Posts tagged as:

emergency

Can universal health coverage be sustained long-term?

November 13, 2009

With health reform looking more likely, it’s worth looking at the Massachusetts model to predict what’s going to happen nationwide.
I’ve written several times that the lack of primary care access will simply shift newly insured patients to already crowded emergency departments, where care is exponentially more expensive. And in the end, it is that [...]

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How teamwork is essential in the emergency department

November 12, 2009

by Edwin Leap, MD
I recently cared for a patient who raised my heart-rate a bit. Of course, any emergency physician will tell you, the potentially difficult and complicated cases often come at the end of the shift, as you’re trying to clean up all of the paperwork and ‘head for the house.’ Nurse [...]

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The decision not to test is often the more difficult choice

November 12, 2009

Ordering that head CT scan is the easy way out.
In a piece from Newsweek (via Bryan Vartabedian), Yale emergency physician Christopher Moore details a common scenario: should he order a CT scan in an asymptomatic 15-year old who was hit in the back of the head while playing soccer?
Dr. Moore encapsulates his thought process: “In [...]

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Football is linked to dementia, and why it should be banned from high schools

November 3, 2009

by Brian E. Moore, MD
Two neuropathologists are prominently spotlighted in an article by Malcolm Gladwell in the October 19 issue of The New Yorker. The article explores a provocative question raised by autopsy results on football players: namely, should football be illegal?
Featured are Dr. Ann McKee, neuropathologist at the Veterans Hospital in Bedford, Massachusetts and [...]

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Incentives promote unnecessary, excessive tests in the ER

October 28, 2009

A professor of medicine visits the emergency department with a seemingly routine case of shingles, and gets the million dollar workup.
Writing in the Washington Post, Jack Coulehan describes how he was subjected to neurology and ophthalmology consults, several MRIs, and a CT scan. All for shingles, a disease that is diagnosed clinically, and treated [...]

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H1N1 rapid tests: Poor sensitivity

October 24, 2009

Originally published in Journal Watch Infectious Diseases
by Stephen G. Baum, MD
Rapid tests for seasonal influenza generally have relatively low sensitivity; their sensitivity for detecting the 2009 H1N1 virus seems even worse.
Many respiratory pathogens can produce an influenza-like illness. With a sensitive and specific rapid test for influenza, the onset of outbreaks could be established and [...]

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When compassion meets progress in American health care

October 24, 2009

by Edwin Leap, MD
Does anyone realize that the chaos of modern American health-care is not a tragedy, but a triumph? We’re so busy trying to fix what isn’t broken and ignoring what is, so busy casting stones and casting doubts that we are blind to what we have.
I have practiced medicine in this labyrinth [...]

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Interruptions when doctors see patients and how that affects care

October 20, 2009

Getting interrupted while in the doctor’s office can be annoying, both for the patient and physician.
In an essay in The New York Times, pediatrician Rahul Parikh notes that, in an average primary care office visit, doctors were interrupted twice. And in the ER, “emergency room doctors experienced an average of 10 interruptions an hour, [...]

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Is emergency department boarding associated with undesirable events?

October 18, 2009

Originally published in Journal Watch Emergency Medicine
by Richard D. Zane, MD, FAAEM
Nearly 30% of ED boarders at a single tertiary care hospital experienced undesirable events.

Emergency department boarding — inpatients in the ED awaiting a hospital bed assignment — is common across the U.S. Although boarding is inconvenient and demoralizing for both patients and providers, [...]

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Unnecessary hospital admissions cost money and can harm patients

October 16, 2009

When the elderly go to the emergency room, more often than not, they are admitted to the hospital.
Stuart Turkewitz, a geriatrician posting at his platintiff attorney brother’s malpractice law blog, explains why. Often times, it’s because emergency doctors aren’t familiar with the baseline state of his elderly patients. Subsequently, “the urge to recommend [...]

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Two nurses face jail time for reporting a doctor to the Texas Medical Board

October 15, 2009

There’s a disturbing case in Texas, involving two whistle-blowing nurses who reported a physician to the Texas Medical Board (TMB).
Apparently, they took offense at the physician who was peddling herbal medications in the emergency room, among other deeds. Unable to convince hospital administration to discipline him, they reported him to the Board.
And here’s where [...]

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Do HMOs drive blacks to the emergency room?

October 13, 2009

Originally published in MedPage Today
by John Gever, MedPage Today Senior Editor
Many African-Americans in California enrolled in health maintenance organizations (HMOs) appear to prefer getting medical treatment in emergency rooms, researchers said.
One-quarter of African-Americans enrolled in Kaiser Permanente or other commercial HMOs in California, who would therefore have a range of treatment options, sought treatment [...]

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Why rapid viral testing for kids with URIs may not help in the ER

October 12, 2009

Originally published in MedPage Today
by Todd Neale, MedPage Today Staff Writer
Rapid viral diagnostic testing did not reduce the burden of treating children with respiratory symptoms and fever in the emergency department, according to a Cochrane Review meta-analysis.
Pooling the results of four trials, researchers found a significant reduction in the use of chest radiography (RR [...]

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Will more primary care doctors keep patients out of the ER?

October 9, 2009

by Edwin Leap, MD
One of the many questions asked in the health-care reform debate is ‘how do we keep people out of emergency departments in order to reduce costs?’ Simply put, we probably can’t. And 16 years into my emergency medicine practice, I think I know why.
Having taken my own children to the [...]

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How much unnecessary testing goes on in the ER?

September 30, 2009

Plenty, if you ask the people most familiar with the situation, the emergency physicians themselves.
According to a survey from Emergency Physicians Monthly , many tests performed in the ER are deemed unnecessary to good patient care. Here’s how doctors responded to the following question: “Given that in a typical shift of eight hours you [...]

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