MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'emergency department'. Sat, 03 Sep 2011 02:03:38 +0100 http://www.medworm.com/index.php?rid=5169552&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-state-of-drug-seeking-in-america-nothing-should-hurt%2F2011.08.26 This might sting a little… When I was a child, I was often painted orange with Merthiolate.  My grandmother, like every good grandmother, kept a bottle handy at all times.  Merthiolate was an antiseptic, containing Mercury, that was marketed for cuts and scrapes. A fall on the gravel, a slide on the pavement, a run through the briar patch and you’d be sitting on the kitchen table while grandma colored you orange with the magical elixir, which incidentally burned like fire! On a recent emergency department shift, we were colluding about the general state of drug-seeking in America, which has been enabled by our ‘nothing should hurt’ ideology.   One of my dear friends, Nurse Nancy, had a realization; an epiphany, really. (more…) *This blog post was originally publ... Better Health blogs http://www.medworm.com/rss/comments.php?id=5169552 Fri, 26 Aug 2011 16:00:34 +0100 5169552 http://www.medworm.com/index.php?rid=5158995&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Freducing-the-use-of-ct-scans-in-children%2F2011.08.25 Well, this is satisfying. Over the years, in our ER we have mirrored the nationwide trend and have significantly increased the utilization of CT scans across the board. The reasons are manifold. Some cite malpractice risks, and indeed in our large group we have had one lawsuit for a pediatric head injury and another for a missed appendicitis which probably did contribute. But, in my opinion, there have been many other drivers of the increased use. For one, CTs have gotten way, way better over the last 15 years, which quite simply has made them a better diagnostic tool. They’ve also gotten way faster. As the facilities have invested in CT scanners, they have increased their capacity and increased their staffing, so the barriers to their use have rapidly diminished. I am so old that I ... Better Health blogs http://www.medworm.com/rss/comments.php?id=5158995 Thu, 25 Aug 2011 12:00:00 +0100 5158995 http://www.medworm.com/index.php?rid=5086172&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Foverwhelmed-ers-continue-to-rise-to-the-challenge%2F2011.07.31 Last night I was contacted by a physician in the local urgent-care.   I like him, and we made polite, but brief, conversation.  ‘So, are you guys busy?’ I gave him the status report.  ‘Well, yeah.  We have about 25 people waiting to be seen the waiting room is full and every patient room is full.  Also, we just received a gun-shot wound to the head by EMS.’ ‘Wow, sounds terrible!  So, here’s what I need to send you…’ What he sent was, in fact, reasonable.  A young woman with signs and symptoms of meningitis (who was treated earlier in the day for and upper respiratory virus…with Amoxicillin, of course.) She needed a lumbar puncture, which I performed and which was  negative. But I had this thought.  I could probably have said, (more…) *This blog ... Better Health blogs http://www.medworm.com/rss/comments.php?id=5086172 Sun, 31 Jul 2011 21:00:39 +0100 5086172 http://www.medworm.com/index.php?rid=5062290&cid=t_143297_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F07%2F25%2Fneed-mental-health-treatment-in-2-weeks-fat-chance%2F This study demonstrates quite the opposite. Read the full article: Medical News: Barriers High in Mental Health Care (Source: World of Psychology) World of Psychology blogs http://www.medworm.com/rss/comments.php?id=5062290 Mon, 25 Jul 2011 20:15:01 +0100 5062290 http://www.medworm.com/index.php?rid=4775396&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fjudging-illness-severity-and-the-financial-implications-of-dialing-911%2F2011.05.01 Nora misjudged the height of the stair outside the restaurant, stepped down too hard, jammed her knee and tore her meniscus.  Not that we knew this at the time.  All we knew then was that she was howling from the pain. There we were on a dark, empty, wet street in lower Manhattan, not a cab in sight, with a wailing, immobile woman.  What to do?  Call 911? Find a cab to take her home and contact her primary care doctor for advice?  Take her home, put ice on her knee, feed her Advil and call her doctor in the morning? Sometimes it is clear that the only response to a health crisis is to call 911 and head for the emergency department (ED).  But in this case – and in so many others we encounter with our kids, our parents, our co-workers and on the street – the course of action is les... Better Health blogs http://www.medworm.com/rss/comments.php?id=4775396 Sun, 01 May 2011 16:00:04 +0100 4775396 http://www.medworm.com/index.php?rid=4734108&cid=t_143297_88_f&fid=38129&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Flifeinthefastlane%2FWZHV%2F%7E3%2FGw3SydNx1Wc%2F Own the wound is a collection of videos on wound care created by Michelle Lin the guru behind Academic Life in Emergency Medicine. (Source: Life in the Fast Lane) Life in the Fast Lane blogs http://www.medworm.com/rss/comments.php?id=4734108 Thu, 21 Apr 2011 00:00:34 +0100 4734108 http://www.medworm.com/index.php?rid=4626835&cid=t_143297_88_f&fid=38129&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Flifeinthefastlane%2FWZHV%2F%7E3%2FL1d65XzpRt4%2F Musings on the point of equipoise for investigating and discharging chest pain patients in light of a new paper in the Lancet describing a rapid rule-out protocol for acute coronary syndromes (the ASPECT trial). (Source: Life in the Fast Lane) Life in the Fast Lane blogs http://www.medworm.com/rss/comments.php?id=4626835 Wed, 23 Mar 2011 08:55:13 +0100 4626835 http://www.medworm.com/index.php?rid=4615103&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdogs-hospitals-and-unintended-consequences%2F2011.03.19 Every day I go to the emergency room to admit my adults, I can hear the screaming babies and toddlers. Sometimes, the screams are actually from their parents after realizing  how much their visit is going to  cost.  But most of the time it’s really frightened kids in an unfamiliar environment. Happy’s hospital used to hand out hospital stickers so kids would associate emergency rooms with a fun place to hang out.  It turns out, after  intense behind the scenes discussions with administration, that this policy was a covert attempt to increase the volume of our pediatric emergency room volumes. After looking at the numbers, and understanding how hospitals get paid,I have now come on board and am part of a committee think tank that does nothing more than think of ways to get ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4615103 Sat, 19 Mar 2011 17:00:00 +0100 4615103 http://www.medworm.com/index.php?rid=4525032&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fnot-enough-psychiatric-beds%2F2011.02.26 I read today that Eastern Ontario has started a bed registry to keep track of where open psychiatric beds are available. This is something I’ve long advocated. The United States now has less than 10 percent of the beds it used to have 50 years ago. Granted, treatment has improved and community resources are enhanced. But there are still areas that often do not have a sufficient number of hospital beds for folks needing acute inpatient psychiatric care. The Ontario story described in the Ottawa Citizen states that six of the area hospitals have been connected to a computerized “bed board” that provides real-time information on who has an appropriate bed available. This saves time in the ER and gets patients to needed treatment more quickly. Otherwise calls need to be made... Better Health blogs http://www.medworm.com/rss/comments.php?id=4525032 Sat, 26 Feb 2011 19:00:00 +0100 4525032 http://www.medworm.com/index.php?rid=4477760&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fin-the-er-with-abdominal-pain-lower-your-diagnosis-expectations%2F2011.02.15 Abdominal pain is the bane of many emergency physicians. Recently, I wrote how CT scans are on the rise in the ER. Much of those scans look for potential causes of abdominal pain. In an essay from Time, Dr. Zachary Meisel discusses why abdominal pain, in his words, is the doctor’s “booby prize.” And when you consider that there are 7 million visits annually by people who report abdominal pain, that’s a lot of proverbial prizes. One reason is the myriad of causes that lead bring a patient to the hospital clutching his abdomen. It can range from something as relatively benign as viral gastroenteritis where a patient be safely discharged home, to any number of “acute” abdominal problems necessitating surgery. But more importantly, we need to consider how limited doctors actually a... Better Health blogs http://www.medworm.com/rss/comments.php?id=4477760 Tue, 15 Feb 2011 16:00:19 +0100 4477760 http://www.medworm.com/index.php?rid=4438886&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fis-the-er-really-the-best-place-to-get-primary-care-quicker%2F2011.02.05 In 1986, when Congress passed the Emergency Medical Treatment and Active Labor Act (EMTALA), hospitals and ambulance services were mandated by law to stabilize anyone needing emergency healthcare services regardless of citizenship, legal status, and/or insurance status. This was instituted at the time to prevent the prevalent practice of “dumping” — refusing to treat patients because of insufficient insurance or transferring or discharging patients on the basis of anticipating high diagnosis and treatment costs. While the implications of this law are indeed very noble in providing undifferentiated care to all patients based solely on healthcare needs and not financial status, it has unfortunately led to many patients presenting to the emergency department (ED) for primary care is... Better Health blogs http://www.medworm.com/rss/comments.php?id=4438886 Sat, 05 Feb 2011 17:00:34 +0100 4438886 http://www.medworm.com/index.php?rid=4304878&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-cancer-hits-a-doctors-home%2F2011.01.02 This year has been a weird one for me and cancer. In the ER, we see cancer patients pretty infrequently. The occasional chemotherapy with fever, but that’s about it. I think the oncologists try hard to keep the patients out of the ER — to everybody’s benefit. But this year, I’ve had a weird rash of cases where I’ve made primary diagnoses of cancer in the ER — several times over and over and over again. In ten years I don’t think I’ve made as many cancer diagnoses as I have this year alone. Just very strange. Unfortunately, it came home to roost. My wife was diagnosed with breast cancer last week. (more…) *This blog post was originally published at Movin' Meat* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4304878 Sun, 02 Jan 2011 22:00:00 +0100 4304878 http://www.medworm.com/index.php?rid=4294628&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fstick-to-one-er-avoid-unnecessary-tests%2F2010.12.28 Via Kaiser Health News: On a recent Friday night at the Boston Children’s Hospital ER, Dr. Fabienne Bourgeois was having difficulty treating a 17-year-old boy with a heart problem. The teen had transferred in  from another hospital, where he had already had an initial work-up — including a chest X-ray and an EKG to check the heart’s electrical activity. But by the time he reached pediatrician Bourgeois, she had no access to those records so she gave him another EKG and chest X-ray. He was on multiple medications, and gave her a list of them. But his list differed from the one his mother gave doctors, neither of which matched the list his previous hospital had sent along. This is excellent advice. Every ED has seen a patient, probably today, with “they saw me at the ER across t... Better Health blogs http://www.medworm.com/rss/comments.php?id=4294628 Tue, 28 Dec 2010 18:00:10 +0100 4294628 http://www.medworm.com/index.php?rid=4241728&cid=t_143297_88_f&fid=38129&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Flifeinthefastlane%2FWZHV%2F%7E3%2FgjJf5eznflY%2F It may feel like the sands of time are fast running through your fingers, but there is still time to buy emergency Christmas gifts for your favourite emergency physician. Here is the official list of UCEM-approved 'Christmas Gifts for the Emergency Department'. (Source: Life in the Fast Lane) Life in the Fast Lane blogs http://www.medworm.com/rss/comments.php?id=4241728 Wed, 08 Dec 2010 09:20:14 +0100 4241728 http://www.medworm.com/index.php?rid=4230161&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-street-economics-of-drug-abuse%2F2010.12.04 I’ve discovered over the years that I really like economics. I never took an econ class in my entire life, since I was pretty focused on the life sciences, but I’ve picked up a fair amount informally over the years. Fortunately I have a strong background in statistics and math, and I’ve done a lot of reading on economics. I wouldn’t say that I have any special level of understanding or credibility on the topic. Perhaps it should be noted that my wife took away the checkbook for good reason. But I enjoy it as a topic, as something to read about and a powerful tool for understanding how the world works. One consequence of being an ER doc is that you are pretty close to “the street,” and I don’t mean Wall Street. I mean the folks living and scroungi... Better Health blogs http://www.medworm.com/rss/comments.php?id=4230161 Sat, 04 Dec 2010 18:00:00 +0100 4230161 http://www.medworm.com/index.php?rid=4214204&cid=t_143297_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2010%2F11%2F30%2Frapid-tranquillisation%2F Rapid tranquillisation is sometimes used with disturbed violent patients in adult in-psychiatric settings and emergency departments. It’s only a small part of the algorithm for the short term management of these patients. Other aspects are prediction, prevention, other interventions than medication and a post incident review. There’s a guideline from the UK’s National Institute for Health and Clinical Excellence (NICE). This guideline makes a distinction between psycotic and non psychotic context. With psychotic context the combination of lorazepam and haloperidol is advised and olanzapine i.m. is also advised with moderate disturbance. The evidence for the latter is mainly from industry sponsored studies and drug industry authored papers. As with most industry sponsored ... Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=4214204 Tue, 30 Nov 2010 07:30:59 +0100 4214204 http://www.medworm.com/index.php?rid=4162922&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdrug-seekers-and-a-new-threat%2F2010.11.13 I wish I could say that every patient encounter worked out well, that all my patients went home happy and satisfied. It would be nice, but unfortunately that is not true at all. There are many patients who present with unrealistic expectations or an agenda which is non-therapeutic, and I am relatively straightforward and unapologetic about correcting patient’s misconceptions about the care that is or is not appropriate in the ED. Unsurprisingly, this often though not always involves narcotic medications. Which is not to say that I am a jerk. I try to be compassionate, and I try to find alternative solutions, and I have been told that I can turn away a drug seeker more nicely than any other doctor in the department. But when it is time to say “no,” I say “no” ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4162922 Sat, 13 Nov 2010 20:00:00 +0100 4162922 http://www.medworm.com/index.php?rid=4055715&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Femergency-medicine-who-should-set-the-standard-of-care%2F2010.10.11 According to the Standard of Care Project at EP Monthly: The Power of Agreement We can stop baseless malpractice suits before they get started. How? By having a majority of practicing emergency physicians go on record as to the baseline “standard of care,” beneath which is negligence. This has been rolling for a while, and I’ve been late to blog it. That does not in any way mean I’m not 100 percent FOR it. The idea is beautifully simple: The standard of care in emergency medicine (EM) should be set by practicing EM physicians, not case-by case in courts before lay juries with battling experts. (AAEM had the “remarkable testimony” series as a retrospective attempt to shame “experts” who gave, well, remarkable statements under oath, which to date has two ca... Better Health blogs http://www.medworm.com/rss/comments.php?id=4055715 Mon, 11 Oct 2010 14:00:31 +0100 4055715 http://www.medworm.com/index.php?rid=4053293&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fanother-er-animation%2F2010.10.09 In a better setting than the animation of the ER patient faking a seizure (which was inexplicably set in what appeared to be a convenience store), this one at least looks medical. But I’m a little concerned about the red blood infusion just hanging in the background, not connected to anything. I’m pretty sure the Joint Commission wouldn’t approve of that. *This blog post was originally published at Movin' Meat* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4053293 Sat, 09 Oct 2010 12:00:00 +0100 4053293 http://www.medworm.com/index.php?rid=4031242&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhot-topic-certification-of-er-doctors%2F2010.10.04 Texas is at the center of a heated national battle over the training emergency physicians need in order to advertise themselves as “board certified.” Via the Houston Chronicle: At stake is the welfare of patients requiring immediate medical attention. Leaders of the traditional board say allowing physicians without proper training to advertise themselves as board-certified would mislead the public. Leaders of the alternative board say the proposed rule change will undermine the ability of Texas’ rural hospitals to staff their emergency departments with board-certified ER physicians. A final verdict may only come, given one board’s already delivered threat, in a court of law. At stake also are the careers of a lot of practicing Emergency Physicians, many of whom I’m proud ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4031242 Mon, 04 Oct 2010 23:00:00 +0100 4031242 http://www.medworm.com/index.php?rid=3959928&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Femergency-rooms-overused-for-routine-care%2F2010.09.11 The Patient Protection and Affordable Care Act (our government’s name for healthcare reform) may make our already crowded emergency rooms swarm with more patients. A new study from Health Affairs shows that more than a quarter of patients who currently visit emergency departments in the U.S. are there for routine care and not an emergency. New complaints like stomach pain, skin rashes, fever, chest pain, cough or for a flare up of a chronic condition should not be treated in emergency rooms. They are best worked up and treated by an internist or family physician, preferably one who knows the patient. So why are these patients waiting for hours and spending up to 10 times as much money for emergency department care? (more…) *This blog post was originally published at E... Better Health blogs http://www.medworm.com/rss/comments.php?id=3959928 Sat, 11 Sep 2010 15:00:00 +0100 3959928 http://www.medworm.com/index.php?rid=3914996&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Felectronic-medical-records-er-wait-times-and-the-medical-blogosphere%2F2010.08.30 Here’s a confession: Despite my steadfast advocacy of medical blogging as a means to promote understanding and education, I continue worry a lot about professional liability. Not just whether the things I write could hurt my career, but, in terms of academic output, is blogging a waste of time? What view does my department’s leadership take on blogging? Still, I’ve continued to support medical blogging as a useful academic endeavor, hoping that someday this support would be borne out. When sites like Sermo and Facebook came along, I despaired that more physician opinions were going to be hidden behind walled gardens, available only to select colleagues or friends. Then, last week, some revelations — I discovered a member of my department’s leadership was blog... Better Health blogs http://www.medworm.com/rss/comments.php?id=3914996 Mon, 30 Aug 2010 20:00:00 +0100 3914996 http://www.medworm.com/index.php?rid=3915002&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-meth-lab-the-er-judgment-and-grace%2F2010.08.29 Last week a trailer less than a mile from our house experienced a small explosion. Trailers, which seldom explode on their own (without undiscovered volcanoes or CIA drones with missiles) was concealing a meth lab. What can you say? If I weren’t an emergency physician I’d say, “Shocking! Ghastly! Unbelievable!” But I do what I do so I say, “Huh, how about that.” I’ve lost much of my capacity to be shocked. I have seen meth users, and probably meth dealers. I’ve known and enjoyed the company of alcoholics and Valium addicts. I’ve cared for murderers and the murdered (albeit briefly in the case of the latter). I’ve been involved in the evaluation of sexual assault victims, car thieves, drunk drivers and child abusers. A meth lab is, in its own way, k... Better Health blogs http://www.medworm.com/rss/comments.php?id=3915002 Sun, 29 Aug 2010 21:00:40 +0100 3915002 http://www.medworm.com/index.php?rid=3913121&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-song-about-ending-up-in-the-emergency-department%2F2010.08.28 Somebody at Apple likes Goldfrapp. They’ve used her latest album for this tutorial and the sublime Seventh Tree was pictured on the first Apple descriptions of the Remote app. It’s nice when a monolithic institution shows a little personality. Of course, my interest in Goldfrapp is mostly professional: Who else has sung as well about ending up in an emergency department? *This blog post was originally published at Blogborygmi* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3913121 Sat, 28 Aug 2010 19:00:00 +0100 3913121 http://www.medworm.com/index.php?rid=3890476&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-little-old-ladys-power-in-the-er%2F2010.08.21 Here’s my column in the August edition of Emergency Medicine News. A person who seems powerless may hold an entire emergency room hostage! Magic Words: ‘I Have Chest Pain’ Propped in her bed, frail and weak, the little grandma sighed. Her complaints were legion: weakness, poor appetite, poor sleep, joint pain, cough, dry mouth. Her daughter, eyes rolling, was trying to balance three reasonable emotions. She desperately wanted to go home and rest after spending the day in the ER. She truly wanted to avoid her mother’s admission to the hospital, and she was, graciously, sympathetic to the physician who brought the bad news. ‘Mrs. Adkins, I know you feel poorly, and I’m sorry. But I have to say, I can’t find any reason to admit you to the hospital. You’re right as ra... Better Health blogs http://www.medworm.com/rss/comments.php?id=3890476 Sat, 21 Aug 2010 16:00:13 +0100 3890476 http://www.medworm.com/index.php?rid=3880858&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Femergency-palliative-care-we-cant-save-you%2F2010.08.18 An alert reader alerted me to this related piece in Slate: “We Can’t Save You: How To Tell Emergency Room Patients That They’re Dying.” An excerpt: The ER is not an easy place to come to these realizations or assess their consequences. A handful of physicians are trying to change that. Doctors like Tammie Quest, board-certified in both palliative and emergency medicine, hope to bring the deliberative goal-setting, symptom-controlling ethos of palliative care into the adrenaline-charged, “tube ‘em and move ‘em” ER. Palliative/emergency medicine collaboration remains rare, but it’s growing as both fields seek to create a more “patient-centered” approach to emergency care for the seriously ill or the dying, to improve symptom m... Better Health blogs http://www.medworm.com/rss/comments.php?id=3880858 Thu, 19 Aug 2010 00:00:00 +0100 3880858 http://www.medworm.com/index.php?rid=3868738&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fan-emergency-medicine-myth%2F2010.08.15 I’ve internalized all the dogma of medicine, for good and bad. When I was an EMT, green as a twig in an ER, I learned the basics: For any wound with hair employ the razor, and get the hair away from the laceration so the doc could do a good closure. So, employment week #3: Eyebrow laceration? Shaved that sucker clean off. ER doc freaked out, and I learned some medical dogma: Don’t shave eyebrows, they don’t grow back. Heard it later, too — all the way through training, in fact. (more…) *This blog post was originally published at GruntDoc* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3868738 Sun, 15 Aug 2010 12:00:29 +0100 3868738 http://www.medworm.com/index.php?rid=3858157&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fbaby-boomers-are-bypassing-primary-care%2F2010.08.11 Office-based practices are focusing increasingly on patients 45 and older, reports the Centers for Disease Control and Prevention. In 2008, those 45 and older accounted for 57 percent of all office visits, compared to 49 percent in 1998. Prescriptions, scans and time spent with the doctor also became increasingly concentrated on those middle aged and older, according to data from the CDC’s National Center for Health Statistics. Also, physician visits increasingly concentrated on medical and surgical specialists and less on care provided by primary care practitioners for those ages 45 and older. Furthermore, for patients ages 65 and older, the percentage of visits to primary care specialists decreased from 62 percent to 45 percent from 1978 to 2008, while the percentage of visits ... Better Health blogs http://www.medworm.com/rss/comments.php?id=3858157 Wed, 11 Aug 2010 16:00:00 +0100 3858157 http://www.medworm.com/index.php?rid=3831354&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fis-that-er-doctor-packin-a-smartphone-or-a-revolver%2F2010.08.06 I have a new “smartphone.” It’s a Droid from Verizon. Pretty cool. I like what it can do, though it tends to enable me tendency to chronically check my email. I like the features, between ease of texting, voice dialing, etc.  But it’s big, compared to me dear departed flipphone, whose corpse lies in state in my pickup truck. But I noticed one day, as I reached around my side, that the large phone now on my hip felt remarkably like my revolver. Odd feeling that. I was in public and I remember panicking, wondering if I had forgotten to conceal my concealed weapon for some reason. And as I pondered this, I realized that both represent fundamental differences in the way we view individuality. Maybe it’s a stretch, but I’m a writer so I’m supposed to stretch. (more... Better Health blogs http://www.medworm.com/rss/comments.php?id=3831354 Fri, 06 Aug 2010 19:00:05 +0100 3831354 http://www.medworm.com/index.php?rid=3831355&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ficu-bingo-game%2F2010.08.06 Ever wonder how ICU nurses get through their daily grind? Why, with ICU Bingo, of course. How does ICU Bingo work? It works just like regular bingo. Every nurse receives their own Bingo card with different ICU diagnoses. And every time they take care of one of these conditions, they get to ”x” it out. Fill out a line or any other predetermined design pattern, and you are the ICU Bingo winner, and you win a prize. This is quite similar to my 2010 March Madness Hospitalist Bracket, only in this case the game is Bingo. As you can see, this nurse has already cared for a GI bleed, a homeless man, a drug overdose, chest pain, DKA, alcohol withrawal, subdural hematoma, a prisoner, and someone with super-morbid obesity. That’s ICU medicine for you. *This blog post... Better Health blogs http://www.medworm.com/rss/comments.php?id=3831355 Fri, 06 Aug 2010 16:30:00 +0100 3831355 http://www.medworm.com/index.php?rid=3831356&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdefibrillator-concept-fun-for-the-kitchen-bad-for-the-er%2F2010.08.06 This clever and funny Toast/e/r (”ER” included in the name) is by designer Shay Carmon. Note the QRS complex grill:   Concept page: Toast/e/r… (via Gizmodo) *This blog post was originally published at Medgadget* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3831356 Fri, 06 Aug 2010 14:00:31 +0100 3831356 http://www.medworm.com/index.php?rid=3794773&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmedical-devices-injure-70000-kids-each-year%2F2010.07.27 FDA researchers have published a study in Pediatrics that analyzed patient records from child and teen ER visits in 2004 and 2005. The investigators are reporting that 70,000 kids each year go to the ER because of issues caused by medical devices. About a quarter of the injuries were from contact lenses, while the other major contributors were needles, wheelchairs, braces, and obstetric exam tools. The study also looked at the devices most likely to cause hospitalization, and they were found to be mostly invasive devices like ostomy appliances and implanted defibrillators. (more…) *This blog post was originally published at Medgadget* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3794773 Tue, 27 Jul 2010 17:00:25 +0100 3794773 http://www.medworm.com/index.php?rid=3786986&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpatients-dont-mind-er-waits-if-they-know-how-long%2F2010.07.25 Patients don’t mind waiting in the ER as long as they’re kept apprised of the time, an industry survey revealed. This is a good thing, since ER waits have risen nationally to an average of four hours and seven minutes this year. Press Ganey Associates, Inc., has conducted the survey annually and says that ER wait times are four more minutes than last year, or a half hour more than the first survey in 2002. The company collected data on 1.5 million patients treated at 1,893 hospitals in 2009. Despite longer wait times, patient satisfaction with U.S. hospital emergency departments stayed about the same in 2009. Communication was the key, as patients who waited more than four hours, but received “good” or “very good” information about delays were just as sa... Better Health blogs http://www.medworm.com/rss/comments.php?id=3786986 Sun, 25 Jul 2010 18:00:00 +0100 3786986 http://www.medworm.com/index.php?rid=3762902&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-beauty-of-life-and-death-too-easily-forgotten%2F2010.07.17 Yesterday I had a university student shadowing me in the emergency department. AF is a bright student, a hard worker who will make a wonderful physician. She is always curious and insightful when I ask her questions, or show her new things. Today,  she saw something that was new for her, but perhaps too common for me. I walked into the room of an infirm, frail old gentleman who was gracious and polite, as was his family. It turns out he came to us with a terminal illness. I did not know it, but his physician was meeting him. So, as AF and I walked into the room, the patient’s physician walked in after us, and continued a conversation about hospice that he had apparently begun earlier in the day. Realizing I had nothing to add, and would not be needed, I slipped away with my shadow... Better Health blogs http://www.medworm.com/rss/comments.php?id=3762902 Sat, 17 Jul 2010 15:00:09 +0100 3762902 http://www.medworm.com/index.php?rid=3724442&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Favoiding-fireworks-related-injuries%2F2010.07.04 Time for a reminder about safe fireworks use. This Daily News article by Lauren Johnston — Doctors replace woman’s missing thumb with big toe transplant –- shows and tells you why. An excerpt: A Long Island woman’s big toe will adapt to function as a thumb after doctors performed a rare transplant operation to replace the vital missing digit. Shannon Elliott, 25, lost the thumb and two fingers from her left hand in November when a firework exploded in her palm… Have a safe and happy July 4th — and stay out of the ER. Please follow these fireworks safety tips: Never allow children to play with or ignite fireworks. Read and follow all warnings and instructions. Fireworks should be unpacked from any paper packing out-of-doors and away from any open flam... Better Health blogs http://www.medworm.com/rss/comments.php?id=3724442 Sun, 04 Jul 2010 12:00:00 +0100 3724442 http://www.medworm.com/index.php?rid=3658956&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmourning-the-death-of-strangers%2F2010.06.13 I was about to leave work a few nights ago when EMS was dispatched to a 10-50, which is a motor vehicle accident. Enough years in emergency care and that tone makes your radar, but doesn’t create much of a blip. Many of those crashes have EMS arrive, only to discover no injuries. Some have patients transported, with minor problems that lead to their speedy evaluation and discharge from our ER. A few have serious, life-threatening injuries. They take all our speed, skill and attention to save life and limb. And often, require transfer to other facilities. But this last call was none of those. Around 1AM the radio traffic crackled back to dispatch (which we could hear in the emergency department): “Probable Signal Nine.” Signal Nine means the victim is dead at the sc... Better Health blogs http://www.medworm.com/rss/comments.php?id=3658956 Sun, 13 Jun 2010 16:00:16 +0100 3658956 http://www.medworm.com/index.php?rid=3595588&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Femergency-cares-ambiguity-in-the-affordable-care-act%2F2010.05.24 There’s just so much hidden and buried in the Affordable Care Act (ACA) that it’s like trying the find all the goodies in an Easter egg hunt. ACEP News pointed out one hidden goodie, nicely illustrated in this article from Kaiser Health News: Under the new health law, insurance companies must extend several new protections to patients who receive emergency care. One of the biggest guarantees: Patients who need emergency treatment will have their costs covered at the same rate, regardless of whether they are treated at “in-network” or “out-of-network” hospitals. The law also bars health plans from requiring prior authorization for emergency services. And it mandates that plans follow the “prudent layperson” rule. For example, if a person goes ... Better Health blogs http://www.medworm.com/rss/comments.php?id=3595588 Mon, 24 May 2010 18:00:00 +0100 3595588 http://www.medworm.com/index.php?rid=3560234&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdespite-uncertainty-why-doctors-should-hang-in-there%2F2010.05.12 There is discontent in the house of medicine. So many physicians struggle. They seem to wade through uncertainty every day — uncertain about diagnoses, about pain, about disposition. We find ourselves uncertain about our jobs, our futures, our finances. The consultants we call are uncertain about their practices and whether they can remain viable in the coming years as medicine evolves into something we may find unrecognizable. Some days, as I enter my 17th year of practice, I don’t know if I can bear to walk around our little department for 10 or 20 more years, like some gerbil on an exercise wheel. I am uncertain if I can bear the weight of more entitlements, more confabulated stories, more regulations, and manufactured drama. I wonder if I can endure decades more of circadian... Better Health blogs http://www.medworm.com/rss/comments.php?id=3560234 Wed, 12 May 2010 20:00:50 +0100 3560234 http://www.medworm.com/index.php?rid=3538095&cid=t_143297_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2F9-tips-to-improve-patient-satisfaction%2F2010.05.05 Some interesting points were raised at a recent Society of Hospital Medicine (SHM) session by Winthrop Whitcomb and Nancy Mihevc on patient satisfaction. To improve satisfaction scores: 1. Review the patient’s chart before you go in the room. It makes a big difference if the patient perceives you know what’s going on without having to bury your face in a chart. 2. Patients are often confused about who they are supposed to see after discharge. This, of course, is a safety issue as well as one that affects patient satisfaction. 3. Sit down when you are visiting a patient. Patients are happiest when they perceive you’ve spent enough time with them, and they are more likely to perceive this if you are sitting than standing with your hand on the doorknob. (more…) ... Better Health blogs http://www.medworm.com/rss/comments.php?id=3538095 Wed, 05 May 2010 18:00:00 +0100 3538095 http://www.medworm.com/index.php?rid=3018994&cid=t_143297_88_f&fid=38264&url=http%3A%2F%2Fms2group.blogspot.com%2F2009%2F11%2Facute-ed-decompression-plans.html This is part of the support material for the ER Overcrowding Solutions Presentation at the bottom of this Post...-Very few Emergency departments and ancillary support interfaces adjust their staffing patterns to have more resources or most efficient members working the days of the week the ED is expected to have more demand. In addition, all departments have what is known as “fatal staff combinations” that should never be allowed to form. For example…having your slowest ED Physicians, your most inexperienced midlevel providers, your less effective charge nurse, your most novice ED techs and the least efficient X-ray Techs all working together a Monday afternoon is hardly a sound strategic choice. Unfortunately, these fatal combinations are allowed to form often and repeatedly in most... Emergency Room Efficiency blogs http://www.medworm.com/rss/comments.php?id=3018994 Mon, 23 Nov 2009 03:40:00 +0100 3018994 http://www.medworm.com/index.php?rid=2576524&cid=t_143297_87_f&fid=38368&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDisruptiveWomenInHealthCare%2F%7E3%2FCUMEh6hQNJg%2F Should managed care sue patients? We arrive at the dawn of yet-another health reform effort with laws and regulations already in place to protect patients. These arose in past decades when the healer-patient relationship was eroding, presumably at the hands of uncaring clinicians and for-profit medical enterprises.    The list of those rights was extensive and today’s debates are adding to the mix – guaranteed coverage despite pre-existing conditions comes to mind. The discussion of patient rights has always been politically attractive and I won’t denigrate any one of them. I’m not just writing from a policy perspective, but a personal one as well. I’m a patient, too. The discussions of patients’ rights, however, has neglected the flip side of rights—responsibilities on the... Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=2576524 Mon, 06 Jul 2009 19:43:58 +0100 2576524 http://www.medworm.com/index.php?rid=2510379&cid=t_143297_87_f&fid=34872&url=http%3A%2F%2Fwww.blisstree.com%2Fhealthbolt%2Femergency-room-waiting-times-increasing%2F Emergency Rooms account for nearly half of all hospital admissions so it’s not surprising that it turns into a waiting game for most patients. A new report released today by Press Ganey Associates has found that there has been a 27 minute increase in waiting time in ER nationwide since 2002. The report, ”2009 Emergency Department Pulse Report: Patient Perspectives on American Health Care”, which analysed the experiences of almost 1.4 million patients who were treated in 1,725 Emergency Departments during 2008. Interesting facts from the report include… South Dakota has the lowest total time spent in the emergency department (3 hours, 52 minutes) while Utah had the highest total time (6 hours, 48 minutes). Virginia patients spent 23 fewer minutes in the emergency department... Healthbolt blogs http://www.medworm.com/rss/comments.php?id=2510379 Wed, 24 Jun 2009 06:44:40 +0100 2510379 http://www.medworm.com/index.php?rid=2522968&cid=t_143297_93_f&fid=35707&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fhemodynamics%2F%7E3%2F7HIfOf4ysX4%2Fdoctors-nurses-and-medical-students-in.html Above: a video from YouTube, with the title 16 JUNE 2009 - Doctors and nurses are protesting in a major hospital in Tehran - Iranwith the following caption:At 1:41 one of nurses is shouting "8 people died in this hospital last night". of them1 died by a headshot...which said that poor brave man shoted by sniper. at 1:35 you can see on that board which writen in persian "28 wounded...8 died"Morning of 16 June...Rasoul Akram Hospital's doctors and nurses are protesting about what happened in the last night gunshots by Goverment's militia (basij) and police. 36 people shots By Gun 8 dies and 28 injured .And...From Nico Pitney at the Huffington Post, an email from an Iranian medical student:Hello,It's painful to watch what's happening.I don't want anything to do with what has been said this fa... hemodynamics blogs http://www.medworm.com/rss/comments.php?id=2522968 Wed, 17 Jun 2009 01:37:00 +0100 2522968 http://www.medworm.com/index.php?rid=2192637&cid=t_143297_88_f&fid=38264&url=http%3A%2F%2Fms2group.blogspot.com%2F2009%2F01%2Femergency-department-efficiency-pearls.html ED Efficiency-Pearls of wisdomThe list below represents a partial list of what operationally efficient emergency departments can accomplish:Main Outcomes: Timely patient service:a. Increases patient satisfactionb. Improves perception of quality of carec. Eliminates patients leaving without being seenHigh operational efficiency:a. Enables control of patient flowd. Prevents ambulance diversionse. Prevents ED overcrowdingMarketability and recognition:a. Increases peer standingb. Increases community standingc. Influences physician referral patternsControlled work environment:a. Increases staff satisfactionb. Improves staff retention ratesc. Facilitates recruitment efforts Increased Hospital revenues:a. Recoups losses from LWOBS and diversiond. Shifts Market Share far from usual catchmente. 10X... Emergency Room Efficiency blogs http://www.medworm.com/rss/comments.php?id=2192637 Thu, 29 Jan 2009 19:36:00 +0100 2192637 http://www.medworm.com/index.php?rid=2192638&cid=t_143297_88_f&fid=38264&url=http%3A%2F%2Fms2group.blogspot.com%2F2009%2F01%2Fcoomon-myths-and-misconceptions-about.html Efficient ED-Myths & MisconceptionsMisconception # 1Operationally efficient EDs see patients faster.Many confuse faster care with timely service when in fact, they are different. The pressure to work faster happens when departments develop patient backlogs and get overcrowded. In this setting, staff needs to rush patient care and dispositions to bring waiting patients and avoid getting farther behind.In contrast, operationally efficient departments see patients as they present without major effort. This prevents patient backlogs and also creates an unhurried work environment. This is actually achieved through well-planned patient flow redirection, reallocation of resources and optimization of ancillary services response times rather than by making staff work faster or changing clinical pra... Emergency Room Efficiency blogs http://www.medworm.com/rss/comments.php?id=2192638 Thu, 29 Jan 2009 19:34:00 +0100 2192638 http://www.medworm.com/index.php?rid=2192641&cid=t_143297_88_f&fid=38264&url=http%3A%2F%2Fms2group.blogspot.com%2F2009%2F01%2Fmetrics-of-operationally-efficient.html In conclusion, the importance of strict adherence to the stated metrics above cannot be understated. A focus on operational efficiency demands that these metrics be attained and, in particular, that Non-Admit Throughput times be kept below 180 minutes. To illustrate, imagine an ED that sees 72,000 patients a year and has Non-Admit Throughput Times of 230 minutes. If it admits 20 % of their patients that means this department discharges 160 patients a day out of an average daily census of 200. Decreasing Non-Admit Throughput Times to 180 minutes represents an average of 133 hours a day or 4,000 hours a month reclaimed from what was previously non-productive or idle time. These 133 hours is essentially the “penalty” this department pays for its operational inefficiency every day.Obviousl... Emergency Room Efficiency blogs http://www.medworm.com/rss/comments.php?id=2192641 Thu, 29 Jan 2009 19:17:00 +0100 2192641 http://www.medworm.com/index.php?rid=2192642&cid=t_143297_88_f&fid=38264&url=http%3A%2F%2Fms2group.blogspot.com%2F2009%2F01%2Femergency-room-efficiency-blog.html Using the words Emergency Room and Efficiency on the same sentence is usually considered an oxymoron...nevertheless, this is not so in every instance...There are hundreds of Emergency Departments in the United States that have transformed their operational models and become not only extremely efficient at managing patient flow but that have attained "world-class" metrics overall...I have been personally involved in helping set-up several of these operationally efficient Emergency Departments throughout the country over the last 6 years...This blog will concentrate on the study, explanation and decoding of what makes these operationally efficient Emergency Rooms work and the system-wide issues that must be addressed to implement them...I will be posting periodically so please check frequent... Emergency Room Efficiency blogs http://www.medworm.com/rss/comments.php?id=2192642 Thu, 29 Jan 2009 19:06:00 +0100 2192642 http://www.medworm.com/index.php?rid=1553318&cid=t_143297_105_f&fid=36987&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FIvorKovicMd%2F%7E3%2F322101162%2F It the last issue of Reader’s Digest two dozen of doctors revealed “41 Secrets Your Doctor Would Never Share“. I recognized myself in quite a few of these thoughts shared by the colleagues. Here are some of their “confessions”: So let me get this straight: You want a referral to three specialists, an MRI, the medication you saw on TV, and an extra hour for this visit. Gotcha. Do you want fries with that? –Douglas Farrago, MD   It really bugs me when people come to the ER for fairly trivial things that could be dealt with at home. –ER physician, Colorado Springs, Colorado   Sometimes it’s easier for a doctor to write a prescription for a medicine than to explain why the patient doesn’t need it. –Cardiologist, Bangor, Maine   Of... Ivor Kovic, M.D. blogs http://www.medworm.com/rss/comments.php?id=1553318 Sat, 28 Jun 2008 16:30:32 +0100 1553318 http://www.medworm.com/index.php?rid=1455494&cid=t_143297_118_f&fid=36984&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FHealthManagementRx%2F%7E3%2F273281922%2Fmaryland-gets-million-to-reroute.html CMS just awarded my former homestate Maryland with a cool $1.78M.Great coverage by Sue Schultz in the Washington Business Journal here. Sue also covers the healthcare funding beat for the Baltimore Business Journal.The CMS capital injection will fund a task force composed of "3 regional healthcare teams" staffed with "several community care providers."The team is, among other things, charged with "avoiding unnecessary emergency room visits."MDs Department of Mental Health and Hygiene will get $732,216 this year for "creation of the teams" - that's $244,072 per team if all dollars are directed right to the bottom line, but there's no way they'll see that much in the budget line after DMHH gets an administrative/overhead cut.This is a much nicer salary than 'community care providers' would e... Health Management Rx blogs http://www.medworm.com/rss/comments.php?id=1455494 Fri, 18 Apr 2008 23:44:00 +0100 1455494 http://www.medworm.com/index.php?rid=1002844&cid=t_143297_111_f&fid=36048&url=http%3A%2F%2Ffeeds.b5media.com%2F%7Er%2Fb5media%2FAHeartyLife%2F%7E3%2F179631435%2F Cocaine isn’t the only illegal drug out there that can cause a heart attack. Ecstasy or “XTC” as it is known has been making a comeback in the younger population. The emergencies rooms across the world are seeing more and more heart attacks and untimely deaths from this nasty little drug. Oh boy, I feel like I want to lock my daughters in their rooms until hey are 30! Physicians in the emergency department should become familiar with this drug because of its emerging trend toward its use, advise the case report’s authors. Although it was once thought that the drug does not cause dependency and adverse side effects, this belief has been overturned by many reports of side effects in recent literature, the report further explains. via Science Daily Share This (Source... A Hearty Life blogs http://www.medworm.com/rss/comments.php?id=1002844 Sun, 04 Nov 2007 15:57:38 +0100 1002844 http://www.medworm.com/index.php?rid=825596&cid=t_143297_134_f&fid=36049&url=http%3A%2F%2Ffeeds.b5media.com%2F%7Er%2Fb5media%2FDiabetesNotes%2F%7E3%2F147105381%2F A new study found that using an insulin pen may result in fewer trips to the emergency department and to the doctor’s office, resulting in substantial savings to diabetics and their insurers. How does $17,000 in savings grab you? Uh huh, I said 17 thousand. Switching from insulin to an insulin pen could save you just that amount. The insulin pen is more accurate in that it gives a specific measured amount, meaning less chance of a mistake. We all know that mistakes with insulin often lead to doctor and hospital visits, so this would put you in the green. We also know that there is a drawback with almost everything that goes along with health care. What is the issue here? The initial cost of “pen users” compared with “syringe users” is higher. And when the annu... Diabetes Notes blogs http://www.medworm.com/rss/comments.php?id=825596 Wed, 22 Aug 2007 23:26:27 +0100 825596