Archive for the ‘Healthcare Update’ Category
Wednesday, September 18th, 2013
Copeptin levels may revolutionize chest pain evaluations in the ED. When standard treatment was compared with early discharge after normal copeptin levels were obtained, there was no significant difference in major adverse cardiac events at 30 days.
Need to review the study data, but this is a promising new test.
Marco Rubio calls federal government’s $8.7 million advertising campaign for Obamacare a “blatant misuse of federal dollars.”
International Longshore and Warehouse Union dumps affiliation with the AFL-CIO, citing support of Obamacare and immigration reform as two reasons for the disaffiilation.
Good thing to keep in mind with start of school – heavy backpacks can cause or can aggravate back problems with children. Ideally, the article states that a backpack should weigh less than 15% of a child’s total body weight.
Kind of amazing ingenuity. When horse bites off one-third of man’s finger, surgeon forms a mold of the missing finger from a pig bladder, attaches it to the patient … and the finger regenerated – bone, nail, and all. Of course, now he has a permanent aversion to bacon, but it is a small price to pay for a new finger.
I started wondering how the surgeon came up with the idea, so I did a little research. The whole pig bladder idea isn’t new. This man grew back a finger with powdered pig bladder after cutting off the tip while working on a model airplane in 2008. This 19 year old war vet grew back 70% of his injured leg muscle using a pig bladder matrix – which saved him from amputation.
Another example of unintended consequences when doctor performance is measured in the inexact science of medicine. When surgeons and hospitals in Massachusetts were labeled as being “outliers” for having excessive death rates after cardiac stenting, they stop treating the patients most likely to die. Can’t get dinged for trying to save a patient who dies if you don’t try to save the patient.
In the study the doctors didn’t come out and say that they stopped treating the sickest patients, but the pre-operative likelihood of patients dying after the procedure dropped by more than 30% after hospitals got the “outlier” label.
What a bunch of hypocrites. In 2009, Chuck Grassley inserted a provision in Obamacare ending their subsidies and requiring all members of Congress and their staff to get insurance through the health exchanges – like everyone else. Congress pressured the Office of Personnel Management to change it.
Recently, Senator David Vitter from Louisiana sponsored another bill to end the subsidies and force everyone on Capitol Hill to purchase their insurance through the exchanges. Now Congressional leaders like Harry Reid and Barbara Boxer are attacking him.
A requirement for government employees to obtain their insurance through the health care exchanges like everyone else should be the sine qua non of the Unaffordable Insurance Act.
Lawsuit Abuse Reduction Act of 2013 is moving through Congress. Would change federal rules of civil procedure to REQUIRE courts to impose sanctions on attorneys who file frivolous, unwarranted, or factually unsupported claims or briefs. Under the current Rule, the decision to impose sanctions is discretionary.
It would still be left to the court’s discretion whether a claim has met those criteria, so the Act doesn’t have as much bite as it appears, but it would be a step in the right direction.
Then we can sanction our way to better legal representation. Hey … it works for medicine, right?
Interesting study on estrogen requirements in … men. Lower estrogen levels in men may be associated with increased fat deposition and decreased libido. It may not just be about “low T.”
Computer programmer comes up with app for smartphone that may put a lot of optometrists out of business. Place a small viewer against a smart phone screen, use dials on the viewer to align the red and green lines on the smartphone screen, then the app calculates the strength of the glasses you need.
The article also links to descriptions of other apps that perform EKGs and diagnose children’s ear infections.
I’m personally waiting for an app that sues the other apps when they make a mistake. Where’s the smartphone courthouse, anyway?
Interesting story about the investigation of a mother with Munchausen’s and Munchausen’s by proxy.
CMS creating more of a regulatory morass for patients admitted less than “two midnights.” Hospitals now instructed that patients expected to stay less than two midnights should be classified as observation status (and will therefore pay more money out of pocket). Doctors also must certify that inpatient stays are “medically necessary.”
Remember that if the government is charged for care is determined to be medically unnecessary, fines, penalties, and criminal charges can be filed against the health care providers.
Australian girl left laying on the floor of the emergency department for nine hours because there were no beds available to treat her. Hospital overwhelmed with sicker patients and a line of ambulances was waiting to offload patients at the time.
Does Australia have the same socialized medical system that the US is heading toward?
Canadian doctor with multiple tweets about safety concerns in Canadian emergency department. “Second ER doc at QEH considering resigning due to safety concerns. Doctors outside the ER need to pull their weight.” Emergency physicians being required to round on inpatients.
Wednesday, September 4th, 2013
Look for more updates on my other blog at DrWhitecoat.com
American Medical News ceasing publication due to decreasing ad sales. Now focusing on online and e-mail publications.
Too fat to rescue? Some patients weighing more than 350 pounds (and even some weighing more than 250 pounds) are being denied air transport due to their weight. Other services are spending millions of dollars to purchase helicopters that can carry patients up to 650 pounds.
What happens with a 750 pound patient, then?
University of Pennsylvania adding metal detectors to its emergency departments. They reportedly aren’t used in emergencies, though.
Young California girls end up in emergency department, then in burn unit after getting lime juice on their skin and then going out into the sun. All apparently suffered from phytophotodermatitis. They’re healing well, but can’t go out into the sun for 6 months and all have scars to their faces, torsos, and extremities.
I’m not even going to post a link, but I’m having difficulty determining whether it is appropriate for a chain of acute care clinics … in Florida … to be advertising how it will provide “stronger” treatment for painful conditions and “emergency pain relief” for patients who don’t want to wait in emergency departments.
Jesse Jackson Jr will be in jail, but receiving almost $150,000/year in federal pension and disability payments for his mood disorder.
Kid has minor blunt head injury? Observation in the ED significantly lessens the likelihood that a CT of the brain will be performed.
Obamacare is great. That’s why Daniel Werfel, the Principal Deputy IRS Commissioner for Services and Enforcement (and one of the people who will be helping enforce the Unaffordable Insurance Act mandates) wants to exempt himself and his employees from the Obamacare exchanges.
Patient’s gone wild again. California patient goes to the ED for treatment, then once he gets inside begins chasing staff around, punching one staff member in face. Now he’s cooling his heels in the Greybar Motel.
Wednesday, August 28th, 2013
Find more updates on my other blog at DrWhitecoat.com
British National Health Service now gives physical therapists and podiatrists the authority to prescribe medications to patients without physician supervision. Good for them.
I still believe that all drugs aside from antibiotics and perhaps narcotics should be over the counter anyway.
Not only the King of Beers, it’s the King of Emergency Department visits. One third of injury visits to Level 1 trauma centers were alcohol related. Personally, I think that number is low. Of the patients who admitted drinking before their injury, 69% were male and 69% were black. Of the types of alcohol consumed before the injury, Budweiser ranked supreme. Malt liquor was consumed by 46% of patients before their injury while it only accounted for 2.4% of consumption in the general population. (.pdf file)
As a result of this study, the researchers suggested that alcohol content on malt liquors should be clearly labeled and that perhaps the availability of malt liquor should be limited … which just tells me that the researchers really have no clue about real world effects of their recommendations.
Welcome to the Abercrombie and Fitch emergency department, how may I help you? When payments for providing care get cut, some hospitals get creative in making more income. Ohio State University is one of them. Hey – think about the Ronald McDonald Childrens Hospitals. Not sure I disagree with the tactic, although it may tend blur the distinction between medical care and retail which I don’t think is a good thing.
Although personally I would think it was funny if some rich donor from another school purchased the naming rights for a hospital and made it the Michigan Wolverine Trauma Center.
Elevated BMI may not be the best indicator of poor health. In fact, some studies show that an “obese” BMI improves survival under certain conditions. So why do we use it? “Because it’s simple,” says one of the authors of the paper.
Strangely similar to Press Ganey scores, isn’t it?
Using Google Glass to record and live-stream surgery? The Reebok Chair of Orthopedics at Ohio State Wexner Medical Center is doing it. Check out the video.
Had you going for a second with that “Reebok” thing, didn’t I?
Why we need free markets and open pricing. Hospitals charge $787 for IV fluids that cost about $1 per bag. Then hospitals accept $119 as payment in full of bills for more than $2,100.
Illinois emergency department gets a bolus of 79 teenaged patients who were crop-dusted while in a field detasseling corn. What felt like raindrops was really some chemical being dropped on the field next to theirs.
Monsanto apparently owned the field and the patients were being contracted to work in the field. A spokesman for Monsanto, who incidentally has three eyes, seventeen fingers, and involuted genitals, said there was nothing to worry about.
I’m kidding. She only has thirteen fingers.
Are you giving epinephrine to patients with suspected or actual anaphylaxis in your ED? If not, you should be.
Tort reform works. Or, if you’re a plaintiff attorney, tort reform is a sham. Medical malpractice payouts reach an all-time low in 2012.
One final note from the ED community to the ED community. A third year emergency medicine resident at Cook County Hospital in Chicago was recently diagnosed with a rare form of liver cancer. Because it is so rare, there is no standard treatment, so insurance won’t cover any therapy.
If you can spare a few bucks to help or if you can attend a fundraising event, it would be appreciated.
Wednesday, August 21st, 2013
Look for more updates on my other blog at DrWhitecoat.com
Judge orders Colorado family to pay $340,000 in legal fees after losing the medical malpractice suit it brought against a hospital.
The family plans to declare bankruptcy. The family’s attorney, Stacy Warden, alleges that the hospital lacked compassion for “going after a family with a severely disabled child.” If attorneys file frivolous cases, perhaps the attorneys should be on the hook, not the families …
West Virginia couple is suing a physician for failing to diagnose an epidural abscess that later rendered the patient with permanent paralysis, in addition to other physical pain and suffering.
The details of the case aren’t provided, so the comments below are not necessarily related to this case.
However, just consider …
Spinal epidural abscesses present as either neck or back pain in 70-100% of cases. Fever and neurologic deficits accompany the pain in only 10-15% of initial presentations.
CT or MRI of the spine is the only way to diagnose this disease process and early diagnosis is important to a good outcome.
But the American Academy of Family Physicians and the Choosing Wisely campaign state that CT or MRI for acute low back pain is “often a waste of money” and probably not needed unless there is “a history of cancer, unexplained weight loss, fever, recent infection, loss of bowel or bladder control, abnormal reflexes, or loss of muscle power or feeling in the legs.” Remember … these symptoms are present in only 15% of patients with spinal epidural abscesses.
Therefore, according to the AAFP and the Choosing Wisely campaign, it should be “unnecessary” to diagnose the 85% of spinal epidural abscesses that present with only acute back pain.
Yeah, that logic didn’t work too well with me, either.
Want a *brief* look into a day in the life of an emergency nurse … since certain other emergency nurses aren’t blogging any more? Here’s a local newspaper’s brief overview.
SAMHSA study (.pdf file) shows that emergency department visits due to nonmedical use of prescription stimulants and caffeine pills increased fourfold between 2005 and 2011.
Another hospital starts collecting payments at the time of a patient’s emergency department discharge. Wonder what happens if patients don’t pay …
Number of emergency department visits from magnetic foreign body ingestions increases fivefold between 2003 and 2011. The government already put buckyballs out of business due to safety concerns. The only logical conclusion is to criminalize the manufacture of any magnet smaller than the size of a child’s mouth. Come on, Joint Commission. You’re dropping the ball here. Our childrens’ safety is in jeopardy.
Next stop: Outlawing credit cards. Those magnetic stripes could KILL a person!
What happens when you pass laws to provide medical insurance to everyone? Emergency department visits increase. Massachusetts Medical Society President notes that when people have medical insurance and they don’t have a primary care physician, they “go to the emergency room.” Same thing can be said when people have medical insurance and their physicians won’t take their medical insurance because it pays less than the cost of care for the patients. Not that that would ever happen …
The rhetoric is getting old already. Your doctor is a worrywort, therfore you may end up getting “unnecessary” tests and paying for lots of expensive tests. But if your doctor misses a diagnosis because he didn’t order the “unnecessary” test, he’s a flaming idiot and should have his license revoked.
Harvard law professor Michelle Mello, who commented on the article, says that mediation in front of a judge would reduce defensive testing because it would reduce the stigma of being accused of malpractice and negligence. Just goes to show you that just because you’re a Harvard professor doesn’t mean that you know what you’re talking about. Doctors still have to report all claims – mediated or not – when applying for hospital privileges or state licensure, and any payments on a physician’s behalf get reported to the National Practitioner Databank – which is queried every time that a physician seeks licensure, insurance, or hospital privileges.
But thanks for spreading the misinformation, professor.
Tuesday, August 6th, 2013
Look for more updates at my other blog at Dr.Whitecoat.com
Naked West Virginia patient steals ambulance from emergency department parking lot, goes on joy ride and then crashes into three vehicles – requiring more ambulances to take injured patients to the hospital. Hopefully this time they locked the ambulance doors. And I’m not sure I’d be wanting to sit on the driver’s seat without a plastic cover until after the seat gets washed down.
Use of chest x-rays in asthma patients increasing between 1995 and 2009. According to a 2005 study cited within the post, most xrays in children with asthma are deemed “unnecessary.” I don’t have access to the full article, but if it doesn’t have prospective criteria for what are considered necessary tests in wheezing or dyspneic children, then the results are suspect. Remember, kids don’t come to the emergency department saying “treat my asthma.” Kids come to the emergency department with trouble breathing, with wheezing, and with coughing. If the researchers are saying retrospectively, based on a normal CXR, that the kids had asthma and didn’t need an x-ray, that’s classic hindsight bias.
What’s that? You have an ingrown toenail? Well, you’re getting tested for HIV. Why? Because some study says so. Who’s paying for it? Who cares? The study says there’s a benefit. Out of 9,572 patients offered testing, 40% agreed and they found SIX new HIV cases. But don’t you dare call that an “unnecessary test,” dammit. Tests are only unnecessary when doctors do them for … well …
Oh nevermind. Carry on.
How good are emergency physicians at diagnosing Bell’s Palsy in the emergency department? Greater than 99% accurate by this study. Just hope that your patient isn’t one of the less than one percent who ends up having a brain bleed, stroke, or meningitis instead. Those outcomes are more likely in the elderly, in diabetics, and in blacks, with black race being the largest risk for patients having a diagnosis other than Bell’s Palsy.
Would be interesting to see how many of the misdiagnosed patients developed bad outcomes and sued for failure to diagnose.
Failing to perform testing that would have made the alternative diagnosis is seen as a negligent event while performing testing in the exact same patient when no alternative disease is present is considered “unnecessary,” “greedy,” and “wasteful”.
Study by Safe Kids Worldwide (.pdf file) shows that there were more than 1.3 million visits to the emergency department for sports injuries in 2012. Of those visits, 163,000 were for concussions meaning about one concussion every three minutes. That’s a lot of damaged neurons.
Nothing new in this study. Health Affairs study shows that physicians with higher concern for medical malpractice are more likely to practice ‘defensive medicine” than those with lower concerns for medical malpractice. Scenarios presented to physicians included patients coming to a medical office with chest pain and patients complaining of a headache. Those physicians with higher levels of malpractice concern were more likely to send the chest pain patients to the ED and were more likely to obtain imaging on the headache patients.
And if, using our magical retrospectoscope, we truly believe that patients with those complaints shouldn’t go to the emergency departments and shouldn’t obtain advanced imaging, then we need to change the system to reflect those values. Maybe we make “failure to diagnose” an exception to medical malpractice suits.
Any of you medical professionals want to help your fellow Americans when a disaster hits? Stay away from Missouri. After the devastation from the Joplin, MO tornado, charities sent medical care to the area but weren’t allowed to help because of Missouri laws. State legislatures saw the problem and created legislation that would have permitted licensed health professionals from other states to provide free care in Missouri and would have protected them from medical malpractice. Missouri Governor Jay Nixon vetoed the bill, stating that it was “unnecessary” because Missouri already has a system that encourages volunteers.”
Wonder if all the people in Joplin who needed medical care after the last tornado felt the same way.
Another example of the WhiteCoat Effect. Bert Fish Medical Center in … Florida … puts out creative ad with picture of surf board and shark bite taken out of the top using the caption that it has “emergency care when you need us.” New Smyrna, Florida’s public information officer takes offense at the ad, stating that the ad “doesn’t help us to market the safety of our beaches.” Well, when your beaches have the most shark bites in 2012 in the WORLD according to one study, maybe you should stop throwing chum in the surf, then, lady. Now even more people are going to know how New Smyrna, Florida is the shark bite capitol of the planet and how people could be taking their lives into their stumps … er … um … hands … by setting stump … er … um … foot … on the beach there.
Monday, July 29th, 2013
Look for more health care stories from around the web at my other blog at DrWhitecoat.com
InQuickER has some competition for violating EMTALA in the “reserve a spot for my emergency department visit” market. Massachusetts hospital using service called “ResERved” and another company called ER Express is also filling this niche … at least until malpractice attorneys realize that EMTALA violations and decisions from hospital administrators to utilize these services aren’t subject to state malpractice caps and also bring in another set of “deep pockets” when patients suffer an injury.
Brazilian man dies when cow falls through roof of his home and lands on him in bed. Family doesn’t blame cow, but rather blames the excessive amount of time that the patient waited to be examined in the hospital.
Now the owner of the cow could be charged with manslaughter.
Those commenting to the article note how red meat isn’t good for you.
Why do low income patients go to the emergency department?
1. More accessibility. If you’re bored some day, get a list of doctors offices in your area, call around and tell them that you have Medicaid and need an appointment as soon as possible. Walk into the emergency department and you get evaluated by a medical professional.
2. Lower out of pocket costs. Primary care physicians sent many patients to multiple specialists – each who required a co-pay. Emergency departments took care of the problems in one visit.
3. Higher quality of care. Well, you know. What can all of us emergency docs say?
Fourteen of the 500 or so NHS hospitals are allegedly to blame for up to 13 thousand excess patient deaths in the past 8 years. Report shows “alarming levels of infections, patients suffering from neglect and appalling blunders such as surgery performed on the wrong parts of bodies.”
After the shock headline was disseminated, the author of the report, when asked for comment, responded “Don’t believe everything you read, particularly in some newspapers.”
The cited report was supposed to be published two weeks ago. I found a summary of the allegations here, but I can’t find the report itself anywhere online.
Interesting point to keep in mind regarding testing for pulmonary embolism: The higher the d-dimer level, the more likely that a PE will be present. Those with the highest d-dimer levels had a 45% chance of having PE on chest CT scans.
Should we have a new criteria to presumptively diagnose PE solely by blood testing?
Gynecologist’s assets seized after $5 million malpractice judgment.
Patient develops metastatic ovarian cancer when gynecologist discusses removing ovaries during a hysterectomy, but doesn’t “strongly advise” that they be removed.
Skeptical Scalpel creates a nice summary of the case, Downs v. Trias. The court opinion notes that the patient previously had bilateral mastectomies due to strong family history of breast cancer, that the doctor testified he had limited knowledge of the patient’s ovarian cancer risk, and that plaintiff experts testified that the doctor did not properly inform the patient about her risk of developing cancer.
What message does a verdict and asset seizure like this send to physicians?
Refer cases to multiple specialists for expert opinions on everything. Order more testing so that patients can be fully informed about all the potential risks of any of their medical problems. It is only called “defensive medicine” when the testing is performed and the results are normal. Take proactive steps to protect your assets in the event that any one of the hundreds of medical decisions you make each day turns out to be incorrect and results in harm to a patient.
Two Alabama postal service employees hospitalized after coming into contact with KY Gel that had leaked out of a package. Yeah, that same stuff doctors put on their gloved fingers before performing rectal exams. Oh, the comments running through my mind right now …
Tuesday, July 9th, 2013
More updates available tomorrow on my other blog at DrWhitecoat.com
Why does an $11,596 emergency department visit cost $1,100? A spokesperson for the California Hospital Association says that it is because of government regulation. I want to know what doctor ever gets paid $4,242 for a Level 4 emergency department visit.
California attorneys are trying to raise the cap on damages under California’s Medical Injury Compensation Reform Act. Caps are currently $250,000 and haven’t been raised in more than 35 years.
The article says that many attorneys won’t take medical malpractice cases in California because they are too time-intensive and costly and attorneys don’t get a big enough payoff when they win.
So much for that whole argument about how malpractice plaintiff’s attorneys are in it only to make sure that their clients receive “justice” ….
Think you have a “spider bite”? You probably don’t. Out of 40,000 species of spiders, only about a dozen actually can cause damage to humans. Most of the others either are not toxic to humans or don’t have “fangs” big enough to pierce human flesh.
One study on the issue showed that many people with alleged spider bites actually had an infection with the “superbug” MRSA which is caused in large part by antibiotic overuse. Keep popping those amoxicillin prescriptions and Augmentin refills, though.
Speaking about antibiotics … this study in the British Journal of Dermatology shows that children who are exposed to antibiotics in their first year of life are about 40% more likely to develop eczema later in life.
Emergency physician at Logansport Memorial Hospital in Indiana sends letter to administrator seeking to terminate their group’s contract which points out the obvious: In rural areas, there aren’t a lot of emergency physicians to choose from. Getting rid of the group only changes management, but often results in either expensive locum tenens physicians or in many of the current emergency physicians being recruited by the incoming group. However, if the hospital has been through three emergency department groups in three years, maybe the hospital board needs to take a closer look at how hospital CEO Dave Ameen is running the ship.
Maybe the dogs are onto something. British researchers can detect bladder cancer with 100% sensitivity just by the smells in the urine.
Perhaps that’s why my dog shakes his head after sniffing the bases of some light posts … “Poor Shep has the Big C.”
Working out too hard too fast can cause kidney failure. One man alleged that the workout system P90X caused him to break down so much muscle that he developed rhabdomyolysis. New onset of Coca-Cola-colored urine is usually a dead giveaway that you need to seek medical attention.
Cardboard box blows out of dumpster in North Carolina hospital parking lot, police shut down roads and hospital emergency department so they can x-ray the box to make sure it isn’t harmful. Dang. I don’t know how the roads stay open on garbage pickup days.
Wednesday, June 26th, 2013
See more HealthCare Updates at my other blog at http://drwhitecoat.com.
UK Accident and Emergency Department criticized for multiple failures after going into “crisis” mode from January through March due to a surge in patient volumes. Of course, all the investigators go and pick through the hospital’s policies four times in April after things have calmed down, rather than going and trying to address the problems in real time while they’re happening.
Want to see me faint? Give me a story about an inspector going to a hospital during a crisis, and making a specific real-time recommendation on how to improve the crisis. None of the vague doublespeak about doing something to “make sure a proper system was in place to identify and manage any risk to the health and safety of people using the hospital.”
Inspectors like this seem to have no problems criticizing other peoples’ solutions – especially after the fact – but they’re hard-pressed to come up with their own innovative solutions during a crisis.
The MERS virus is the latest deadly virus to hit the circuit. The reported mortality rate is 65%! Outbreaks in one case were spread from one dialysis patient to seven others in the same hospital.
One vector was hypothesized to be contaminated dates from Saudi Arabia. Next month’s celebration of Ramadan in Saudi Arabia will be a big test of the infectivity of the MERS virus.
The US isn’t the only country experiencing difficulty managing psychiatric patients from the emergency department. Some Australian hospitals seeing excessive wait times for placement. At Calvary Mater Newcastle Hospital, one in every 15 patients is mentally ill.
Georgia Supreme Court set to hear case challenging Georgia’s emergency medical care statute. Fifteen year old boy undergoes arthroscopic knee surgery to repair a football injury. Eight days later, he comes to the emergency department with chest pain. Labs, EKG, CXR show nothing and he is diagnosed with pleurisy. Two weeks later, he died from bilateral pulmonary emboli.
Georgia’s statute states that emergency medical providers can only be liable if clear and convincing evidence shows that the providers actions showed “gross negligence”.
Two nationally-recognized emergency medicine experts are apparently prepared to testify that the physician’s actions were grossly negligent, which I think is a total crock of an opinion.
140 million patient visits this year and soon to rise even higher with implementation of the UnAffordable Insurance Act. Fewer emergency departments. Higher acuity. Oh, and so what if you don’t get paid for your services. Now to avoid government penalties for patients who are re-admitted too soon, emergency physicians will be expected to provide “observation care” in their limited beds. What could go wrong?
This author says emergency physicians need to be “at the table”. More like we need to fight back before we’re “on the table.”
Patients having pain in the emergency department? Don’t give them 2mg of Dilaudid all at once! Give them 1mg now and 1mg in 15 minutes because according to this Annals of Emergency Medicine study, by the second dose, 42% of the patients have already experienced “adequate anesthesia.”
Oh, and in case you didn’t hear, yours truly is officially going to have his work overseen by one Judith Tintinalli. As in the Emergency Medicine Tintinalli. Talk about pressure …
Dr. Tintinalli has been named as EP Monthly’s new Editor-in-Chief, replacing Dr. Kevin Klauer who is moving over to ACEP News. Welcome aboard! And if you need some pithy commentary for the next edition of your book, you know where to find me.
Saturday, June 15th, 2013
More HealthCare Updates from around the web are at my other blog at http://drwhitecoat.com.
What’s the highest sodium level you’ve seen? These docs saved a patient with a corrected sodium level of 196 which is the highest I’ve ever heard of. Lower 170s is the highest I can remember. The patient drank a quart of soy sauce on a dare, then started having seizures a couple of hours later. Some quick thinking docs gave him 6 liters of free water over 30 minutes and the patient survived and was neurologically intact! Amazing. The docs from University of Virginia in Charlottesville deserve a lot of credit for saving this fellow.
Another story about the case is here.
$5 heroin killing many New Jersians. Ocean County, NJ has lost 53 people to drug overdoses this year alone.
California man enters hospital, walks into emergency department restroom, pulls out gun and shoots himself dead.
Are CT scans useful for evaluating dizziness in the emergency department?
This study showed that there was a 1 in 50 chance of a significant finding. Some people had bleeding in their cerebellum, some had hydrocephalus, some had cancers. When patients received a follow up MRI, 13% of patients had significant findings – most of which were strokes that had gone undiagnosed on the initial CT scan. I’m betting that if the testing was negative, certain groups of people [cough cough Consumer Reports hack cough] would label the tests “unnecessary” and state that the testing shouldn’t have been performed.
What would you want if it was your family in the emergency department?
An unfortunate case of “crying wolf”? UK patient takes overdose of pain medications then is taken to the emergency department (A&E department). There, she denies taking any medications to cause her lethargy. She was assigned to be watched by “unqualified” Healthcare Assistants, and was believed to be faking a coma because she was a “frequent flyer.” She stopped breathing and died from a narcotic overdose 12 hours later.
Now the Secretary of State for Health is being petitioned to prevent Healthcare Assistants from observing seriously ill patients and requiring that only nurses do so.
With more patients, fewer facilities, and lower reimbursement for care, we’re moving toward the system already present in the UK. Can we learn anything?
Another interesting article from the UK. When one hospital closes its emergency department, the domino effect on nearby hospitals is significant. Waiting times to be seen skyrocket: There is a five-fold increase in numbers of patients waiting more than 4 hours to be seen. The number of cancelled elective surgeries doubles. Patients die in ambulances waiting in the hospital parking lots just to get into the emergency departments.
Take note of these types of problems as the United States heads closer to a socialized system.
But at least their care is free.
Thursday, June 6th, 2013
More HealthCare Updates from around the web are at my other blog at http://drwhitecoat.com.
Remember the case where hospital administrator Bruce Mogel allegedly planted a gun in a doctor’s car then called the police to frame him because the administrator didn’t like the doctor’s criticisms of the way the hospitals were being managed? The doctor sued the hospital and won $5.7 million.
Well a judge just threw out that judgment. Employers can’t be liable if the employee/officer’s actions are not reasonably related to the job or reasonably foreseeable.
Patients gone wild. Combative New Jersey patients gets beat down by police, then causes officer to dislocate his ankle. Now charged with aggravated assault on an officer.
UK hospital emergency department director states that there is “toxic overcrowding” and that hospitals are at a “crisis point.” Notes that the EDs are “simply not equipped to safely care for such numbers of patients, an increasing proportion of whom are elderly and frail with complex medical, nursing and social needs.”
More patients, sicker patients, “substandard conditions” … what could go wrong?
Missouri Clinic sued for failing to drain an allegedly nonexistent perirectal abscess. The patient was instead placed on antibiotics, instructed to use sitz baths, told to see the surgeon the following day, and instructed to return to the emergency department if his condition worsened. Four days later when the next surgery appointment was available, the patient was determined to have had necrotizing faciitis which by that time had spread from his buttocks to his knee.
Experts in the case allege that immediate lab tests, CT scans/ultrasounds were required and that the patient should have been admitted to the hospital. The emergency physician plaintiff’s expert testified that it is a deviation from the standard of care to discharge a patient with such an abscess from the emergency department.
Canadian politicians demanding an inquest into death of a patient who fell and hit her head, then left emergency department after waiting six hours to be seen. She was found dead the following day. According to statistics in the article, the number of patients leaving hospitals without being seen by physicians increased nearly 10% between 2011 and 2012.
Brainiac Democratic Nevada politician Marilyn Kirkpatrick tries to amend the Nevada constitution to cap costs for anyone receiving treatment in a hospital emergency department.
Changing the CONSTITUTION to reflect how much people should have to pay when someone else renders private services to them? How much more idiotic can legislators in this country get?
Why stop at emergency services? What’s next? A constitutional amendment to limit the charges in Nevada for fast food hamburgers? Pints of alcohol? Attorney’s fees? How about capping Nevada lawmaker’s salaries?
Fortunately, this colossal example of poor judgment died without even coming up for a vote.
Two thirds of Americans aren’t sure that they will purchase coverage required by Obamacare by the January 1, 2014 deadline. More than 60% of people believe that the UnAffordable Care Act will lead to higher health care costs. It already has.