from the public on identifying Medicare regs that contain more restrictive supervision requirements than existing state scope of practice laws or that limit health professionals from practicing at the top of their license.

In response to this request for information, physician groups united in expressing concern about potential reg changes—with dozens of organizations including ACEP signing on to a letter from the American Medical Association (AMA). The letter specifically requests that CMS not make any regulatory changes until it carefully reviews and considers fact-based resources that highlight the vast differences in education and training of physicians compared to non-physician practitioners. We argue that while non-physician practitioners have an important responsibility providing care to patients, their skillsets are not interchangeable with that of fully-trained physicians.

Improving Behavioral Health Care in the Emergency Department and Upstream

From the Institute for Health Improvement:

The paper includes:

  • A framework for a better system of care that comprises four key components: Processes, Provider Culture, Patients, and Partnerships
  • High-leverage changes and specific change ideas
  • Suggested measures
  • Practical tips and examples
  • Resources and tools