Can better tech improve doctor-patient conversations? A case study with CAT scans in the ER

From Yale News:

A Yale-led team of researchers have developed an electronic application tool that puts patients at the center of a decision about an overused medical test: the CAT or CT scan. If it pans out in wider pilot testing, the innovative app could inform the way that health technology tools are developed and used by physicians and patients, said lead author Dr. Ted Melnick.

CT scans are routinely ordered for patients who visit the emergency department with mild head injuries. However, the test is often unnecessary. While many doctors are provided guidance, such as alerts and reminders, to help them make decisions about tests like CT, they don’t always use the tools, which are viewed as burdensome.

To address this problem, Melnick and his co-authors decided to develop a different tool utilizing a process often applied in the tech industry: user experience testing. Instead of introducing a fully developed tool to doctors, they first tested a prototype app with the “end users” — patients, emergency department clinicians, researchers, and designers.

Through several rounds of testing and retooling, they settled on a version of the app they called Concussion or Brain Bleed. Unlike other decision-support tools for doctors, the Concussion app is designed to be used by both doctor and patient. Rather than providing the clinician with an answer or script, the app provides cues and prompts to facilitate doctor-patient communication.

Where the jobs are: Rural hospitals desperately need more nurses

From CNBC:

  • The nursing shortage is caused by patients are living longer than ever before, requiring more care than was needed in the past.
  • More nurses are also aging out of the workforce, leaving a skills gap as they wind down their careers.

Young doctors are fleeing Illinois. Here’s why.

From Crain’s:

AR-170519811 (1)New graduates of the state’s two publicly funded medical schools are hightailing it to other locales for their post-university training. Though school leaders offer differing opinions on whether these grads are spooked by the state’s interminable standoff or leaving for other reasons, the underlying fact is clear: The number of medical graduates from SIU and the University of Illinois College of Medicine who will remain in Illinois for their residencies has hit a combined all-time low.

Earlier Antibiotics in ED Reduced In-Hospital Sepsis Deaths

From MedPage Today:

Earlier administration of antibiotics, but not intravenous fluids, was associated with lower in-hospital death rates among patients with suspected sepsis treated in New York state emergency departments following the adoption of statewide hospital mandates known as “Rory’s Regulations.”

The first-in-the-nation regulations requiring the early assessment and treatment of sepsis in the hospital emergency department setting were implemented in 2013, following the death of 12-year-old Rory Staunton from sepsis undiagnosed in a hospital ED until it was too late to save him.

The study findings support the association between time to treatment and outcome among patients with sepsis or septic shock treated in emergency departments under the statewide initiative, said researcher Christopher W. Seymour, MD, of the University of Pittsburgh School of Medicine.

 

How physicians use VR to train for emergency care

From Multi-Briefs:

Recreating the sights and sounds of a trauma bay is a challenge for doctors in training. Without witnessing it firsthand, residents may have trouble fully understanding what treating a trauma patient can entail.

To introduce residents to the experience, some schools are turning to virtual reality technology to fill the gap between the classroom and the emergency department.

Using VR, residents have the opportunity to play a variety of roles and learn each team member’s responsibility during a case. Residents are able to view the scenario from different perspectives — the doctor standing next to the patient, someone standing at the end of the gurney, the nurse or medical technician — to get a glimpse of a real-world situation.

“The goal eventually is to have hundreds of patients to teach different scenarios, like, ‘This is what a gunshot victim looks like,’ ‘This is what a stabbing looks like,’ ‘This is what a car accident looks like,'” Dr. Thanh Nguyen, a trauma services physician at OhioHealth Grant Medical Center in Columbus, Ohio, told The Associated Press.

People will die without access to healthcare

From The Hill:

I served as an emergency physician for 10 years. Here’s what I know beyond a shadow of a doubt:

First, thousands of Americans die because they don’t have access to health care. That’s a fact.  I have seen this far too many times. Just one example is the 55-year-old woman who came into my ER with vaginal bleeding. Because she didn’t have health insurance, she never had a pap smear.  It turned out she had advanced cervical cancer, and she died five months later. She died because she didn’t have access to healthcare.

Second, as a civilized society, our standard has to be higher than whether or not someone died.  Being forced to the edge of death because you don’t have access to healthcare is indecent and inhumane.  I have seen countless patients in my ER because they couldn’t afford Lasix, a medicine that prevents fluid retention in people with congestive heart failure.  They were literally drowning in their own bodily fluids.  As a matter of policy, do we really want to say that is acceptable?

Third, it is degrading and offensive – and just plain wrong – to say that some groups of people, just because they are not wealthy, put a lower value on their own lives and health.  Every ER doctor will tell you about patients with a history of a mild stroke who stopped taking their Coumadin because they couldn’t afford it.  Many of them ended up in ERs after having a larger stroke, often paralyzed for life.  How can anyone suggest they deliberately chose that path because they didn’t care about their health?

Finally, it’s simply false that ERs are an acceptable or cost efficient way of providing primary healthcare – that is not their intended purpose. Anyone who has ever spent time in an ER as either a patient or a relative of a patient knows that. If your only option for receiving healthcare requires you to wait for hours while surrounded by people in cardiac arrest or victims of automobile accidents and gunshot wounds, you’ll do what most people without health coverage do: forego care until there truly is an emergency. And many of those people will die because they didn’t get the care when they needed it.

Surgeons on board with teaching public to stop bleeding in emergencies

From Reuters:

Just as many regular people have already learned CPR, members of the public can and should learn techniques to stop bleeding after mass-shooting events or everyday injuries, a survey of U.S. surgeons concludes.

“It’s a simple skill, which if you don’t have it, could lead to someone bleeding significantly and potentially dying,” said lead study author Lenworth Jacobs, director of the Hartford Hospital Trauma Institute in Connecticut.

“Our goal is to inform and empower the public because that first line of defense can really make a difference,” he told Reuters Health. “If someone drops in front of you, you want to feel like you can save a life.”

Jacobs and his colleagues tested their 15-minute bleeding control course, called B-Con, at a national meeting of surgeons in October 2016 by teaching 341 attendees techniques for stopping bleeding just as members of the public would be trained.