How Older Adults Experience an Emergency Department Visit: Development and Validation of Measures

From the Annals of Emergency Medicine:

Study objective

This study aims to develop and validate measures of experiences of an emergency department (ED) visit suitable for use by older adults or their family members.


A cohort of patients aged 75 years and older who were discharged home was recruited at 4 EDs. At 1 week after the visit, patients or family members were interviewed by telephone to assess problems experienced at the visit. Twenty-six questions based on 6 domains of care found in the literature were developed: 16 questions were administered to all patients; 10 questions were administered to bed patients only. Scales were developed with multiple correspondence analysis. Regression analyses were used to validate the scales, using 2 validation criteria: perceived overall quality of care and willingness to return to the same ED.


Four hundred twelve patients completed the 1-week interview, 197 ambulatory and 215 bed patients; family members responded for 75 patients. Two scales were developed, assessing personal care and communication (8 questions; α=.63) and waiting times (2 questions; α=.79). Both scales were significantly independently associated with perceived overall quality of care and willingness to return to the same ED.


Two scales assessing important aspects of ED care experienced by older adults are ready for further evaluation in other settings.

Intubation of prehospital patients with curved laryngoscope blade is more successful than with straight blade

From the American Journal of Emergency Medicine:


Direct laryngoscopy can be performed using curved or straight blades, and providers usually choose the blade they are most comfortable with. However, curved blades are anecdotally thought of as easier to use than straight blades. We seek to compare intubation success rates of paramedics using curved versus straight blades.


Design: retrospective chart review. Setting: hospital-based suburban ALS service with 20,000 annual calls. Subjects: prehospital patients with any direct laryngoscopy intubation attempt over almost 9 years. First attempt and overall success rates were calculated for attempts with curved and straight blades. Differences between the groups were calculated.


2299 patients were intubated by direct laryngoscopy. 1865 had attempts with a curved blade, 367 had attempts with a straight blade, and 67 had attempts with both. Baseline characteristics were similar between groups. First attempt success was 86% with a curved blade and 73% with a straight blade: a difference of 13% (95% CI: 9–17). Overall success was 96% with a curved blade and 81% with a straight blade: a difference of 15% (95% CI: 12–18). There was an average of 1.11 intubation attempts per patient with a curved blade and 1.13 attempts per patient with a straight blade (2% difference, 95% CI: −3–7).


Our study found a significant difference in intubation success rates between laryngoscope blade types. Curved blades had higher first attempt and overall success rates when compared to straight blades. Paramedics should consider selecting a curved blade as their tool of choice to potentially improve intubation success.

Effect of target temperature management at 32–34 °C in cardiac arrest patients considering assessment by regional cerebral oxygen saturation: A multicenter retrospective cohort study

From Resuscitation:


Target temperature management (TTM) is used in comatose post-cardiac arrest patients, but the recommended temperature range is wide. This study aimed to assess the effectiveness of TTM at 32–34 °C while considering the degree of cerebral injury and cerebral circulation, as assessed by regional cerebral oxygen saturation (rSO2).


This is a secondary analysis of prospectively collected registry data from comatose patients who were transferred to 15 hospitals in Japan after out-of-hospital cardiac arrest (OHCA) from 2011 to 2013. The primary outcome was all-cause mortality at 90 days after OHCA, and the secondary outcome was favorable neurological outcomes as evaluated according to the Cerebral Performance Category. We monitored rSO2 noninvasively with near-infrared spectroscopy, which could assess cerebral perfusion and the balance of oxygen delivery and uptake.


We stratified 431 study patients into three groups according to rSO2 on hospital arrival: rSO2 ≤40% (n = 296), rSO2 41–60% (n = 67), and rSO2 ≥61% (n = 68). Propensity score analysis revealed that TTM at 32–34 °C decreased all-cause mortality in patients with rSO2 41–60% (average treatment effect on treated [ATT] by propensity score matching [PSM] −0.51, 95%CI −0.70 to −0.33; ATT by inverse probability of treatment weighting [IPW] −0.52, 95%CI −0.71 to −0.34), and increased favorable neurological outcomes in patients with rSO2 41–60% (ATT by PSM 0.50, 95%CI 0.32–0.68; ATT by IPW 0.52, 95%CI 0.35–0.69).


TTM at 32–34 °C effectively decreased all-cause mortality in comatose OHCA patients with rSO2 41–60% on hospital arrival in Japan.

Anthem Changes to ED Payment Policy Leaves Some Unsatisfied

From the AJMC:

Anthem said that it was adjusting its policy on paying for emergency department (ED) visits, but some advocates and healthcare associations said Friday the changes by the insurer don’t go far enough. In addition, lawmakers in the Missouri House and Senate will consider legislation that would require a board-certified emergency physician to review the patient’s medical history regarding the ED visit before sending a bill, according to a published report.

Anthem makes changes to controversial ED program

From Modern Healthcare (hat tip: Dr. Menadue):

After facing pushback from healthcare providers and lawmakers, Anthem tweaked its controversial emergency room program that doesn’t pay for patient ER visits if conditions are later determined not to have been emergencies.

Indianapolis-based Anthem said it has made several exceptions to the ER program so it will always pay for some types of ER visits. Those exceptions include when a patient is directed by a healthcare provider to go to the ER; the patient is under 15 years old; the patient is traveling out of state; or the patient received any kind of surgery, IV fluids or IV medications, or an MRI or CT scan.

The Chartis Center for Rural Health Unveils 2018 Top 100 Critical Access Hospitals and Top 100 Rural & Community Hospitals

Today, The Chartis Center for Rural Health announced the 2018 Top 100 Critical Access Hospitals and Top 100 Rural & Community Hospitals. The announcement was held at the National Rural Health Association’s (NRHA) annual Rural Health Policy Institute conference.

(Here’s the CAH list)

The Chartis Center for Rural Health’s Top 100 Critical Access Hospitals and Top 100 Rural & Community Hospitals are determined using the Hospital Strength INDEX® from iVantage Health Analytics. Now in its eighth year, the INDEX leverages 50 rural-relevant indicators across eight pillars to provide the industry’s most comprehensive and objective assessment of rural provider performance.

ACUTE CARE is proud to be partners with several of the winners:


Physician recruitment and retention: How 2 rural hospitals are overcoming the challenge

From Becker’s (Hat Tip: Dr. Menadue):

Recruiting and retaining physicians poses a significant challenge for rural hospitals.

In fact, a 2016 Merritt Hawkins white paper cited 6,080 Health Care Professional Shortage Areas for primary care nationwide, 67 percent of which are in rural locations.

There are several reasons hospitals in rural areas have trouble recruiting physicians. Many rural hospitals are in towns that may not be attractive to physicians, and they are often in isolated geographic areas with a more limited local candidate pool.