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Get the scoop on news within the field of emergency medicine 



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Study: Poor and uninsured not to blame for annual rise in ED visits

Researchers find the middle-class is the fastest growing segment of the EM market
by Howard Kim

San Francisco, Calif.– Contrary to popular belief, the poor and uninsured are not responsible for fueling the huge increases in hospital emergency department visits each year. Patients who are covered by insurance and those who can afford to see a primary physician are the chief culprits, according to a study published in April by Annals of Emergency Medicine.
Using tracking data of adult ED visits from 1996 to 2004, researchers determined that the proportion of visits by the uninsured remained stable across the decade while the proportion of visits by patients with incomes higher than 400 percent of the federal poverty line and those with access to a family doctor rose by as much as 59 percent in one year. Researchers cited convenience and age factors as two reasons for the rise.
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ACEP issues recommendations to eliminate inpatient boarding
Physician panel cites boarding as a serious safety concern
by Howard Kim

Washington, DC – With overcrowding and long wait times in emergency departments reaching “a breaking point,” the American College of Emergency Physicians issued a set of long-awaited recommendations aimed at eliminating one of the worst aspects of the overcrowding crisis – inpatient boarding.
 Last month, an ACEP panel in cooperation with the American Hospital Association in Chicago, IL recommended that hospitals and physicians work together to better coordinate inpatient flow to ease overcrowding.
The recommendations included: 1) moving admitted patients out of the ED as quickly as possible and into inpatient areas on other floors, 2) discharging hospital inpatients as early as 12 noon to open more beds and improve patient flow in the ED, and 3) scheduling elective procedures and surgical cases later in the week so that they don’t create bottleneck on other floors.
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Judge vetoes alleged EMTALA violation in patient death case
The death was a result of inadequate emergency care, family argued
by Howard Kim

New London, Conn. – The family of a man who died as a result of sustaining a myocardial infarction during transfer from a health clinic to a hospital ED failed to convince a judge that his death violated federal EMTALA statutes. 
In pre-trial motions, Judge Susan Peck granted the defendants’ request to remove the alleged EMTALA violation from a malpractice suit filed against physician Michael Alper, MD and Pequot Health Center, a clinic operated by Lawrence and Memorial Hospital. The family had argued that the providers acted irresponsibly in moving the patient Craig Guerri before he was properly stabilized.
But the defendants’ attorney successfully argued that the EMTALA statutes don’t stipulate whether the medical care a person receives has to be correct or “non-negligent” in all cases but only that it be consistent among patients in similar circumstances.
In granting the motion to strike, the judge did not hear the plaintiff’s arguments.  A trial date in the case has yet to be determined.
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ED group offers solution to on-call shortage: Shield them from lawsuits
‘Sovereign immunity’ would help solve the problem of malpractice exposure
by Howard Kim

Orlando, Fla. – Emergency physicians in Florida believe they have come up with a novel way to eliminate the reluctance of on-call specialists asked to put in additional hours in the ED – make them agents of the state.
The Florida College of Emergency Physicians plans to ask the state legislature to extend “sovereign immunity” to specialists who agree to work in the ED on the grounds that they provide a service mandated by state and federal laws and therefore should receive protection from malpractice liability.
The group cited surveys showing that the heightened risk of liability and a specialist’s reluctance to put in extra hours in the ED are key factors in the growing crisis over access to emergency care. However, critics give the immunity proposal little chance of passing.
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EP’s treatment call is questioned in tug-of-war over parental consent
Diagnosis of possible meningitis lies at the heart of lawsuit
by Howard Kim

Boise, Id. – An EP who tested a five-week-old patient for meningitis over the parent’s objections may have to prove whether he exaggerated the severity of the child’s condition. An Idaho federal judge returned part of a lawsuit against Richard K. MacDonald, MD, asking the original trial court to determine, among other questions, whether MacDonald overstated the seriousness of the child’s diagnosis.
Over the mother’s objections, MacDonald requested that St. Luke’s Regional Medical Center contact authorities requesting their intervention in the matter. Officers took custody of the child fearing its life was in danger whereupon MacDonald treated the baby with antibiotics and performed a spinal tap.
The mother refused to authorize the test reportedly out of concern that the procedure’s risks outweighed the existence of the infection. A jury will have to decide the issue. No hearing date has been set.
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Local EDs grappled with relatively few cases following Midwest tornadoes 
Officials: The number of injured was light compared with destruction
by Howard Kim

Macon, Ga. – Despite a series of devastating tornadoes that swept through at least four Midwestern states over just one weekend in May, local area hospitals and their EDs were thankfully spared much of the human toll despite more than 22 deaths at the scene and countless millions of dollars in destruction.
Hospitals in Central Georgia, Missouri, Kansas, and Oklahoma near the epicenters of some of the 66 tornadoes that swept through the region over Mother’s Day weekend May 10 and 11 reported seeing relatively few serious injuries resulting from the destruction.
Miami Integris Baptist Regional Medical Center in Oklahoma reported no in-hospital deaths but some 45 injury cases directly linked to the windstorms. Most of the cases involved broken limbs, bruises, and lacerations. But Mount Carmel Hospital in Pittsburgh, Kansas, which was closest to the tornadoes there, was not affected at all, according to state officials.
Witnesses aren’t sure why, but they speculated that the suddenness of the violent, funnel-shaped winds, and in some cases, the exact hour of their occurrence may have sharply reduced the potential number of casualties and mortalities that could have presented at local EDs.
Central Georgia’s tornadoes, for example, hit in the early morning hours between 5 a.m. and 7 a.m. “If you had seen the amount of destruction you wouldn’t believe how easily we got off,” said Ralph Griffin, MD, medical director and chairman of the ED at the Medical Center of Central Georgia in Macon. The hospital reported four serious spinal and orthopedic cases and some 20 other minor injuries.


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