WhiteCoat

Healthcare Update — 11-03-2010

Because men like getting a Q-Tip shoved up their woo-hoo when they go to the emergency department for nasal congestion. The American Society for Clinical Pathology recommends that men be screened for sexually transmitted diseases in the emergency department. Just what we need – longer waits due to “mission creep.” We screen for tuberculosis, domestic violence, tetanus immunization, and a bunch of other things already. What’s next, mandatory prostate checks? Personally, I think that all medical examiner offices and microbiology labs should be required to screen everyone for sexually transmitted diseases. Walk right in to your local morgue for your free screening, folks. Pathologists want to make the rules, let them deal with the requirements.

Another news story about how emergency department violence is on the rise.

Vaccine exemptions have quadrupled in the San Diego area in the past decade. Is it any surprise that pertussis infections has set a new record in San Diego County this year? Or maybe it is an Al Queda plot. The second link even has an audio file of what whooping cough sounds like. Ten infants have died from the disease statewide. With such a preventable disease, shouldn’t parents of unimmunized children who die from preventable infections suffer some consequences?

They don’t go very well with milk. Methotrexate vials recalled due to contamination with glass flakes.

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Inside the ER, qeustion if more security is needed.” Answer: YES. Outside the “ER,” “qeustion” if more proofreading is needed …

How much should emergency nurses make each year in salary? Divide these numbers by an average of 2000 work hours in a year and the hourly wage isn’t as much as it should be for someone who may be the difference between you walking out of the hospital and you being rolled out of the hospital.

Pennsylvania man wins $3.5 million verdict after physicians misdiagnose brain infection as cancer.

When sharks sense blood in the water, you know what happens … Ohio attorneys battling over spoils from a $13.9 million medical malpractice verdict.

The question is whether she’ll get billed for her own services. On duty emergency department nurse asks colleague to do an EKG on her after having bouts of fatigue and jaw pain. The she gets admitted for several days when the EKG shows that she is having a heart attack.

Drug seeking behavior in emergency department doubles. And if those patients give you low Press Ganey scores for not feeding their habit, your hospital fires you, your group gets rid of you, or your pay gets cut. Maybe the goal is to get providers so fed up that they leave the system and then the government doesn’t have to pay for as many health care services. Boy am I glad I’m a doctor.

Connecticut teens becoming more likely to abuse prescription drugs than to abuse heroin, marijuana, and cocaine. Emergency department visits in the area have increased 60 percent from 2004 to 2007. Wonder who fills out the teen Press Ganey surveys.

The “No Wait” Emergency Department. Has anyone out there implemented this type of program? I’d like to know the mechanics of patient flow. I think it’s great that people see a doctor within 30 minutes. The question is: How long do they spend their time “doing something else than waiting” before they are discharged? My cynical side says that this is just a PR move to increase patient volume. Bigfoot, Santa Claus, and the Loch Ness Monster seem to like the idea, though.

19 Responses to “Healthcare Update — 11-03-2010”

  1. Steve says:

    I agree that the growing “mission creep” is a problem…the only way I could see this being possible is to use the urine assays that I have seen at some hospitals that use “dirty urine” where you don’t use a wipe because not a lot of guys will want the swizzle stick if they come in for a URI. I’ve heard this test is pretty expensive.

    Also- in order for this to not take up ER staff time, you need to hire additional staff. I have been to hospitals that have additional staff to do oraquick swabs for HIV during the day so it doesn’t take up ER staff time and that program works well…but its a lot of money and commitment.

    I agree with the larger picture- we can’t be everything to everyone. We aren’t primary care. One of the worst mission creep I’ve experienced was at a Peds ED where the primary care pediatricians wanted the ED to do obesity counseling because they “don’t have time to do it in clinic” With 40+ in the waiting room at any time during the winter months I don’t think we have the time either.

  2. Matt says:

    “When sharks sense blood in the water, you know what happens … Ohio attorneys battling over spoils from a $13.9 million medical malpractice verdict.”

    Anyone who has ever seen a physician practice break up for any reason other than retirement knows there are no more shark-like people than them when it comes to doing the dividing. Ask any lawyer who’s ever been a part of one – ugliest partnership breakups of any profession come from the docs. Plenty of cash to litigate, and plenty of anger to fuel it.

  3. ThorMD says:

    I have a friend who worked in a “No Wait” ER. All of the resources went to seeing patients within 30 minutes. And NO resources went to getting people OUT of the ER within a reasonable time. So their TID (time in department) went up by a lot. Epic fail.

  4. throckmorton says:

    We have been having our own epidemic of pertussis. This has led to many issues besides innocent people having their lives put at risk because of those who choose not be be vaccinated.

    First, when we diagnosis a case we have to report it to the health department who then mandates a 16 page form be filled out. Our pulmonologist has suggested that this is the health departments job to track this down but they are only there from 930 to 11 and then 1 to 330 and say they just don’t have the staffing. So, the pulmonologists just call it a “malignant tracheitis”. When they did try to fill out the forms, it would ask the name of the patient and who they had contact with, this would of course lead to the main source of pertussis in our area, one of the many who use the alias Jose Gonzales. Since the majority of our cases arise from illegals, the health department does nothing.

    I had the opportunity to ask our local ICE about vaccination status of the illegals, and got the answer ” we don’t ask”.

    I contacted the CDC about our issue of “malignant tracheitis”. I was expecting to talk to a physician, epidemoiologist or microbiologist/MPH. Turns out, all I got was an attorney that was a political appointee. He said that we are not having and epidemic of pertussis. I explained that this was what all the cases of malignant tracheitis were, and explained why it was diagnosed as that. A few minutes later he said that they don’t track cases of malignant tracheitis and then asked what “tracheitis was?”. I knew right away that we were screwed. When I reported all this to our pulmonolgists, they looked at me and said, “we’ve been there and done that” we are just going to call it “COPD exacerbation”.

    The long and short of it, we have those who aren’t vaccinated getting pertussis from illegal immigrants who in turn cause our adults to get sick because they haven’t had a booster shot.

    So, Matt. If I take all necessary precautions and get pertussis from some patient who chose not to get vaccinated, am I entitled to damages?

    • Matt says:

      I doubt it. Those people don’t owe a duty to you, which would be necessary to establish a negligence claim. You could try an intentional tort theory – that has worked as a criminal battery when people with HIV fail to disclose that to their partners.

    • WhiteCoat says:

      Your story is a perfect example of why attempts at measuring “quality indicators” that depend on self-reporting will result in completely misleading data.
      Whether it is catheter associated infections or pertussis, the results will follow the path of least resistance, which will usually be what the government wants to show.

  5. Mama On A Budget says:

    More than 2/3 of the pertussis patients were fully vaccinated and up-to-date on boosters. Maybe instead of going for the easy blame blanket of the non-vaccinated, we should be questioning whether the vaccine is effective.

    • VA Hopeful says:

      Source please

    • throckmorton says:

      The article just states that they were up to date, it does not mention boosters. It is suggested that adults be revaccinated but it is elective. These patients did not have the booster. Your immunity declines with age in the case of pertussis. The vaccination is not the best but does seem to prevent you from spreading it to others. Therefore when you choose not to get the vaccine, you put yourselves and others at risk.

      The patients here are mostly adults who unfortuantely the pertusis exacerbates their underlying copd and is very severe.

      • Mama On A Budget says:

        But that’s NOT the same as non-vaccinating people, which is exactly what WhiteCoat was implying with his news bite.

      • throckmorton says:

        Patients who have been vaccinated and their immunity is decreasing tend to get pertussis but do not tend to spread it. It is spread by those who do not get vaccinated. These are the exemptions that he was talking about. What people do not want to talk about is the epidemic that is following the unvaccinated illegal immigrants.

    • WhiteCoat says:

      First, I’ll put up an article on whether the pertussis vaccine is effective in a separate post since I can’t post pictures in the comments section.
      I think it’s hard to make an argument that pre-vaccine there were more than 200,000 annual cases of pertussis and post-vaccine there were 15,632 cases, but somehow the vaccine isn’t effective.
      Same with smallpox. Suddenly the disease just “died out”?
      The whole issue of people contracting pertussis despite being vaccinated is troublesome. I’d have to see more data about those people before commenting further.
      The fact that young infants are dying from this preventable disease is another reason that we should encourage everyone to be immunized in order to establish “herd immunity.”

  6. Steve says:

    Kudos for the reporting on whooping cough…however, the second article that included the audio clip of whooping cough failed to point out that infants that are too young to be vaccinated make up the majority of the deaths thus far and they don’t get the classic whoop like older kids do…so that may give someone a false sense of security by thinking that their kid can’t have pertussis since they don’t have the whoop.

  7. ER Murse says:

    I think the folks who put the recall out on methotrexate could have saved a bunch of money by changing the preparation instructions and advising chemo nurses to draw it up through a filter needle. Lots of medications already say that, and I have yet to find a unit that didn’t stock filter needles. Problem solved, with no change in availability or cost.

    • Chelsea says:

      If the methotrexate were only given in hospitals or chemo clinics, maybe that might suffice, but many autoimmune patients take methotrexate in low doses and, if they are not on the pill form, they either inject it or put the liquid form in a drink to take orally. The liquid form is cheaper and at doses over 20mg, the injectible works better than the pill. So no getting around that.

  8. [...] hoc ergo propter hoc. There is even the possibility that the data could be a government plot to classify pertussis infections by some other name to falsely increase vaccine effectiveness and to enrich the pharmaceutical companies that produce [...]

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