Healthcare Update Satellite — 06-26-2013

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UK Accident and Emergency Department criticized for multiple failures after going into “crisis” mode from January through March due to a surge in patient volumes. Of course, all the investigators go and pick through the hospital’s policies four times in April after things have calmed down, rather than going and trying to address the problems in real time while they’re happening.
Want to see me faint? Give me a story about an inspector going to a hospital during a crisis, and making a specific real-time recommendation on how to improve the crisis. None of the vague doublespeak about doing something to “make sure a proper system was in place to identify and manage any risk to the health and safety of people using the hospital.”
Inspectors like this seem to have no problems criticizing other peoples’ solutions – especially after the fact – but they’re hard-pressed to come up with their own innovative solutions during a crisis.

The MERS virus is the latest deadly virus to hit the circuit. The reported mortality rate is 65%! Outbreaks in one case were spread from one dialysis patient to seven others in the same hospital.
One vector was hypothesized to be contaminated dates from Saudi Arabia. Next month’s celebration of Ramadan in Saudi Arabia will be a big test of the infectivity of the MERS virus.

The US isn’t the only country experiencing difficulty managing psychiatric patients from the emergency department. Some Australian hospitals seeing excessive wait times for placement. At Calvary Mater Newcastle Hospital, one in every 15 patients is mentally ill.

Georgia Supreme Court set to hear case challenging Georgia’s emergency medical care statute. Fifteen year old boy undergoes arthroscopic knee surgery to repair a football injury. Eight days later, he comes to the emergency department with chest pain. Labs, EKG, CXR show nothing and he is diagnosed with pleurisy. Two weeks later, he died from bilateral pulmonary emboli.
Georgia’s statute states that emergency medical providers can only be liable if clear and convincing evidence shows that the providers actions showed “gross negligence”.
Two nationally-recognized emergency medicine experts are apparently prepared to testify that the physician’s actions were grossly negligent, which I think is a total crock of an opinion.

140 million patient visits this year and soon to rise even higher with implementation of the UnAffordable Insurance Act. Fewer emergency departments. Higher acuity. Oh, and so what if you don’t get paid for your services. Now to avoid government penalties for patients who are re-admitted too soon, emergency physicians will be expected to provide “observation care” in their limited beds. What could go wrong?
This author says emergency physicians need to be “at the table”. More like we need to fight back before we’re “on the table.”

Patients having pain in the emergency department? Don’t give them 2mg of Dilaudid all at once! Give them 1mg now and 1mg in 15 minutes because according to this Annals of Emergency Medicine study, by the second dose, 42% of the patients have already experienced “adequate anesthesia.”

Oh, and in case you didn’t hear, yours truly is officially going to have his work overseen by one Judith Tintinalli. As in the Emergency Medicine Tintinalli. Talk about pressure …
Dr. Tintinalli has been named as EP Monthly’s new Editor-in-Chief, replacing Dr. Kevin Klauer who is moving over to ACEP News. Welcome aboard! And if you need some pithy commentary for the next edition of your book, you know where to find me.

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