In January, it was reported that 29 children had died from influenza nationwide1. More recently, the CDC reported that through February 2 pediatric deaths had increased to 59. Such numbers cause the public to cry out that the medical community do more to prevent these catastrophes. But can these cases be prevented? As awful as it sounds, I have to say that I doubt it.

With Washington embroiled over whether to cut entitlements, it can be easy to lose sight of sensible ways to cut major healthcare waste. Here are six cost-cutting solutions presented by Donald Berwick which could save the healthcare system upwards of a trillion dollars.

It may take 700 LPs to find a subarachnoid hemorrhage, but it’s a needle-in-a-haystack worth finding.  Dr. Klauer challenges Dr. David Newman’s cost-effective approach in the SAH workup.

A recent article in the NY Times pointed to the belief that “the move to electronic health records may be contributing to billions of dollars in higher costs for Medicare, private insurers and patients by making it easier for hospitals and physicians to bill more for their services, whether or not they provide additional care”.

A walk down memory lane reminds us that we have yet to see a stroke study of sufficient size to end the tPA debate. And even when we had such data, it was largely ignored. Let’s study our history to avoid repeating mistakes.

Lincoln County Hospital 1982. A mother bursts into the ED waiting room where I happen to be, sees my white coat and hands me a non-breathing infant. The look on her face stuns me and in less than an instant her panic, fears and raw emotions become my own. All the preparation, planning, memorization and practice in the world cannot fully prepare you for that moment.

Although the technology is fascinating, caution must be exercised when applying coronary computed tomography angiography (CCTA) to emergency department chest pain patients. The only way this diagnostic modality will help us, and our patients, is if it guides us with risk stratification, showing a clear path to discharge for patients we currently don’t know what to do with.

Should antibiotics be used in conjunction with incision and drainage of a simple abscess? Recent studies suggest not, yet they leave room for physician discretion at the bedside.

The College’s new policy lacks a comprehensive perspective and too readily discourages the use of opioids. The dearth of valid evidence should lead EPs to a balanced approach on pain, rather than a restrictive one.

Last month, Dr. Kevin Klauer suggested that emergency physicians “unbundle the sepsis bundle.”
This month, Dr. Emanuel Rivers offers his rebuttal, explaining why EGDT greatly improves sepsis outcomes.