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 room'. Sat, 03 Sep 2011 02:02:46 +0100 http://www.medworm.com/index.php?rid=5125743&cid=t_123747_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fer-nurse-explains-what-its-really-like-to-be-an-rn%2F2011.08.12 You want to be a registered nurse? Let’s cut through the B.S. and get real about it. Put a hold on all this soft-focus “I live to care!” or “It gives my life meaning…” Here’s the reality. *** You will study your butt off. Nursing science is based on biology, chemistry, microbiology, anatomy, physiology, psychology, sociology and philosophy. Yeah, every single one of them. You will incorporate those into every decision you make in your practice. It’s called critical thinking. You master it and become a professional, or you don’t and you become a robotic technician. Bottom line. Your choice. Oh, and the studying doesn’t stop after you graduate. Nursing school is just the warm-up. *** The work is physically exhausting and emotionally demanding. (more…) *... Better Health blogs http://www.medworm.com/rss/comments.php?id=5125743 Fri, 12 Aug 2011 12:00:35 +0100 5125743 http://www.medworm.com/index.php?rid=5069476&cid=t_123747_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-surprising-life-saving-advantage-of-facebook%2F2011.07.26 “Health is social,” says SPM member Phil Baumann, RN (@PhilBaumann) at HealthIsSocial.com. Slate has a dramatic story of how a mother’s Facebook network helped spot – rapidly – Kawasaki Disease, a rare auto-immune disease that the family’s doctors had initially missed. Her social network contains some medically knowledgeable people. (Do you have any docs, nurses, etc in your Facebook circle?) Note that friends’ availability is sometimes far greater than a doctor’s office. Read how the diagnosis unfolded. And read what her family physician said, when she called from the E.R.: “You know what?” he said, “I was actually just thinking it could be Kawasaki disease. Makes total sense. Bravo, Facebook.” Then this, as the crisis wound down: (more…) *This blog... Better Health blogs http://www.medworm.com/rss/comments.php?id=5069476 Tue, 26 Jul 2011 21:00:21 +0100 5069476 http://www.medworm.com/index.php?rid=4968491&cid=t_123747_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhospitalization-vs-discharge-when-is-one-the-preferred-option%2F2011.06.25 I received a call recently from an emergency room (ER) physician about a patient who presented there with rectal bleeding. Does this sound blogworthy? Hardly. We gastro physicians get this call routinely. Here’s the twist. The emergency room physician presented the case and recommended that the patient be discharged home. He was calling me to verify that our office would provide this patient with an office appointment in the near term, which we would. We had an actual dialogue. This was a refreshing experience since the typical emergency room conversation of a rectal bleeder ends differently. Here’s what usually occurs. We are contacted and are notified that the patient has been admitted to the hospital and our in-patient consultative services are being requested. In other words, we ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4968491 Sat, 25 Jun 2011 16:00:00 +0100 4968491 http://www.medworm.com/index.php?rid=4960120&cid=t_123747_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F06%2F22%2Fcan-you-take-someone-to-the-er-for-mental-health-help%2F When I came home from work, she was sitting on the back porch steps, crying. Another friend was sitting next to her, arms draped around her shaking shoulders, trying to understand the words in between her hiccuped sobs. “Is everything okay?” I asked, even though I knew this wasn’t just a normal bout of tears. Julie (not her real name) had been crying the entire day. When I left for work she had been sobbing in the bathroom, and (I learned later) had turned on the shower to muffle the sound of her emotion from the rest of the house so no one would come and check on her. No one knew how long she had stayed like that, melted to the bathroom floor, clutching a towel to her chest, the shower running hot and humid whenever she felt she was getting too loud. It’s possible ... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=4960120 Wed, 22 Jun 2011 18:45:24 +0100 4960120 http://www.medworm.com/index.php?rid=4841581&cid=t_123747_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F05%2F19%2Fmuzzling-doctors-who-ask-questions-about-gun-safety%2F Imagine that your 16-year-old daughter has been bullied mercilessly in school, but hasn’t talked to you about it, or spoken about her suicidal impulses. One day, she is brought by ambulance to your local hospital emergency room, having made superficial cuts on her arms while in school. The emergency room physician tries to call you at work, but your cell phone isn’t picking up. The doctor begins her evaluation of your daughter, including an assessment of all relevant risk factors for suicide. Now imagine that the doctor believes she is forbidden by law from asking your daughter whether there are guns in your home — despite the fact that firearms in the home markedly increase the risk of gun-related suicide.1 You needn’t use much imagination. In Florida, Gov. Rick Scott is expec... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=4841581 Thu, 19 May 2011 10:38:43 +0100 4841581 http://www.medworm.com/index.php?rid=4801883&cid=t_123747_139_f&fid=38879&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FVirologyBlog%2F%7E3%2FAjU2KX-f-9Q%2F Hosts: Vincent Racaniello, Rich Condit, Dickson Despommier, Alan Dove, and Alfred Sacchetti Vincent, Rich, Alan, and Dickson speak with Alfred Sacchetti, MD, Chief of Emergency Services at Our Lady of Lourdes Medical Center, about viral infections encountered in the emergency room. Click the arrow above to play, or right-click to download TWiV #132 (48 MB .mp3, 100 minutes). Subscribe to TWiV (free) in iTunes , at the Zune Marketplace, by the RSS feed, by email, or listen on your mobile device with the Microbeworld app. Links for this episode: Dr. Sacchetti’s posts at EM-blog Molluscum contagiousum TWiV on Facebook Letters read on TWiV 132 Weekly Science Picks Al – The Physics of Superheroes and NKT Watch Dickson - Fibonacci Fun by Trudi Hammel Garland and Rachel Gage... virology blog blogs http://www.medworm.com/rss/comments.php?id=4801883 Mon, 09 May 2011 00:21:43 +0100 4801883 http://www.medworm.com/index.php?rid=4622331&cid=t_123747_113_f&fid=34634&url=http%3A%2F%2Fwww.emrandhipaa.com%2Femr-and-hipaa%2F2011%2F03%2F17%2Fa-trip-to-the-er-emrs-aren%25e2%2580%2599t-enough%2F Guest Post: I got the following story that someone wanted to share about the challenges of EMR and workflow in a hospital. I love reading first hand experiences with EMR. Reminds me of a great experience that Neil Versel documented at an urgent care during HIMSS. I look forward to hearing your comments on the story. Last month, my wife felt some discomfort in her chest. They weren’t pains, nor were they indigestion so much as a gurgling sensation. After two days and no change, she called our family physician. He told her she could come in for a blood enzyme test, but the lab result would take four days. Instead, he said to go to an ER where they could get the result in half an hour. That evening, a Friday, we went to the nearest ER, at Large, Modern, Suburban DC hospital (LMSDC.) We walk... EMR and HIPAA blogs http://www.medworm.com/rss/comments.php?id=4622331 Thu, 17 Mar 2011 21:04:52 +0100 4622331 http://www.medworm.com/index.php?rid=4532437&cid=t_123747_129_f&fid=36038&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Ftrevis-life-with-multiple-sclerosis-ms%2Fms-induced-humility%2F If you have to make a trip to the emergency department at your local hospital, 6:30 on Oscar night isn’t a bad time to be seen quickly. Not to worry – it was far from life-threatening, the accident which predicated my evening visit to the local medical crew. Still – and I’ll beg that we keep it at this – while we made as much light of it as we could, the accident could have been quite serious. “As much light of it as we could”… Yeah; we laughed and made the medical staff laugh right along with us. I firmly ascribe to the adage, “If I didn’t laugh, I’d cry” very oft about multiple sclerosis and it seems to have bled into the rest of my life. I suppose that just plain age brings along with it a certain amount of devil-may-care to our association with our bodies. Being... Life with MS blogs http://www.medworm.com/rss/comments.php?id=4532437 Mon, 28 Feb 2011 20:26:48 +0100 4532437 http://www.medworm.com/index.php?rid=4525032&cid=t_123747_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=4522144&cid=t_123747_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F02%2F25%2Fbest-of-our-blogs-february-25-2011%2F This article looks at different types of narcissism (even healthy ones) and provides information that may make you rethink the way you perceive narcissists. (Source: World of Psychology) World of Psychology blogs http://www.medworm.com/rss/comments.php?id=4522144 Sat, 26 Feb 2011 02:18:48 +0100 4522144 http://www.medworm.com/index.php?rid=4498293&cid=t_123747_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F02%2F19%2Fshould-you-tell-your-boss-about-a-mental-illness%2F Many people struggle with the question of whether or not to tell their bosses about their mood disorders at work. Washington Post columnist Amy Joyce wrote an excellent article on this a few years ago. I have included the first few paragraphs below, but urge you to read the rest of her article, as it gives no straight answers but explores that terrain with great depth. If you have depression or some other mental illness, what do you do about work? Hope no one notices? Disclose your illness early on and trust that your boss will understand? Should You Tell is a complicated question. There is no right answer, and there are some risks to consider. I discovered this years ago after watching a movie at home with two friends. One of them looked up, scared. She hesitated. And then she let it out:... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=4498293 Sat, 19 Feb 2011 13:39:08 +0100 4498293 http://www.medworm.com/index.php?rid=4438886&cid=t_123747_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=4545168&cid=t_123747_136_f&fid=39027&url=http%3A%2F%2Fwww.cancerlifeandme.com%2F2011%2F02%2Fcomin-atcha-from-the-er%2F Hello. It’s certainly been too long since I’ve added an update. What better time than now, during the middle of a boring emergency room visit? Thank goodness this place (UC Davis) has free wifi. I have no phone signal here, but I AM online at least. And this is a nice way to not be bored out Continue reading Comin’ atcha from the ER (Source: Cancer, life, and me) Cancer, life, and me blogs http://www.medworm.com/rss/comments.php?id=4545168 Sat, 05 Feb 2011 02:01:26 +0100 4545168 http://www.medworm.com/index.php?rid=4304878&cid=t_123747_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_123747_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=4230161&cid=t_123747_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=4200561&cid=t_123747_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-we-should-be-thankful-for-the-uninsured%2F2010.11.25 In what has become a tradition over the past few years, DrRich proudly reprises his annual Thanksgiving message to his beloved readers: Gathered around the Thanksgiving table, DrRich’s large extended family, carrying out a longstanding tradition, each offered in their turn one reason for being thankful on this most reflective of American holidays. DrRich listened respectfully as each of his loved ones, and each of the ones he was obligated to tolerate benignly because they had married (or in some other manner had committed to) one of his loved ones, recounted a cause for thanks. There is no need for DrRich to recite their utterances here, because they were all perfectly predictable and fairly mundane, having mostly to do with items such as maintaining good health, finding a job, being ab... Better Health blogs http://www.medworm.com/rss/comments.php?id=4200561 Thu, 25 Nov 2010 16:00:30 +0100 4200561 http://www.medworm.com/index.php?rid=4162922&cid=t_123747_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_123747_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_123747_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=3959928&cid=t_123747_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_123747_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_123747_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_123747_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_123747_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_123747_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_123747_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_123747_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_123747_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_123747_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_123747_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_123747_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_123747_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=3726561&cid=t_123747_83_f&fid=34856&url=http%3A%2F%2Finsidesurgery.com%2F2010%2F07%2Funderage-binge-drinking-july-4-spike-er-visits%2F In a yearly ritual that is no surprise to trauma and emergency room physicians, visits to the emergency room fueled by binge-drinking, alcohol-soaked minors doubles over the July 4 weekend (Source: Inside Surgery) Inside Surgery blogs http://www.medworm.com/rss/comments.php?id=3726561 Mon, 05 Jul 2010 14:52:03 +0100 3726561 http://www.medworm.com/index.php?rid=3724442&cid=t_123747_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_123747_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=3625468&cid=t_123747_87_f&fid=36050&url=http%3A%2F%2Fblisstree.com%2Flive%2Fer-congestion-new-program-may-reduce-hospital-wait-times%2F photo: Thinkstock Waiting in the ER is the worst. Whether you’ve sprained an ankle or just feel under the weather and don’t have insurance, if you’re a low-priority case, you could wait all day (or night). So Louisville Metro Emergency Medical Services has launched a program aimed at eliminating unnecessarily long waits in its ER waiting room. When patients call 911, the dispatcher directs the lowest-risk cases to a nurse. The nurse evaluates the person’s symptoms and determines if they need a trip to the ER, or a different course of treatment. The goal of the program is to reduce costs and provide better patient care. While we’re all for initiatives to reduce wait times in ERs, we can’t help but wonder what would happen if someone doesn’t adequate... Breastfeeding 1-2-3 blogs http://www.medworm.com/rss/comments.php?id=3625468 Wed, 02 Jun 2010 21:27:10 +0100 3625468 http://www.medworm.com/index.php?rid=3595588&cid=t_123747_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=3588963&cid=t_123747_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Falternatives-scenes-in-a-life-of-chronic-pain%2F Quite often when you rent a movie, on the main menu they give you an opportunity to view deleted scenes, humorous flubs and alternative endings. I find it interesting and have often thought how wonderful it would be to be able to delete many of my past and present “scenes” in a life with chronic pain. I could fill a DVD with humorous misadventures and examples of screwing up and most certainly, it would be a good thing to write alternative adventures, whether they are beginnings or endings. So much of our daily life with chronic pain is far too boring to be an interesting movie. I can see it now in my mind’s eye. The main character is limping to the bathroom. She or he is struggling to get into a hot shower, camera pans to foggy windows. He grumbles into his clothes as life p... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=3588963 Fri, 21 May 2010 21:03:33 +0100 3588963 http://www.medworm.com/index.php?rid=3567892&cid=t_123747_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-doctors-hauntings%2F2010.05.15 2:30AM: The beeper sounds. “Please call the ER x2222.” Why are they calling me? I’m not on call. A flash then a clap of thunder outside. “Your patient from a few days ago is here in the ER.” The mind races. You remember the case clearly. No problem at all. What could be going on? You ask 20 questions, you get 20 answers. All of the bases have been covered. “Doin’ better now,” you’re told. “We’ll just admit ’em and you can see ‘em in the morning.” Hesitantly you return to bed, mind racing. (more…) *This blog post was originally published at Dr. Wes* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3567892 Sat, 15 May 2010 16:00:00 +0100 3567892 http://www.medworm.com/index.php?rid=3560234&cid=t_123747_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=3378438&cid=t_123747_87_f&fid=36050&url=http%3A%2F%2Fblisstree.com%2Flive%2Fin-sickness-and-in-health-in-theory%2F Last October, my son and I were enjoying a cozy Saturday morning reading Dr. Seuss while my husband readied himself for work. Suddenly, we heard a loud thud coming from the first floor. We flew down the stairs to find my husband lying prone in the front hall. His back had given out. He’d been having back trouble for about a year, but since beginning regular physical therapy, I had deluded myself into thinking he was on the mend. What I thought now was, “Oh, shit!” This “I’ve-fallen-and-I-can’t-get-up” version of my husband was unfamiliar to me. The guy I married never gets sick. He pooh-poohs the notion of illness. In the 12 years we’ve known each other, I’ve only seen him take Tylenol twice. I’m the pill popper in the family. One four-hour visit to the ER later, th... Breastfeeding 1-2-3 blogs http://www.medworm.com/rss/comments.php?id=3378438 Thu, 18 Mar 2010 14:00:49 +0100 3378438 http://www.medworm.com/index.php?rid=3018994&cid=t_123747_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=2993854&cid=t_123747_123_f&fid=39037&url=http%3A%2F%2Fblogs.drgreene.com%2Fblog%2F2009%2F11%2F14%2Fwhen-should-you-go-to-the-doctor-or-emergency-room-for-the-flu%2F 540 children in the US have died so far this year from known or suspected H1N1 flu. This tragic number is more than six times higher than in an entire typical flu year, and the current flu season may only be getting started. This tragic number is very low, however, compared to the more than [...] (Source: Conversations with Dr Greene) Conversations with Dr Greene blogs http://www.medworm.com/rss/comments.php?id=2993854 Sat, 14 Nov 2009 19:21:56 +0100 2993854 http://www.medworm.com/index.php?rid=2984801&cid=t_123747_88_f&fid=38958&url=http%3A%2F%2Fwww.yourerdoc.com%2Fnaked-side-effects-of-ambien%2F I believe this could be a new protocol for cardiac stress testing. Recently on the late shift, the nurses on the telemetry unit were alerted to an elderly female patient who was having tachycardia. Her heart rate had been steady at around 80, but for no clear reason it accelerated to about 150 beats per minute. The charge nurse walked quickly over to investigate. The patient noted that she had been having some insomnia, so she decided to read her romance novel. Suddenly, she had a very realistic hallucination. “What did you see dear?” asked the nurse. “Well, it was a very good looking man, who just walked into my room and asked where the grocery store was. And, he was . . . completely naked.” She admitted. The nurse reassured the patient that it was nothing, and tuc... Your ER Doc blogs http://www.medworm.com/rss/comments.php?id=2984801 Thu, 12 Nov 2009 00:49:34 +0100 2984801 http://www.medworm.com/index.php?rid=2510379&cid=t_123747_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=2788575&cid=t_123747_88_f&fid=38958&url=http%3A%2F%2Fwww.yourerdoc.com%2Fdiagnosis-youre-drunk%2F A middle aged man recently drove to the ER looking to get some medical attention for a rash that he had for over a year. It was a bit unusual to come to the ER for a chronic rash, but I’ve seen stranger things for sure. The timing was stranger still, since it was about 2am. But let’s give him the benefit of the doubt, and assume he was just trying to come in when the ER wasn’t too crowded. It wasn’t though–pretty much packed and full of cops who were there for a car crash and an assault. This turned out to be bad news for the man with the rash since he was completely drunk. He knew it was bad mojo when he pulled into the parking lot and saw all the squad cars. If his plan was to be inconspicuous, that didn’t work too well, because he drove in the wrong w... Your ER Doc blogs http://www.medworm.com/rss/comments.php?id=2788575 Wed, 17 Jun 2009 02:29:57 +0100 2788575 http://www.medworm.com/index.php?rid=2442201&cid=t_123747_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fguideposts-in-a-life-of-daily-pain%2F One of my favorite magazines, which I’ve been reading for 30 years, is Guideposts magazine, founded by the Rev. Norman Vincent Peale and his wife, Ruth Stafford Peale. I’ve enjoyed that particular publication in good times and bad. One of the aspects of it I think I’m most fond of is that it embraces all religious faiths, without showing prejudice or preference so none are segregated or left out. This matter of finding our way in life, following our own guideposts, seems to be independent of any particular religious faith. Faith is faith. I apologize if that offends any of you; but it is my belief as I have lived a considerable number of years and witnessed the hardships of the Jews over the years, the bigotry toward the Catholics in some parts of the country and the judg... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=2442201 Wed, 27 May 2009 21:41:50 +0100 2442201 http://www.medworm.com/index.php?rid=2788577&cid=t_123747_88_f&fid=38958&url=http%3A%2F%2Fwww.yourerdoc.com%2Fgratitude%2F I think one of the fundamental desires of humans is to be appreciated. They want to do things that are important, they want to make an impact on other people, and they want acknowledgement for their efforts. I suspect ER doctors are no different, and many of them (including me) probably went into medicine to satisfy this desire. Sometimes however, you don’t want to be thanked. One such time was a few years ago, when I had a man in his early 60’s present to the ER with fevers, rash, and feeling crummy for a couple weeks. His symptoms were not adding up to a typical infection, so I ran some tests. Turns out he had acute leukemia. This was obviously terrible news, and I had to deliver it. The man was typically upset, but took the news with great composure. He then asked if he coul... Your ER Doc blogs http://www.medworm.com/rss/comments.php?id=2788577 Fri, 15 May 2009 03:21:28 +0100 2788577 http://www.medworm.com/index.php?rid=2788580&cid=t_123747_88_f&fid=38958&url=http%3A%2F%2Fwww.yourerdoc.com%2Fstop-punching-me-in-the-butt%2F One of our more commonly seen fractures is the appropriately named “Boxer’s fracture.”  This results from punching objects, usually a wall, sometimes another person’s face.  The hand is broken at the neck of the pinky metacarpal bone, just before the big knuckle.  One recent sufferer from this injury is a young man who I know well.  However, he did not punch a wall, or a person’s face.  No, he punched his friend’s butt.  Yes, that’s right.  I thought I’d seen it all.  All I know is, I wish my butt was firm enough to cause hand fractures, but sadly, punching it would barely result in a sprain. (Source: Your ER Doc) Your ER Doc blogs http://www.medworm.com/rss/comments.php?id=2788580 Fri, 24 Apr 2009 23:59:37 +0100 2788580 http://www.medworm.com/index.php?rid=2788581&cid=t_123747_88_f&fid=38958&url=http%3A%2F%2Fwww.yourerdoc.com%2Fnight-shifts%2F Perhaps my least favorite thing about my job is night shifts.  As I get older, they get more and more painful.  If I don’t get a nap before going in at 11pm, my brain gradually turns to oatmeal.  Come 4am, and I’m hoping I don’t have to think very much.  A sore throat or ear infection is about all I want to tackle. One surprising side effect of night shifts is that the nurses start getting chatty, and all kinds of intense conversations spring up.  Last night, I was working with some of my favorite nurses and we somehow started talking about religion.  My usual rule is not to get into any debates about religion, because it never ends well.  Unfortunately at 4 in the morning, it seems like you can really get to the bottom of these issues and solve them.  You can&#82... Your ER Doc blogs http://www.medworm.com/rss/comments.php?id=2788581 Tue, 14 Apr 2009 03:30:42 +0100 2788581 http://www.medworm.com/index.php?rid=2192637&cid=t_123747_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_123747_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_123747_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_123747_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=2021310&cid=t_123747_87_f&fid=34825&url=http%3A%2F%2Fwww.wesleyjsmith.com%2Fblog%2F2008%2F12%2Fnhs-meltdown-not-enough-emergency-docs.html And the tales of medical woe continue to mount in the UK as the NHS collapses. Now, there is a serious shortage of emergency room doctors. From the story:The College of Emergency Medicine has issued a report calling for the number of A&E consultants must double within three years in order to ensure there is proper supervision of junior doctors so patients get the best care.In their report The Way Ahead, the College said there needs to be 1500 emergency medicine consultants by 2012 as this would mean there was a senior doctor on duty in each A&E at all times. Currently only a minority of hospital emergency departments have adequate numbers of senior doctors and complex cases and very sick patients are seen by doctors who are still training.This is not the direction in which we shoul... Secondhand Smoke blogs http://www.medworm.com/rss/comments.php?id=2021310 Tue, 09 Dec 2008 06:07:00 +0100 2021310 http://www.medworm.com/index.php?rid=1779893&cid=t_123747_129_f&fid=36035&url=http%3A%2F%2Fblog.healthtalk.com%2Fchronic-pain%2Flife-with-chronic-pain%2Fsue-takes-on-the-job-of-healing%2F I hardly know where to begin. I have so many new ideas for blogs thanks to my recent life experiences. Each day, there was a time when my mind would hum with ideas and I would reach for a pad and pen, sometimes in the middle of the night, just to jot down an idea. My get well motto became, “OKAY, LIFE, BRING IT ON AND I’LL JUST WRITE A BLOG ABOUT IT!” I would have to say my mind just insists on “first things first.” What else do you do when you are confronted by so many problems all at once and you feel too rotten to cope? I was in the hospital for the second time in a week, I had five operative procedures performed on my gut with mesh holding it all in; I had a urinary tract infection, which is a concern when you have an unexpected stint in your ureter because the doctor “nick... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=1779893 Tue, 09 Sep 2008 23:58:48 +0100 1779893 http://www.medworm.com/index.php?rid=1492361&cid=t_123747_129_f&fid=36035&url=http%3A%2F%2Fblog.healthtalk.com%2Fchronic-pain%2Flife-with-chronic-pain%2Fthe-balancing-act-of-living-with-chronic-pain%2F There’s rarely anything simple about chronic illness. In considering all of you who communicate with me as well as my own experience, I would have to say it’s never just one thing. If only life would come at us one problem at a time, it seems it would be so much simpler. Do any of you have only one complaint, one symptom or one challenge? You see, I didn’t think so. Neither do I. As for me and my body, the two of us are usually juggling like crazy. We would make that guy in white tights at the circus, with the plates spinning on the sticks, look like a clumsy oaf. Living with chronic illness, especially when it’s accompanied by pain, is very complicated. We have to battle on many fronts and put out the fire that’s burning the hottest; and wrestle into submission the dilemma that ... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=1492361 Tue, 03 Jun 2008 22:39:06 +0100 1492361 http://www.medworm.com/index.php?rid=1191605&cid=t_123747_129_f&fid=36035&url=http%3A%2F%2Fblog.healthtalk.com%2Fchronic-pain%2Flife-with-chronic-pain%2Fsue-takes-a-trip-to-the-hospital%2F I have shared with all of you, over the last couple of months how I have experienced one virus after another as well as a case of diverticulitis. For the last 10 days or so, I’ve been coughing, blowing and generally feeling lousy on top of all my other problems. Last Sunday evening, three days ago, we had a light rain followed by a freeze, followed by a soft and truly beautiful snowfall. It reminded me of Dr. Zhivago without the sleigh bells. In between coughing spells, I was catching glimpses out the bedroom window giving my husband a blow-by-blow description of the weather. He was trying to sleep but you have to know that he’s always asleep after 8 p.m. I went into the bathroom to take my usual vitamins and Metamucil caps. I’ve been taking the caps lately because when I don’t fee... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=1191605 Thu, 31 Jan 2008 21:15:32 +0100 1191605 http://www.medworm.com/index.php?rid=747340&cid=t_123747_131_f&fid=35743&url=http%3A%2F%2Fthegenesherpa.blogspot.com%2F2007%2F07%2Fsome-times-you-dont-need-genetic-test.html Before I head home post call I want to talk about an important case I saw early this morning. I was in the emergency department admitting this poor gentleman who had developed something called angioedema. He had just started a new medication for his blood pressure called an ACE inhibitor. There is some thought that this reaction is brought about by a genetic predisposition. We do have examples of hereditary angioedema and the mechanism for this man's angioedema is likely very similar.While seeing him and having the Ear, Nose and Throat doctor secure his airway with a cricothyrotomy (a hole cut into the neck to insert a breathing tube) an emergency room tech runs and hands me an EKG. He says "This patient is having a heart attack" The hallmark findings of heart attack on ekg were indeed the... Gene Sherpas: Personalized Medicine and You blogs http://www.medworm.com/rss/comments.php?id=747340 Fri, 20 Jul 2007 12:36:00 +0100 747340