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Monday, October 20, 2014

Alexander Thai, a third-year medical student at the University of Louisville, determined that using a bedside ultrasound in a pediatric ED is cost-effective, lessens the length of an ED stay, and provides images equal in accuracy to an x-ray or CT scan without exposing children to radiation, according to a university press release.

 

Mr. Thai and his colleagues found that annual average costs of obtaining and using a point-of-care ultrasound (POCUS) in the emergency department total $75,240. The annual average revenue realized from the use of POCUS is $115,969, resulting in an annual net operating revenue of $40,729.

 

The researchers found the revenue can be realized using POCUS for four common pediatric procedures: the Focused Assessment for Sonography in Trauma (FAST) exam, an evaluation of abscesses, for draining abscesses, and for performing a femoral nerve block as a local anesthetic prior to surgery.

 

Mr. Thai presented the results from the study, “Cost-Effectiveness of Implementation of Point-of-Care Ultrasound in a Pediatric Emergency Department,” at the American Academy of Pediatrics National Conference and Exhibition in San Diego on Oct. 10.


Friday, October 17, 2014

The U.S. Food and Drug Administration approved Lumason for patients whose echocardiograms are difficult to read with ultrasound waves, the FDA announced in a press release. (http://1.usa.gov/ZYo1w9.)

 

Lumason, a contrast agent made up of gas-filled microbubbles, reflects sound waves to enhance an image, and helps a physician see a patient’s heart more clearly. Its safety and efficiency were established in three clinical trials involving 191 patients with suspected cardiac disease whose echocardiograms were difficult to interpret. All three studies showed visual improvement in the majority of the patients who received a 2 ml dose of the agent.

 

The most commonly reported side effects associated with Lumason were headache and nausea.


Thursday, October 16, 2014

By Edwin Leap, MD

 

Emergency medicine is its own religion. Our profession grew out of a pressing need for physicians who could provide immediate and life-saving care to the sick and injured at all hours of the day. Our founders’ goals were to ensure that we did the right research, learned the right skills, and brought those abilities to a nation in dire need of high-quality care in times of crisis. The early disciples, deeply committed to the early statements of faith, brought many into the fold. Our creed might have been: “I believe in saving life and limb, anytime and anywhere, with all the skills I have. I believe that the doctor is accountable and responsible for leading and acting to accomplish this goal.”

 

Our catechism? Our first Communion? Residency, oral, and written boards. Our sacraments and liturgy? History, exam, intubation, chest tubes, central lines, and charcoal. We held sacred that we were accountable for patients above all. Humans dwelled at the center of our act of worship. We even accepted the idea that no one should be forced to pay for that care.

 

The gray on my head testifies that I have been a believer long enough to see the transformations that have led us away from our true faith and into heresies that blur the ways of old. Our religion thrives on one level. Like shiny mega-churches, our residencies are the envy of many specialties. Medical students clamor for the excitement and immediacy of the ED. Maybe they sense the apocalypse, and want to be on the right side when the end comes. Perhaps our residents have prophetic gifts. America's health care system is in barely-controlled collapse right above its emergency departments, which will be the only thing to carry the day when the dark ages of medicine finally arrive.

 

The science, the medicine is good. We do amazing things. But we have polluted our faith with too many rituals, dogmas, and liturgies. Our believers are burdened with unyielding laws.

 

The rites of passage now? Yearly tests, yearly fees, tests each decade. Immersion in evidence-based everything to prove that we are skeptical about the right things. More documents to show that we are true acolytes. Forms to show we make people happy and attestations to prove we're studying. Systems to show that we've squeezed all of the money out of every paying patient. We worship new minor deities in check boxes, decision rules, systems, and consultants.

 

The sacraments? They include more and are more complex. Time-outs, more passwords than we can recall, warnings to check drugs, questions about whether we're allowed to see the chart, impossible algorithms for admission of the sick. We honor pointless pain scales, we cringe in fear of violating EMTALA and HIPAA. We sing praises to meaningful use and add more because humans are less important than ever. We have a priesthood of administrators and consultants, federal regulators and rule-makers, and state board functionaries and hospital overseers, the cost of whose collective salaries dwarf ours.

 

The early missionaries are eclipsed by armies of men and women dressed in the vestments of a profession they barely understand but are happy to run. People who want to work “in medicine” but never walked the Via Dolorosa of lonely hallways and endless shifts. Some did, but found greener pastures in collecting indulgences from the rest of us.

 

The new creed is now, “I believe in saving life and limb at all hours of the day, and I will do it no matter how maligned I am. I believe everyone who says “emergency” has an emergency. I believe I must respect the bad choices of all, never condemn, never judge. I believe I must be attuned to satisfying customers and to giving credence to everyone placed above me, whether nurse, secretary, or administrator. I believe I must work long and hard as an employee and never complain. I believe forms and computer screens deserve my full attention. I believe capturing billing data is as important as comforting the sick. I will do as I'm told.”

 

The creed is more complex, and we are widening the gulf from our origins and empowering the churchistocracy above us. We've lost our way. The generations will see ridiculous rules and hypocritical leadership when they could have seen the wonder of life as a physician when we knew exactly what we were here to do. And were allowed to do it. We were a little disorganized, but our hearts were on fire. Maybe, just maybe, it's time for a reformation.

 

Access the links in EMN by reading this on our website or in our free iPad app, both available at www.EM-News.com. Comments? Write to us at emn@lww.com.

 

Dr. Leap is a member of Blue Ridge Emergency Physicians, an emergency physician at Oconee Memorial Hospital in Seneca, SC, a member of the board of directors for the South Carolina College of Emergency Physicians, and an op-ed columnist for the Greenville News. He is also the author of three books, Working Knights, Cats Don’t Hike, and The Practice Test, all available at www.booklocker.com, and of a blog, www.edwinleap.com/blog. Follow him @edwinleap, and read his past columns at http://bit.ly/LeapCollection.


Wednesday, October 15, 2014

Editor:

Dr. Carlo Reyes’s final thought on California’s Proposition 46 certainly takes a prize for understatement of the year. (At Your Defense: “Raising Noneconomic Damages Cap Bad for EPs and Patients Alike,” EMN 2014;36[10]:18; http://bit.ly/1v6MvMB.)

 

The proposed law, of course, was never intended to improve health care or patient safety. Rather, it was carefully crafted to give trial lawyers more clients on contingency by reversing the cap on noneconomic damages that has made California a relatively safe place for physicians to practice medicine without having to do so defensively 100 percent of the time since 1978.

 

Even the plaintiff's bar admits that certain provisions, like the one subjecting physicians to mandatory drug testing when their hospitalized patients experience complications, were added as "sweeteners" to encourage voters to support the entire package. It is more than cynical to suggest that patients or health care will benefit if physicians are drug-tested because of bad outcomes caused by systems errors, or are required to report one another of suspected impairment to a state board that has disbanded its mechanisms to deal effectively with physician impairment in favor of disciplinary measures.

 

No, it seems obvious that the proposed bill, if passed, will decrease the health and safety of patients by driving physicians out of California. At last report, the measure seems to have mobilized physicians out of a sense of complacency about this dangerous precedent. All I can say is may the most honorable profession win on Nov. 4.

 


Louise B. Andrew, MD, JD

Victoria, BC


Tuesday, October 14, 2014

Facebook is in the early stages of building a research and development team for mobile apps and tools, according to a Reuters report. (http://reut.rs/1pIoPuN.) 

 

The company is also reportedly creating online support communities to connect users with the same illnesses. The social network’s successful organ donor status launch in 2012 drove the company to take the idea of health-related apps and services more seriously. The day that Facebook allowed members to specify their organ donor-status, 13,054 people registered to be organ donors online in the United States, according to a June 2013 study. (Am J Trans 2013;13[8]:2059;http://bit.ly/1oKussc.) 

 

Facebook is considering rolling out its first health application quietly and under a different name, a source told Reuters. Market research commissioned by Facebook found that many of its users were unaware that Instagram is owned by Facebook, the source said. Facebook's recent softening of its policy requiring users to go by their real names may also benefit the latest health care initiative because those with chronic conditions may prefer to use an alias.