Emergencies / First Aid
People who receive primary care from free clinics are less likely to use the emergency department for minor issues, according to a team of medical researchers.
Nationally, the number of emergency departments (EDs) has decreased yet the number of ED visits has gone up, the team reported. Therefore, it is important to figure out how to reduce unnecessary ED visits.
According to the National Association of Free and Charitable Clinics, there are more than 1,200 free clinics nationwide. Many of these clinics work in cooperation with one of their local hospitals.
Wenke Hwang, associate professor of public health sciences at Penn State College of Medicine, and his colleagues analyzed records of uninsured patients from five hospitals and four free clinics across neighboring Virginia communities.
Over the last 20 years, the number of hospital emergency departments in nonrural areas in the U.S. has declined by nearly 30 percent, with for-profit ownership, location in a competitive market, low profit margin and safety-net status associated with an increased risk of emergency department closure, according to a study in the May 18 issue of JAMA.
“As the only place in the U.S. health care system that serves all patients, emergency departments (EDs) are the ‘safety net of the safety net.’ Federal law requires hospital EDs to evaluate and treat all patients in need of emergency care regardless of ability to pay,” according to background information in the article. “Between 1998 and 2008, the number of hospital-based EDs in the United States declined, while the number of ED visits increased, particularly visits by patients who were publicly insured and uninsured. Little is known about the hospital, community, and market factors associated with ED closures.”
Renee Y. Hsia, M.D., M.Sc., of the University of California, San Francisco, and colleagues conducted a study to examine the factors that may be associated with the closure of hospital EDs. The study included emergency department and hospital organizational information from 1990 through 2009, acquired from the American Hospital Association Annual Surveys and merged with hospital financial and payer mix information available through 2007 from Medicare hospital cost reports.
The elderly, the uninsured and the critically ill are among the groups most likely to rely on an ambulance to get to the hospital, a new study finds—raising the possibility that such high-risk patients are the ones most affected when hospitals turn ambulances away due to emergency room overcrowding.
To help relieve overburdened ERs, hospitals across the U.S. rely on a practice called ambulance diversion—temporarily directing incoming ambulances to other medical centers.
The policy has come under criticism for potentially putting patients at risk by increasing their transit time to the hospital. On the other hand, the goal of the practice is to get patients the treatment they need more quickly—since ER overcrowding may delay the care of both newly arriving patients and the ones already waiting.
Widespread use of the Canadian C-spine rule by triage nurses in emergency departments would ease discomfort of trauma patients and improve patient flow in overcrowded emergency departments in Canada and abroad, according to a study (pre-embargo link only) http://www.cmaj.ca/embargo/cmaj091430.pdf in CMAJ (Canadian Medical Association Journal) http://www.cmaj.ca.
A clinical decision rule called the Canadian C-spine rule, which helps clinicians with diagnostic or therapeutic decisions, was previously developed for c-spine evaluation. It was designed to help physicians “clear” the c-spine without radiography and to decrease immobilization time. If nurses were also able to follow this clinical decision rule, it could improve trauma care efficiency in Canadian hospitals.
Canadian emergency departments annually treat 1.3 million patients with blunt force trauma from falls or vehicle accidents and who are at risk of injury to the cervical spine. Most of these patients are alert and their conditions stable. Less than 1% have C-spine fractures.
More than 40 percent of the 120 million visits that Americans made to hospital emergency departments in 2006 were billed to public insurance, according to the latest News and Numbers from the Agency for Healthcare Research and Quality.
According to the analysis by the federal agency, about 50 million emergency department visits were billed to Medicaid and Medicare. The uninsured accounted for another 18 percent of visits for emergency care, while 34 percent of the visits were billed to private insurance companies and the rest were billed to workers compensation, military health plan administrator Tricare and other payers.
The agency’s study of hospital emergency department use in 2006 also found that:
So-called virtual colonoscopies—done using souped-up x-rays—detect tumors and precancerous lesions almost as well as standard colonoscopies using a camera threaded through the colon, Italian researchers reported on Tuesday.
The virtual procedure, done using computed tomography scans, might offer an alternative for people who are embarrassed or afraid to have a standard colonoscopy and encourage them to be examined, Dr Daniele Regge of the Institute for Cancer Research and Treatment in Turin, Italy, and colleagues said.
Their study, published in the Journal of the American Medical Association, adds to a growing body of evidence showing the CT procedures are safe and almost as good as standard colonoscopies.
Spring has sprung and many people are out walking their dogs, prompting the American College of Emergency Physicians (ACEP) to remind people about the dangers of dog bites.
According to the ACEP, more than 4 million people are bitten by dogs each year, many of them children who can’t resist petting the animals.
“Most dogs are friendly, with no intentions to cause harm to anyone,” said ACEP president Dr. Nick Jouriles. “But sometimes they act aggressively toward strangers for a variety of reasons. “Most dog bites are not fatal, but at least one in five requires medical attention, including a trip to the emergency department.”
The recent death of actress Natasha Richardson, after what initially seemed just a minor bump on the head, was tragically sad.
However, researchers are seeing evidence now that her untimely passing at the age of 45 has provided a valuable public health lesson.
For example, CNN reported a story about a 7-year-old girl in Ohio who was hit in the head while playing baseball with her father. Two days later, she complained of a headache. Her parents, who had just learned what caused Natasha Richardson’s death, immediately called their pediatrician and took their daughter to the hospital. Doctors now say the girl would have died in her sleep that night if her parents had not sought treatment when they did.
The U.S. government’s Medicaid program for the poor may put more financial burden on overcrowded hospital emergency rooms than the nation’s 47 million uninsured, according to a study published on Thursday.
Researchers at the University of California San Francisco and Stanford University found that the uninsured patients paid 35 percent of their overall emergency room bills in 2004, versus 33 percent for Medicaid.
New rules to help the United Nations contain public health emergencies took effect on Friday, requiring countries to disclose potential threats from disease, chemical agents, radioactive materials and contaminated food.
The World Health Organisation (WHO) said its revised International Health Regulations, approved by member states in 2005, would hasten the detection, investigation and control of potentially devastating outbreaks.
Bangladesh began immunizing 2 million children against polio on Sunday in an emergency vaccination drive in a southeastern region close to Myanmar, officials said.
The campaign follows confirmation that a polio-infected child from Myanmar had traveled to Chittagong and Cox’s Bazar for treatment in March.
There is some belief that Emergency Departments are being used for non-emergency medical care. In particular, do Medicaid recipients and uninsured patients overutilize ED for services better provided in other settings” In two studies conducted at Oregon Health and Science University, to be presented at the 2007 Society for Academic Emergency Medicine (SAEM) Annual Meeting, researchers have investigated some common assumptions about ED use and found some surprising results.
To analyze ED usage, a research tool called the “Emergency Department Algorithm” (EDA) has been developed that attempts to categorize all ED visits into four categories: non-emergency; emergency, primary care treatable; emergency, needing ED, but potentially avoidable; and emergency, needing ED, not avoidable.
The proportion of chronically ill young children dying in intensive care after being admitted to other hospital wards has steadily risen year on year since the end of the 1990s, reveals a study in the Journal of Medical Ethics .
The researchers analysed the records of one large children’s hospital, to find out where children had died, and of what causes.
Parents’ psychological responses to asthma attacks are among the strongest motivators of seeking accident and emergency (A&E) services for their child, according to a study conducted in London.
In contrast, characteristics of the home environment, such as dampness, overcrowding, or living with a smoker, have little effect on use of emergency departments.
An analysis of state Emergency Medicaid spending contradicts assumptions about emergency care provided to recent immigrants, researchers from the University of North Carolina at Chapel Hill and the Carolinas Center for Medical Excellence have found.
The study appears in the March 15 issue of the Journal of the American Medical Association. Dr. Annette DuBard, a research associate at UNC’s Cecil G. Sheps Center for Health Services Research, will present the results Tuesday (March 13) at a JAMA media briefing on access to care at the National Press Club.