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Tough question for hospitals: Who’s too risky to release? – Auburn Citizen

NEW YORK Four days before Alexander Bonds ambushed and killed a New York City police officer, he was in a hospital emergency room getting a psychiatric evaluation. The hospital released him the same day.

Now the hospital’s actions are under a state review ordered by the governor. St. Barnabas Hospital says it handled Bonds appropriately and welcomes the inquiry.

The decision was one psychiatrists across the country make regularly: whether patients pose enough danger to themselves or others to require hospitalization. Practitioners say that it’s often a difficult call to make and that even an experienced evaluator can’t predict someone’s behavior.

“Most of the time, it’s very complicated. You’re trying to make an assessment: Is the person going to a home? Is there family? Are they reliable? What was the specific reason they were brought in? Is that likely to occur again?” said Bea Grause, president of the statewide hospital and health system association HANYS and a former emergency room nurse.

Bonds, 34, evidently had a history of mental health problems. There were antidepressant and anti-psychotic medications in his apartment, and his girlfriend told officers she took him to St. Barnabas for the psychiatric evaluation July 1, police said.

He was observed for seven to eight hours in the emergency room, where he was seen by a physician and then a psychiatrist, hospital spokesman Steven Clark said.

“We believe the proper protocols and standards were met,” he said.

By the night of July 4, Bonds’ paranoid, erratic behavior worried his girlfriend enough that she called police to look for him. They didn’t find him before he marched up to a parked police vehicle and shot through the window just after midnight, striking Officer Miosotis Familia in the head. Soon after, officers shot and killed him after they say he drew a weapon on them.

The state Health Department said it plans to interview St. Barnabas staffers, conduct inspections and examine records to review Bonds’ case and the hospital’s policies and prescribing practices.

Under state law, people can be involuntarily hospitalized for at least 48 hours if they pose a substantial risk of causing serious injury to themselves or others.

“If you’re making a determination that someone’s a danger to themselves or others, you better be pretty clear about it. Because you’re taking away their liberties,” said Grause, whose association represents hospitals and nursing homes.

Psychiatrists caution that the risk can be difficult to pinpoint.

“While psychiatrists can often identify circumstances associated with an increased likelihood of violent behavior, they cannot predict dangerousness with definitive accuracy,” the American Psychiatric Association said in a 2012 position statement.

Doctors and other hospital staffers can encounter agitated emergency room patients they’ve never seen before.

While paying close attention to what patients say and do, doctors also might test to determine whether a medical problem or medication might be spurring the behavior. They consider whether the cause could be alcohol or illegal drugs, a clue sometimes illuminated by observing patients for hours. They may look into whether someone has dementia.

Some patients arrive clearly violent, and others are just having a bad drug reaction that will wear off. But “there’s this vast gray area in the middle that takes a lot of experience, a lot of knowledge and balancing all of the factors that go into a good assessment,” said Dr. Vivian Pender, a New York City psychiatrist and public affairs representative for the New York County Psychiatric Society.

Police have been working to determine Bonds’ motive in shooting Familia. Bonds, who had served prison time for a 2005 armed robbery, had railed about police and prison officers in a Facebook video last September.

Familia, 48, was a 12-year New York Police Department veteran and a mother of three. She was selfless, “incredibly funny” and full of warmth and wisdom, her 20-year-old daughter, Genesis Villella, said Friday.

She “went to work every day proud to do her job, to protect us,” Villella said.

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Tough question for hospitals: Who’s too risky to release? – Auburn Citizen


LA emergency rooms prepare for influx of July 4th fireworks injuries – LA Daily News

WEST HILLS >> The Fourth of July ushers in a season of legal and illegal fireworks that hurt thousands of people across the country each year.

So emergency rooms in the Los Angeles region are girding for a crush of patients burned by sparklers, rockets, firecrackers and more.

Our emergency room and the Grossman Burn Center at West Hills Hospital are ready to treat patients with fireworks-related injuries, said Elizabeth Reid, the hospitals emergency room director, in a statement. These injuries can range from simple burns to loss of fingers, other extremities and even death.

The U.S. Consumer Product Safety Commission reports an average of 200 people each day go to the emergency room with fireworks-related injuries in the month surrounding July Fourth.

RELATED STORY: Here are the July 4th events happening in and around LA

To reduce the chance of getting hurt, the Grossman Burn Center issued the following safety tips:

Obey the law. Lighting fireworks is prohibited in Los Angeles and Ventura counties.

Never make your own fireworks.

Legal fireworks labeled Safe and Sane can still cause injury. Read and follow all warnings and instructions.

Keep young children away from any firework activity. Young children should wear earmuffs to prevent any damage to the eardrum.

Animals have sensitive ears too and can be extremely frightened or stressed by fireworks. Keep pets indoors to reduce the risk that theyll run away or get injured.

Peter Grossman, medical director for The Grossman Burn Center, also suggests anyone who gets burned should seek emergency medical care when the burn is bigger than the palm of your hand.

Victims should also seek care when the burn is on the face, hands, feet or genitals, or when it is white, leathery or painless. In the case of a life-threatening injury, call 911.

People seem especially laid-back about sparklers but the tip of a sparkler can heat up to 2,000 degrees Fahrenheit posing serious burn risks and can easily catch ones clothes on fire, Grossman said. Burns can even occur after fireworks sparks and flames are gone.


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LA emergency rooms prepare for influx of July 4th fireworks injuries – LA Daily News


New standalone emergency room to open in Roanoke County later this year – WDBJ7

ROANOKE CO., Va. (WDBJ7) Rain cancelled the groundbreaking of LewisGale’s new standalone emergency room back in April, so dignitaries traded their shovels for sharpies to take part in a “beam-signing ceremony” Tuesday morning.

The construction they were celebrating is well under way, with the $12 million, 10,000 square foot facility now taking shape near Tanglewood Mall.

“It’s a logical step for us to grow and put an asset like this in this part of the county,” said LewisGale Regional Health System CEO Brian Baumgardner, “and bring the same level of service that we have in Salem to this part of the 419 corridor.”

This isn’t the first standalone emergency room that construction company CPPI has built. The contractor has worked on more than a dozen, including five for HCA, LewisGale’s parent company.

“It is absolutely a trend,” said CPPI Vice President Vinne Moreschi. “We’re noticing it throughout the country that hospital providers that we’re building for are building them all over the place.”

The benefit for the Roanoke Valley, LewisGale says, is the additional emergency room capacity, and the ability to see more patients more quickly.

Dr. Steve Pasternak is Medical Director of the Emergency Department.

“It just provides more emergency department beds,” Pasternak told WDBJ7. “We just don’t have enough in the Roanoke Valley. Both Carilion and LewisGale, we’re at capacity. We’re filled all the time so I think most importantly this presents more emergency department evaluation beds for the valley.”

Construction should be completed in November, with the new emergency room opening before the end of the year.

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New standalone emergency room to open in Roanoke County later this year – WDBJ7


Report: Opioid use continues to swamp Virginia emergency rooms – Daily Press

In one year, Riverside Regional Medical Center saw an increase of more than 47 percent in emergency room visits related to opioid use.

The Newport News hospital had 26 cases in 2016, compared with 16 in 2015. There were 23 in 2014, hospital spokeswoman Wendy Hetman said in an email.

A national report shows the local hospital is not alone opioid treatment in emergency rooms have surged 99 percent since 2005. There were 1.3 million opioid-related emergency room visits or hospital stays in 2014, the latest year for which complete figures were available.. With the country in the midst of an opioid epidemic, experts expect the numbers to continue to rise, according to the Agency for Healthcare Research and Quality, which released the report.

“Our data tell us what is going on. They tell us what the facts are. But they don’t give us the underlying reasons for what we’re seeing here,” report co-author Anne Elixhauser, a senior research scientist with the agency, told The Washington Post.

The 2014 numbers, the latest available for every state and the District of Columbia, reflect a 64 percent increase for inpatient care and the jump for emergency room treatment compared with figures from 2005, the Post reported.

The sharpest increase in hospitalization and emergency room treatment for opioids was among people ages 25 to 44. The data also show that women are now as likely as men to be admitted to a hospital for inpatient treatment for opioid-related problems.

At least 1,420 people died in Virginia last year from drug overdoses, the fourth year that drugs have outpaced motor vehicle accidents and gun-related incidents as the leading cause of unnatural death, the Virginia Department of Health reports. On Tuesday, the state agency hosted more than 300 health officials, community agencies and law enforcement officers at an opioid summit in Hampton to discuss a drug crisis decades after the “War on Drugs” was declared.

The crowd listened to a series of speakers who talked about coordinating continuous care for drug addicts.

Fred Brason II of the North Carolina-based Project Lazarus, which worked with officials there to create an opioid overdose prevention program, talked about successes the state had with its opioid problems. And he encouraged local officials not to try to copy North Carolina’s program.

“You have to create a program that will work for your communities,” Brason said. “You know your communities and what they need. You have to own it to make it a success.”

Several local agency leaders expressed a need for an agency to coordinate care for people and not just leave them to their own devices to find counseling on their own after facing a crisis. Brason told the crowd if a person is ready and wants treatment, the community has to have services in place to help him or her succeed.

In 2014, fatal overdoses overtook motor vehicle crashes as the most common cause of accidental death in Virginia. Last year, Gov. Terry McAuliffe and state health officials declared the opioid epidemic a public-health emergency in the state.

By this time last year, more than 300 people in Hampton Roads had overdosed on drugs, local police and health officials reported. Sixty-five of those overdoses many of them pertaining to heroin and prescription painkillers were fatal.

When the health department planned the opioid summit, organizers worried they wouldn’t have enough people who wanted to participate, said Dr. Heidi Kulburg, director of the Virginia Beach health department and the Hampton Roads Opioid Working Group.

They were encouraged to see so many people interested in helping, she said.

The Washington Post contributed to this story. Canty can be reached by phone at 757-247-4832.

Report: Opioid use continues to swamp Virginia emergency rooms – Daily Press


Study shows opioid-related emergency department visits highest in Maryland – WBAL Baltimore


A new nationwide survey on hospital ER visits and inpatient care shows Maryland ranks No. 1 in opioid-related hospital stays.

As communities handle a growing drug crisis, hospitals in Maryland and other places are treating more and more patients with opioid-related problems.

The Agency for Healthcare Research and Quality released a study Tuesday showing 1.27 million emergency room visits and inpatient stays in 2014, the latest year numbers were available.

Opioid-related emergency department visits were highest in Maryland, the study found. Nationwide inpatient stays increased 64 percent, with patients ages 25-44 and 45-64 having the highest rates. The data comes from 44 states and Washington, D.C.

Baltimore City Health Commissioner Dr. Leana Wen addressed hospitalizations and overdoses, saying: “It’s not surprising. We are seeing a large increase in the number of fatal overdoses here in Baltimore and across Maryland.”

Wen said one-third of Maryland’s overdose deaths in 2016 happened in Baltimore. She said it’s not just about emergency room and hospital stays. Heroin and fentanyl use have increased, with about two people in the city dying each day in 2016.

While the drug naloxone, which reverses an overdose, is helping save lives, the supply and demand of illegal drugs isn’t ending and the need for treatment is increasing.

“This is an epidemic. I want people who have an addiction to seek treatment. So for people to go into an emergency department and hospital for treatment, in a way, it’s a good thing. The problem is we lack treatment capacity,” Wen said.

Wen said that finding available treatment at any time is complex.

“In the ER, I see patients who need treatment, but we may not be able to get them in to see someone or have a bed for weeks or months,” Wen said. “Studies have shown around the country (that) one in 10 people with the disease of addiction are able to get the treatment they need. That’s what we have to work on here in Maryland and across the country.”

Earlier this year, Gov. Larry Hogan declared a state of emergency for the heroin epidemic. Wen said the state has not said how any additional funding will be used to combat the problem. She’s hoping it will be spent in the areas of greatest need, including Baltimore.

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Study shows opioid-related emergency department visits highest in Maryland – WBAL Baltimore


Overdoses flood area emergency rooms – The Columbus Dispatch

Encarnacion Pyle The Columbus Dispatch @EncarnitaPyle

Charlie Stewart knew just what to do and say after paramedics brought the woman to the Mount Carmel West hospital emergency department after she nearly died of a heroin overdose.

She was crying, scared and didn’t want to walk out of the hospital only to use again. But she was new to Columbus and didn’t know the resources or whether she had the strength to attempt recovery again.

“She was in a bad place,” Stewart said.

After getting to know her and her situation, he helped get her signed up for Medicaid and into a detox bed within a matter of days.

“I want people to know that there’s hope,” he said. “And I want them to see the potential I see in them.”

Stewart is not a doctor, nurse or social worker. He’s a recovering addict who, through training and experience, knows a thing or two about what to do to upright a life. It’s what makes him so effective, his hospital colleagues say.

The hiring of peer-support coaches, who have been addicts themselves,is just one of many ways that local hospitals are trying to better support patients struggling with addiction and ending up in their emergency departments.

Between 2009 and 2014, Ohio saw the greatest jump in opioid-related emergency department visits of 44 states,with a 106 percent increase, according to a report by a division of the U.S. Department of Health and Human Services.South Dakota came in second with a 95 percent increase; Georgia, third, with an 85 percent jump.

In addition to treating overdoses, emergency department staffers also see people with skin and soft-tissue infections caused by their drug use or, in more serious cases, heart and spinal infections, said Dr. Alan Gora, chairman of Mount Carmel West’s emergency department.

The rate of hospital inpatient stays in Ohio because of opioid use also increased 52 percent from 2009 to 2014, according to the latest available data fromtheAgency for Healthcare Research and Quality. It’s justanother piece of grim proof that the abuse of heroin and narcotic painkillers has hit alarming levels, officials say.

“I’d like to tell you that the percentages have fallen or flattened since 2014, but they haven’t,” said Amy Andres, a senior vice president with the Ohio Hospital Association.

From 2014 to 2015, there was a 39 percent increase in the number of Ohio emergency room visits due to opioids. Last year, there was a 41 percent jump, according to an analysis by the hospital association.

People alsocan sit on a waiting list for weeks before a detox bed opens up, and some recovery programstake only private insurance or pay, leaving those with fewer financial resources fewer options, experts say.

A few hospitals across the country have had early success with administering buprenorphine,a medication that blocks opioids from affecting the brain, to stabilize patients in the emergency department before referring them to medication-assisted drug treatment. But the practice is relatively rare and most local hospitals said they’ve only started talking about the possibility.

Central Ohio’s emergency responders are increasingly being overwhelmed by overdoses caused by heroin laced with potent synthetic drugs such as fentanyl and carfentanil, an animal tranquilizer so strong that a few grains can be lethal. There were a record 3,050 overdose deathsstatewide in 2015.

That figure is expected to be shattered when final 2016 numbers are released this year. According to figures compiled by The Dispatch from county coroners, there were at least 4,149 people who died of overdoses last year. That doesn’t include tallies from six small counties that didn’t respond to the newspaper’s requests.

“It’s devastating, and I don’t see it getting any better unless we can stem the flow of drugs getting into people’s hands,” said Dr. Terrill Burnworth, director of the emergency department at Licking Memorial Hospital in Newark.

The one piece of good news: More overdoses are being reversed than ever before.

The percentage of emergency department patients who died from opioid-related overdoses at hospitals statewide dropped from 21 percent in 2009 to 14 percent in 2014, largely due to getting naloxone in the hands of more people, Andres said. The medicationabruptlyand effectively counteracts deadly overdoses and is now being administered by paramedics,hospital staff and even family members who have received some basic training.

Since starting a pilot program in July, University Hospital East has dispensed 220 naloxone kits to patients who have been treated in the emergency department or their families, said Ken Groves, a nurse manager at the Near East Side facility.

“The best thing we can offer them is an element of hope and a feeling of being supported until they’re ready to seek treatment,” Groves said.

The hospital also has an addiction counselor who helps with emergency room and inpatient consultations, he said.

Since the end of March,OhioHealth has sent 36 patients treated at one of its four emergency departments in Columbus, Marion, Pickerington and Westerville home with naloxone, said Dr. Krisanna Deppen, a family physician who specializes in addiction medicine.

“I think there’s a lot of stigma associated with naloxone, and some people believe we’re enabling bad behavior,” she said.

But like other chronic diseases, such as diabetes, addicts can’t change their behavior overnight, Deppen said. And naloxone is just a tool to keep them alive until they can start to work on recovery, she said.

Similar toMount Carmel West, its Marion hospital is working with a local drug and alcohol addiction group to hirepeer-recovery coaches, whom they hope patients will trust because of the common experiences they share.

Stewart, 25, of Hilliard, said he started “drinking and partying a little too much” as a teenager. He also started taking painkillers after breaking his collarbone in a snowboarding accident.

A misdemeanor theft arrest in 2013 led him to the courtroom of Franklin County Municipal Court Judge Scott VanDerKarr, who at the time presided over a “drug court.”

Stewart said he has been clean and sober since and helping others seek treatment. He joined Mount Carmel in November and has been working with people struggling with addiction since January. He also has a personal-training business as part of his quest to get a “healthier body, mind and spirit.”

After discharge,Stewart helps patients with food stamp applications, housing, job searches or whatever they need to start down the path toward sobriety.

The one out-of-state woman he helped get into detox is in a day-treatment program now. He also helped get her brother into detox recently.

“Last week she sent me a text that said I had saved her life,” he said. “It’s just so humbling and amazing to touch people’s lives this way.”


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Overdoses flood area emergency rooms – The Columbus Dispatch


Can Comfort Care At The ER Help Older People Live Longer And … – NPR

As baby boomers age, more older Americans are visiting the emergency room, which can be an overcrowded, disorienting and even traumatic place. Heidi de Marco/Kaiser Health News hide caption

As baby boomers age, more older Americans are visiting the emergency room, which can be an overcrowded, disorienting and even traumatic place.

A man sobbed in a New York emergency room. His elderly wife, who suffered from advanced dementia, had just had a breathing tube stuck down her throat. He knew she never would have wanted that. Now he had to decide whether to reverse the life-sustaining treatment that medics had begun.

When Dr. Kei Ouchi faced this family as a young resident at Long Island Jewish Medical Center, he had no idea what to say. The husband, who had cared for his wife for the past 10 years, knew her condition had declined so much that she wouldn’t want to be rescued. But when Ouchi offered to take out the tube, the man cried more: “She’s breathing. How can we stop that?”

Ouchi had pursued emergency medicine to rescue victims of gunshot wounds and car crashes. He was unprepared, he says, for what he encountered: a stream of older patients with serious illnesses like dementia, cancer and heart disease patients for whom the life-saving techniques he was trained to perform often only prolonged the suffering.

As baby boomers age, more of them are visiting the emergency room, which can be an overcrowded, disorienting and even traumatic place. Adults 65 and older made 20.8 million emergency room visits in 2013, up from 16.2 million in 2000, according to the most recent hospital survey by the Centers for Disease Control and Prevention. The survey found 1 in 6 visits to the ER were made by an older patient, a proportion that’s expected to rise.

Half of adults in this age group visit the ER in their last month of life, according to a study in the journal Health Affairs. Of those, half die in the hospital, even though most people say they’d prefer to die at home.

Some states on board

The influx is prompting more clinicians to rethink what happens in the fast-paced emergency room, where the default is to do everything possible to extend life. Hospitals across the country including in Ohio, Texas, Virginia and New Jersey are bringing palliative care, which focuses on improving quality of life for patients with advanced illness, into the emergency department.

Interest is growing among doctors: 149 emergency physicians have become certified in palliative care since that option became available just over a decade ago, and others are working closely with palliative care teams. But efforts to transform the ER face significant challenges, including a lack of time, staffing and expertise, not to mention a culture clash.

Researchers who interviewed emergency room staff at two Boston hospitals, for instance, found resistance to palliative care. ER doctors questioned how they could handle delicate end-of-life conversations for patients they barely knew. Others argued that the ER, with its “cold, simple rooms” and drunken patients screaming, is not an appropriate place to provide palliative care, which tends to physical, psychological and spiritual needs.

Ouchi saw some of these challenges during his residency in New York, when he visited the homes of older patients who frequently visited the emergency room. He saw how obstacles like transportation, frailty and poor vision made it difficult for them to leave the house to see a doctor.

“So what do they do?” Ouchi asks. “They call 911.”

When these patients arrive at the emergency room, doctors treat their acute symptoms, but not their underlying needs, Ouchi says. In more severe cases, when the patient can’t talk and doesn’t have an advanced directive or a medical decision-maker available, doctors pursue the most aggressive care possible to keep them alive: CPR, intravenous fluids, breathing tubes.

“Our default in the ER is pedal to the metal,” says Dr. Corita Grudzen, an emergency physician at NYU Langone Medical Center who studies palliative care in the ER. But when doctors learn after the fact that the patient would not have wanted that, the emergency rescue forces families to choose whether to remove life support.

When older adults are very ill if they need an IV drip to maintain blood pressure, a ventilator to breathe, or medication to restart the heart they are most likely to end up in an intensive care unit, where the risk of developing hospital-acquired infections and delirium is increased, Grudzen says. Meanwhile, it’s not clear whether these aggressive interventions really extend their lives, she adds.

Some have sought to address these problems by creating separate, quieter emergency rooms for older patients. Others say bringing palliative care consultations into regular emergency rooms could reduce hospitalization, drive down costs and even extend life.

There’s no hard evidence that this approach will live up to its promise. The only major randomized controlled trial, which Grudzen led at Mount Sinai Hospital in New York City, found that palliative care consultations in the emergency room improved quality of life for cancer patients. It did not find statistically significant evidence that the consultations improved rates of survival, depression, ICU admission or discharge to hospice.

Trying to avert suffering

But frontline doctors say they’re seeing how palliative care in the ER can avert suffering. For instance, Ouchi recalls one patient a man, in his late 60s who showed up at the emergency room for the fifth time in six months with fever and back pain. Previous visits hadn’t addressed the underlying problem: The man was dying of cancer.

This time, a nurse and social worker called in a palliative care team, who talked to the patient about his goals.

“All he wanted was to be comfortable at home,” Ouchi says. The man enrolled in hospice, a form of palliative care for terminally ill patients. He died about six months later, at home.

Now Ouchi and others are trying to come up with systematic ways to identify which patients could benefit from palliative care.

One such screening tool, dubbed P-CaRES, developed at Brown University in Providence, R.I., gives ER doctors a list of questions. Does the patient have life-limiting conditions such as advanced dementia or sepsis? How often does the patient visit the ER? Would the doctor be surprised if the patient died within 12 months?

Doctors are using the tool to refer patients at the University of California-San Francisco Medical Center at Parnassus to palliative care doctors, says Dr. Kalie Dove-Maguire, a clinical instructor there. The questions pop up automatically on the electronic medical record for every ER patient who is about to be admitted to the hospital.

Dove-Maguire says UCSF hasn’t published results, but the tool has helped individual patients, including a middle-aged man with widespread cancer who showed up at the ER with low blood pressure. The man “would have been admitted to the ICU with lines and tubes and invasive procedures,” she says, but staff talked to his family, learned his wishes and sent him to home hospice.

“Having that conversation in the ER, which is the entry point to the hospital, is vital,” Dove-Maguire says.

Measured in minutes

But time is scarce in ERs. Doctors’ performance is measured in minutes, Grudzen notes, and the longer they stop to make calls to refer one patient to hospice, the more patients line up waiting for a bed.

Finding someone to have conversations about a patient’s goals of care can be difficult, too. Ouchi enlisted ER doctors to use the screening tool for 207 older ER patients at Brigham and Women’s Hospital in Boston, where he now works as an emergency physician. They found a third of the patients would have benefited from a palliative care consultation. But there aren’t nearly enough palliative care doctors to provide that level of care, Ouchi says.

“The workforce for specialty palliative care is tiny, and the need is growing,” says Grudzen.

Palliative care is a relatively new specialty, and there’s a national shortfall of as many as 18,000 palliative care doctors, according to one estimate.

“We’ve got to teach cardiologists, intensivists, emergency physicians, how to do palliative care,” she said. “We really have to teach ourselves the skills.”

Kaiser Health News is an editorially independent part of the Kaiser Family Foundation.

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Can Comfort Care At The ER Help Older People Live Longer And … – NPR


Tip No. 1 For Taking Charge Of Mass. Health Care Costs: Avoid The ER – WBUR

wbur (Open Grid Scheduler / Grid Engine/Flickr)

If you’re wondering why health care costs so much in the U.S., here’s one little piece of the answer: emergency room visits.

Forty-two percent of emergency room visits in Massachusetts in 2015 were for problems that could have been treated by a primary care doctor, according to the state’s Health Policy Commission. This state agency, which is charged with driving down costs, says a 5 percent cut in avoidable emergency room trips would save $12 million a year; 10 percent fewer such visits would save $24 million.

That extra spending is passed on to all of us in the form of higher health insurance premiums. Andgoing to an emergency room for non-urgent care is often not the best move.

“If its not a true emergency, youre going to wait for hours in the emergency room, its not the best practice for coordinated care, and you run the risk of having a lot of tests that might not have been necessary if you saw your regular provider,” saidSarah Sadownik, deputy director of the research and cost trends team at the Health Policy Commission.

The commission is breaking down some of the ways we in Massachusetts could save money without doing ourselves any harm. We’ll be posting many of these tips as they are released.

What’s your guess about the most common reason your neighbors go to an emergency department (ED)? Here’s the answer, by zip code:

Statewide, the top five reasons are: sinus problems (sinusitis), stomach pain (that’s my work zip code), rashes and skin conditions, acid reflux and bronchitis.

I go to the ED on weekends or after 5 p.m. when the office of my wonderful doctor is closed. But it looks like most people go during office hours.

Sometimes we go to the emergency room because we can’t tell if our symptoms signal a common problem or something more serious.

We used to assume that most of the people who visit an emergency room were uninsured. But that doesn’t seem to have been the case before the state expanded health coverage and is likely even less true now. Here’s the most recentcomparison we could find.

I’m surprised cost is not a factor for more people. An emergency room visit is more expensive than going to see your doctoror visiting urgent care facilities, which are often open on evenings and weekends. So what’s missing from this analysis? What are your reasons for going to the Emergency Department?

If you want more juicy details about avoidable ED visits, try this. And if you’re up for a deep dive into the reasons Massachusetts has some of the highest health care costs in the country, and maybe the world here’s the HPC’s most recent cost trends report.

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Tip No. 1 For Taking Charge Of Mass. Health Care Costs: Avoid The ER – WBUR


GOP Rep. Kevin Cramer claims emergency rooms are universal health care – Shareblue Media

Rep. Kevin Cramer (R-ND) has repeatedly and falsely claimed that a law mandating hospital emergency rooms provide care to anyone who needs it is the same thing as universal health care a cruel interpretation of the law that has become an article of faith for Republicans.

Cramer, who may run against Democratic Senator Heidi Heitkamp in 2018, made his statement in at least four appearances over the last two weeks.

At a town hall meeting, he told constituents, We have universal health care access because we require by law and by tradition and by compassion that any person that walks into an emergency room receives care.

In another appearance, Cramer said, In the early 80s or mid-80s wepassed a law requiring health care for everybody in the United States of America. That was 30 plus years ago. So that means no one can be turned down for care.

He also made the claimin tworadio interviews, and at another town hall meeting, as repeated justification for his vote in favor of the Republicans health care repeal plan, which would strip health insurance from at least 24 million Americans.

CRAMER: Back in the 1980s, actually, when Ronald Reagan was President we the country passed universal healthcare by, you know, guaranteeing that no one would be denied health care. So, weve had it since the 1980s, this mandate. Its just that how you pay for it has always been the sticking point. So, most people, for a long time it was through the emergency room, and thats very expensive care. And that burden is then passed on to other people who have insurance and drives up costs.

Cramer is citing a 1986 law which mandates emergency room treatment for anyone who needs it, but the law does not cover care before or after an emergency room visit.

And no matter how many times Republicans say it, emergency room care is not health care.

Laws like the Affordable Care Act understand this, and provide for health care access so doctors and other health care professionals can catch illnesses before they become so severe that an emergency room visit is needed.

The goal of preventative medicine is to save money in the long run, but more importantly to prevent pain and long-term suffering. Catching someone before they have a heart attack is obviously preferable to an emergency room visit for cardiac arrest, for instance.

Furthermore, the emergency room is useless for diseases that need ongoing treatment, like cancer, diabetes, and end-stage renal disease. The emergency room cannot provide chemotherapy or ongoing dialysis that hundreds of thousands of Americans need to survive.

Universal health care is a system that provides health care to all citizens, regardless of income. That means in all phases of care, not just when things are so critical or life-threatening that emergency services are needed.

An actual universal system of care does not yet exist in the United States, and Cramer is lying to his constituents when he says otherwise.

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GOP Rep. Kevin Cramer claims emergency rooms are universal health care – Shareblue Media


Marijuana sending more teenagers to the emergency room, Children’s Hospital doctor finds – The Denver Post

The number of teenagers and young adultsgoing to the emergency room at Childrens Hospital Colorado for what appears to be marijuana-related reasons increased significantly after legalization, a new study by a Childrens doctor found.

Dr. Sam Wang said his study contrasts with surveys that suggest youth marijuana use in Colorado has not increased since legalization. But he said the study also has its limitations, meaning it adds important data to the debate over legalization but is not the final word on it.

Everything has to be taken with a grain of salt, he said. I dont think one database is perfect. But this is just another way to look at the data that shows more teenagers are coming to the ER.

Wang gathered data on marijuana-related emergency-room visits to Childrens Hospital and its satellite clinics for teenagers and young adults no older than20by looking at two measures.

The first is a hospital billing code used on a patients chart when marijuana is involved in a patients medical problem. Wang said marijuana might not be the primary reason the patient went to the hospital, but marijuana usually has to be sufficiently connected to the patients symptoms to warrant the code being written down. He said it is unlikely the code would be put on a patients record for marijuana use unrelated to the symptoms.

The second measure is when a patient has a urine drug screen that comes back positive for marijuana. Such drug screens occur when a patient ingested an unknown substance orbefore a patient undergoes a psychiatric evaluation.

Collecting those numbers, Wang said he found that 106 teens and young adults visited Childrens emergency room for marijuana-related reasons in 2005 and that number jumped to 631 in 2014. The rate of those visits increased as well although by 2015 marijuana still accounted for only fourout of every 1,000 visits.

Perhaps most worrisome, Wang said he found that the number of kids and young adults in the emergency room for marijuana-related reasons and who subsequently needed a psychiatric evaluation also increased rapidly from 65 in 2005 to 442in 2014. Wang said patients who receive psychiatric evaluations may be severely intoxicated or may have tried to commit suicide or talked about committing suicide.

Colorados medical marijuana dispensaries began opening in large numbers in 2010, and Colorado voters legalized the sale and possession of limited amounts of marijuana for any purpose in 2012, with recreational stores opening Jan. 1, 2014.

Looking at the trend, it is definitely significant, Wang said.

Wangs study results were first presented this month at an academic conference in San Francisco. He said he hopes to publish the findings in a journal later this year.

The findings add another layer to understanding how marijuana legalization has affected kids. So far, much of the survey data of Colorado teens and young adults has suggested little impact. Both state and federal surveys have found that Colorado teen marijuana use rates whileamong the highest in the country have remained flat since legalization.

Our worst nightmares havent materialized, Colorado Gov. John Hickenlooper said earlier this year of legalization.

In a previous study, though, Wang found that the number of older youths going to the emergency room for accidental marijuana exposure increased following legalization. He said his new study showsthere is still more to learn about why a subset of kids is ending up in the hospital.

Were finding things contrary to other national survey data, he said. And so we feel like, to really better understand the impact in this particular population, I think we need to use multiple data sources.

Here is the original post:
Marijuana sending more teenagers to the emergency room, Children’s Hospital doctor finds – The Denver Post


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