Comments on: Stretching the Definition of “Quality” http://www.epmonthly.com/whitecoat/2012/10/stretching-the-definition-of-quality/ A blog from inside the emergency department Wed, 19 Jun 2013 05:14:04 +0000 hourly 1 http://wordpress.org/?v=3.5.1 By: Steve http://www.epmonthly.com/whitecoat/2012/10/stretching-the-definition-of-quality/#comment-103249 Steve Sun, 28 Oct 2012 21:27:06 +0000 http://www.epmonthly.com/whitecoat/?p=8686#comment-103249 So this study has a MAJOR weakness- it is based on the NHAMCS database. This is a database of outpatient visits that has been data dredged a lot on the theory that it provides very large numbers to look at trends.

Recent findings- pending publication in Annals of EM- 24% of all patients intubated in the ED go to non-critical care floors…WHHAAATTT??? Yeah, there may be the occasional overflow into a low nurse:patient ratio step down or a discharge after an intubation for an opoid overdose, GHB, etc. But 24%? There is NO WAY this percentage is correct but that is what the database data says.

Same database, different study- only 56% of patients with ectopic pregnancy had a pregnancy test ordered. 56%???? Anything below 99% is just not reflecting reality. We just know that this cannot be the case.

Interestingly enough, they listed all the “false positives” that the database listed had an intubation- patients with a chief complaint of “ankle sprain” “scabies” “hypertension” and “rash” to name a few. These were patients with benign diagnoses that were listed as being intubated by the database but we know that there is no way this can be true.

So from now on, anytime I see a study based on the NHAMSC database I am skipping over it.

]]> By: Mary http://www.epmonthly.com/whitecoat/2012/10/stretching-the-definition-of-quality/#comment-102869 Mary Fri, 26 Oct 2012 19:01:34 +0000 http://www.epmonthly.com/whitecoat/?p=8686#comment-102869 FYI, a lead shield blocks/absorbs some of the radiation, but internal scatter, which is actually the primary source, cannot be shielded for. In fact, the only time a lead shield is actually effective is if the area being shielded is either within the primary beam, or within 4 – 5 cm of the primary beam. Otherwise, shielding is pretty much done because that is what the patient expects. Here are the sources: NCRP report 147 and http://www.hps.org/publicinformation/ate/q4362.html

]]> By: Jamie http://www.epmonthly.com/whitecoat/2012/10/stretching-the-definition-of-quality/#comment-102837 Jamie Fri, 26 Oct 2012 14:10:06 +0000 http://www.epmonthly.com/whitecoat/?p=8686#comment-102837 What’s funny reading this is that when I was in my late teens/early twenties, when I went to the doctor for ANYTHING, they gave me a pregnancy test eventhough it was not a possibility.

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