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Entry to Leesburg hospital ER moving as part of $27 million expansion – Orlando Sentinel

LEESBURG The entrance to Leesburg Regional Medical Centers emergency room, which will grow in size as part of a $27 million expansion, will close Thursday as part of the construction, hospital officials said.

Starting then, patients will be required to access to the ER through the hospitals main entrance, officials said. Signage and extra security will be in place to help guide patients and family members. Additional parking spaces have been added to the east and west lots to accommodate patients and visitors.

The expansion will increase the hospitals east side by almost 48,000 square feet of space, adding 24 beds to the ER and including a fast-track unit to handle pediatric patients, three or four trauma-sized rooms for critical-care treatment, a spacious waiting room and an atrium-like lobby.

Its the first increase in the ERs capacity since it was built more than 50 years ago, according to Don Henderson, president and CEO of Central Florida Health, LRMCs nonprofit parent company. The expansion is due to be completed in spring of 2018. or 352-742-5916

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Entry to Leesburg hospital ER moving as part of $27 million expansion – Orlando Sentinel


Anthem asks Missourians to think twice before going to the emergency room – KBIA

Anthem Blue Cross Blue Shield, one of Missouris largest insurers, no longer covers emergency room visits that it deems unnecessary.

The policy aims to save costs and direct low-risk patients to primary care physicians and urgent care clinics. But doctors say patients may avoid going to a hospital when they really need it, if they fear a large bill.

Theyre forcing the lay public to make a medical determination, said Dr. Doug Char, a Washington University emergency physician. Theyre basically telling people you have to decide if this chest pain youre having is indigestion or a heart attack.

An emergency room is the most expensive place to see a doctor, and insurers are balking at the cost. Between 15 percent and 30 percent of emergency room visits in the St. Louis region are avoidable, according to a study by the nonprofit Midwest Health Initiative. Missouri hospitals charge an average of $372 for emergency room visits for minor issues, but some charge as much as $1,300, according to data compiled by the Missouri Hospital Association.

“Most non-emergent medical conditions can be easily treated at retail clinics, urgent care clinics of 24/7 telehealth services,” Anthem’s Missouri spokesperson, Scott Golden, wrote in an email. “The review by an Anthem medical director will take into consideration the presenting symptoms that brought the member to the emergency room as well as the diagnosis.”

In mid-May, Anthem sent letters to Missouri enrollees to alert them that from June 1, it would no longer cover emergency room services for non-emergencies. In such cases, people who have health insurance could still be stuck with the full cost of their visit, if the insurer determines that their symptoms did not reach the level of requiring emergency care.

Anthem enforces the same guidelines in Kentucky, and put the rule in place for Georgia policyholders this month. Its officials say there are several exceptions, such as if a patient is under 14, the visit occurs on a Sunday or there are no urgent-care centers within 15 miles.

The American College of Emergency Physicians raised a red flag when Anthem sent out a spreadsheet of 1,908 conditions that it may not deem not worthy of coverage in an emergency room. Some of the listed symptoms could indicate a life-threatening emergency, said Dr. Jonathan Heidt, president of Missouris ACEP chapter.

To have them under that threat of not having their bills paid if theyre wrong about what their diagnosis is, its really going to harm patients in the long run, Heidt said. Our patients have a right to seek emergency care.

The doctors argue that Anthems policy, and similar rules set up by state Medicaid programs, violate the federal Affordable Care Acts prudent layperson standard. The rule asserts that a person with average knowledge of health and medicine should be able to anticipate serious impairment to his or her health in an emergency, and that laws should not assume that a person will know more than that. Anthem contends that it reviews claims using this standard already.

Though Anthem began enforcing the Missouri rule at the beginning of June, patients who visit the emergency room for non-emergencies likely will receive bills in the coming months. Heidt said that if Anthem does not reconsider its policy, ACEP may weigh legal action against the insurer.

Were still a little bit early for that,” Heidt said. “But at this time, all of our options are on the table.

According to the Missouri Department of Insurance, Financial Institutions & Professional Registration, the rule is based on previously filed language that was approved by the regulator. Other plans have similar provisions.

“If a consumer believes a claim has been improperly denied, or has questions about how a claim has been handled by their insurer, they can contact the Department’s Consumer Affairs Hotline at 800-726-7390 or they can file a complaint online,” said Grady Martin, the agency’s director of administration.

Follow Durrie on Twitter: @durrieB

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Anthem asks Missourians to think twice before going to the emergency room – KBIA


Patient, BBB seek change with Emergency Room "hidden charges" – FOX 46 Charlotte

CHARLOTTE, NC (FOX 46 WJZY) – Hidden charges at emergency rooms are causing transparency questions to be raised.

“Any other form of purchasing, people know what they’re paying,” patient Steve Komito said. “Somehow if you’re in the emergency room, you don’t have to know and I’m saying that’s wrong.”

Komito took his son to the Carolinas Healthcare Systems Emergency Room in Waxhaw this past Spring. X-rays were done but when Komito received his bill, he noticed a “room charge” for $1,244.44. Komito said, had he known about that charge up front, he would have taken his son elsewhere — adding, the X-rays were not even conducted in that general service room and they could have waited elsewhere.

“I guess my mission at this point is transparency,” Komito said.

Komito said, during his visit, someone with the E.R. told him they will not give pricing ahead of a visit because if the patient determines it’s too expensive and leaves — the E.R. will be held liable if something were to happen with their health.

The Better Business Bureau said it receives roughly 1,000 complaints a year for situations like this in the Greater Charlotte region.

“It’s not like going into a fast-food restaurant and seeing prices up on the board,” BBB’s Tom Bartholomy said.

FOX 46 Charlotte reached out to Carolinas Healthcare Systems earlier this Spring with a list of billing questions that have still not been answered. We sent them an email again on Friday and are waiting for a response. Here’s a portion of the email…

1.Will Carolinas Healthcare System give pricing information prior to service at the Emergency Room, upon request?

2.Does CHS stand behind this standard room charge and policy? When did this charge go into effect?

3.Weve heard talks about Level 3 and Level 4 E.R. room visit cases. What are the specific levels and what determines one of these levels?

4.What goes into the room charge? Is there a time limit a person has to be in there for a charge? A specific procedure? Does a doctor have to physically examine them? What warrants this charge?

5.Does CHS maintain that it will not release pricing prior to an E.R. patient being seen because it can be held negligent if the patients decides the cost is too high, and leaves without treatment?

FOX 46 Charlotte has now reached out to State Senator Tommy Tucker (Komito’s district) to see if he would be interested in any sort of legislation surrounding hospital charges being disclosed up front. Here’s a portion of that email…

Would Sen. Tucker support legislation demanding immediate transparency of ER pricing? As these bills are broken down into “Levels” — why can’t a patient know ahead of time the approximate costs of his service?

*This obviously does not include any additional testing that may be ordered or needed. But again, these prices – all pricing – is slotted ahead of time.

The Better Business Bureau told FOX 46 Charlotte there needs to be more transparency between E.R.’s and patients.

“If there’s going to be a basic charge for you for being in that emergency room no matter what you’re there for, then, yeah, why not?” Bartholomy added.

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Patient, BBB seek change with Emergency Room "hidden charges" – FOX 46 Charlotte


Who pays when someone without insurance shows up in the ER? – USA TODAY

Right now, GOP senators are trying to gather enough votes to pass their Obamacare replacement plan, but even fellow Republicans are having a time a hard time accepting the health care bill. USA TODAY

An ambulance arrives at a hospital emergency room.(Photo: PhotoDisc)

WASHINGTON If an uninsured patient shows up in the emergency room, who pays? The hospital? Taxpayers? The patient? Other patients?

The question is important as Republicans debate health care legislation that could result in more than 20 million fewer Americans having health insurance in ten years.If that happens, some people will go without care. Others will show up at hospitals, but wont be able to pay their bills.

The year the Affordable Care Act passed, hospitals provided about $40 billion in “uncompensated care” that is, care they were not paid for.That was nearly 6% of their total 2010 expenses.

A 1985 federal law requires emergency departments to stabilize and treat anyone entering their doors, regardless of their ability to pay.

But that doesnt mean the uninsured can get treated for any ailment.

Theres lots of medical care we want to consume thats not an emergency, said health care economist Craig Garthwaite, an associate professor and director of the health care program at Northwestern University’s Kellogg School of Management.

It also doesnt mean that hospitals wont try to bill someone without insurance. And the bill they send will be higher than for an insured patient because theres no carrier to negotiate lower prices.

As a result, the uninsured are more likely to be contacted by collection agencies, as they face problems paying both medical and non-medical bills. One study, published in 2016 by the National Bureau of Economic Research, found that someone who goes into the hospital without insurance doubles her chances of filing for bankruptcy over the next four years.

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For the bills that go unpaid, hospitals can try to compensate by charging other patients more. But that doesnt happen as much as many people including policymakers — think.

The authors of the ACA believed thatincreasing insurance coverage through Medicaid and subsidies for private insurance would lessen the cost-shifting that leads to higher insurance premiums. Supreme Court Justice John Roberts also mentioned that benefit in the 2011 decision he authored upholding the laws constitutionality. But researchers havent been ableto document much of a cost shift.

Studying the effects of expanding Medicaid in Michigan where more than 600,000 gained coverage researchers at the University of Michigan havefound no evidence that the expansion affected insurance premiums. They did, however, document that hospitals uncompensated care costs dropped dramatically by nearly 50%.

Conversely, when Tennessee and Missouri had large-scale Medicaid cuts in 2005, the amount of care hospitals provided for free suddenly increased. In a 2015 study published by the National Bureau of Economic Research, Garthwaite and his co-authors estimated every uninsured person costs local hospitals $900 in uncompensated care costs each year.

This is not a trivial thing for a hospital to deal with, Garthwaite said. While hospitals average 7% profit margins, uncompensated care costs can be more than 5% of revenue.

Hospitals do get help with the unpaid bills from taxpayers.

The majority of hospitals are non-profits and are exempt from federal, state and local taxes if they provide a community benefit, such as charitable care. Hospitals also receive federal funding to offset some of the costs of treating the poor.

The ACA scaled back those payments in anticipation that hospitals’ uncompensated care costs would go down. The GOP proposals to overhaul the ACA would reinstate the payments, while making changes to Medicaid and private insurance subsidies that the nonpartisan Congressional Budget Office estimates would result in more than 20 million fewer people having insurance by 2026.


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The return of extra federal payments to hospitals for uncompensatedcare wouldnt be enough to offset the unpaid bills, according to an analysis by the Commonwealth Fund. The study examined the Medicaid changes included in the bill that passed the House in May, and co-author Melinda Abrams said the effects of the Senates pending proposal would be at least as great.

Hospitals operating margins in all states would decline. And hospitals in most of the 31 states which expanded Medicaid under the ACA would have negative operating margins by 2026, according to the analysis.

Ultimately, you have to cut services, fire people, or both, Abrams said. It is shifting the burden of the cost. What is currently shared between the federal government and state governments will be shifted largely to the states. And the burden will be felt by the providers, the patients, the community and the taxpayer.

Pressure from hospitals was often a factor in states decisions to expand Medicaid under the ACA. In some states, such as Indiana, hospitals even agreed to a pay new taxes in exchange for the additional federal revenue from Medicaid patients. Most of the recent decline in hospitals uncompensated care costs has been in states which expanded Medicaid.

And hospitals are among those fighting hard against GOP efforts to phase out the expansion and cap overall Medicaid payments to states.

If these proposed cuts take place, devastation would occur for local rural economies due to hospitals closing and patients incurring huge amounts of debt, Trampas Hutches, CEO of Melissa Memorial Hospital in Holyoke, Colo., said at one of the many events organized by the American Hospital Association and other health care providers in opposition to the GOP bills.

One reason Medicaid has been harder to cut than other safety-net programs such as welfare cash payments is that a large part of the spending is a transfer to health care providers, Garthwaite argues. Thats particularly true for hospitals which are essentially insurers of last resort when there are large coverage gaps.

When policymakers decide not to provide health insurance for a portion of the population that otherwise could not afford insurance,” Garthwaite and his colleagues wrote in their 2015 analysis, “hospitals ultimately bear the cost of that decision,

As President Donald Trump continues to push his agenda of repealing and replacing Obamacare, Americans are not on his side about this. Susana Victoria Perez (@susana_vp) has more. Buzz60

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Who pays when someone without insurance shows up in the ER? – USA TODAY


Thomas Memorial to crack down on emergency room admissions … – The Exponent Telegram (press release) (registration)

Beginning in July, officials at Thomas Memorial Hospital in South Charleston will be changing the rules for admission to try to discourage patients from going to the emergency room for non-emergencies.

We have a tremendous number of people who seek care in our emergency room on a regular basis, said Dan Lauffer, CEO of Thomas Health System. But he said many of them dont have to go to the emergency room, and many would be better served by going to a health clinic, urgent care center or to their regular doctor.

According to Lauffer, about 35,000 people a year visit Thomas Memorials emergency room. But between 30 and 40 percent of those patients arent really experiencing a medical emergency and would be better served by visiting a health clinic, urgent care or doctor.

Lauffer said patients at the emergency room who dont have real medical emergencies jam up the system and create longer wait times for everyone. So, during July and August the hospital will put into place new patient policies designed to discourage those without medical emergencies from going to the emergency room, and encourage them to seek other forms of care.

To begin with, Lauffer said those coming to the emergency room with non-medical emergencies will be asked to pay a co-pay before they will be seen. Thomas ER co-pays begin at $8 for Medicaid patients and go up from there based on a patients insurance coverage.

Lauffer said emergency room visits are about four times as expensive as other medical services, and wait times tend to be much longer before patients can see a doctor. Co-pays for emergency room visits also tend to be higher than co-pays at clinics, urgent care centers and doctors offices.

Visiting a doctor or a clinic before an emergency occurs is also better for a patients overall health, Lauffer said. Routine follow-up care with a doctor is better for your health than episodic visits to the emergency room, he said.

Regular medical care is also usually cheaper than relying on the emergency room, he said. Were also concerned about their financial health, Lauffer said.

In addition to being asked to pay co-pays up front, Lauffer said patients coming to the emergency room without a real emergency will be given a choice about how they would like to be seen. He said patients will be told they can go to Thomas nearby medical clinic and be seen in the order they arrived, or they can remain in the emergency room but be bumped toward the bottom of the list to be seen in the order of the severity of their injuries.

Thomas staff will be telling patients about the new rules during July and August.

Thomas said many patients are just so used to going to the emergency room for every medical issue they may have that they dont give it a second thought. He said education is the key to breaking the emergency room cycle.

If we dont communicate and educate, the cycle will never change, he said. Once patients are told there may be better, cheaper ways to seek health care than the emergency room, They will begin to understand that they dont have to come into the emergency room for every problem they present with.

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Thomas Memorial to crack down on emergency room admissions … – The Exponent Telegram (press release) (registration)


18 Salinas farm workers rushed to emergency room – KSBW The Central Coast


Salinas Valley farm giant Tanimura & Antle is under investigator by state and local officials after 18 of its field workers may have been exposed to pesticides in a Salinas field.

The crew had showed up at a farm field at Harden Ranch near the corner of Abbott and Harris to plant celery early Thursday morning.

About an hour later, workers started getting sick and one employee begin to vomit. The workers were immediately bused to the emergency room at Salinas Valley Memorial Hospital.

The incident triggered a mass casualty incident at the hospital.

“We immediately called a ‘Code Triage,’ said Jeremy Handland of SVMH’s Clinical Emergency Department. We activated our command center and the staff worked extremely well together to treat the patients.”

Workers suffered from dizziness, nausea, vomiting, and abdominal pain, Hadland said.

Investigators say nearby fields where the workers were planting had pesticides applied the night before.

Pesticides applied include Lannate, Coragen, Movento, Pounce, Actara, Fulfill. The fungicides Revus and Previcur were also applied to one field.

Lannate is considered to be a dangerous insecticide.

Its possible the workers may have been overcome by lingering odors.

“Because of the nature of the chemical, there certainty was a risk for serious medical complications,” Hadland said.

Employees were stripped down and showered in a decontamination unit.

Monterey County Agricultural Commissioners Office officials are leading the investigation.

“This is what is characterized as a priority investigation because of the number of people involved,” said Bob Roche, Monterey County assistant agricultural commissioner.

“Its still early in the investigation. But at this point we have no indication anyone violated any pesticide use laws or regulations,” Roche said.

“This investigation will go all the way back to the U.S EPA,” Roche said.

Clothing samples were collected and sent to the state department of pesticide regulation for testing of residues.

“We value our employees, their health, and well being. We take something like this very serious,” said Samantha Cabaluna, spokeswoman for Tanimura & Antle.

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18 Salinas farm workers rushed to emergency room – KSBW The Central Coast


How to Keep Emergency Rooms Focused on True Emergencies – Wall Street Journal (subscription) (blog)

Howard Forman (@thehowie) is a professor of radiology, economics, public health and management at Yale University.

Over the past few decades, hospital emergency rooms have seen a steady increase in visits. This is not surprising since the emergency department (ED) has evolved from a trauma and casualty center to a finely tuned health-care delivery system in its own right. Care that previously would take weeks to deliver can be accomplished there in mere hours. Specially trained emergency medicine physicians (a specialty that is relatively new to medicine) can provide immediate attention for a multitude of traumatic, surgical, medical and mental-health emergencies.

As the availability of ED care has exploded, primary-care and specialty physicians feel more comfortablecurtailing their after-hours clinical availability, allowingunscheduled and poorly documented patients to go to the emergency department. Not surprisingly, a significant amount of nonemergent and less-urgent care is provided in the modern emergency department. This ends up costing more money, distracting highly valued resources with less-critical needs, and disrupting the coordination of care that is better delivered by primary-care physicians.

So what do we do? There are two approaches to solving this problemand only one makes sense.

For decades, insurance companies have tried demand-side strategies to reduce emergency-department visits. ED copays are common; in many cases the copay is waived if the patient was admitted to the hospital (thus signifying, that this was, indeed, a true emergency). Most recently,Blue Cross/Blue Shield of Georgia announced that it will stop paying for ED care deemed to be nonemergent, when assessed after the fact by the insurance plan. To the casual eye, this might make sense: If the encounter is not an emergency, the patient should wait to seek outpatient care, typically at a lower cost. Aligning incentives (lower cost to the patient) with the desired behavior (avoiding the emergency room and obtaining care on a nonemergent basis from your primary-care physician or specialist) would seem logical.

The problem with this scenario is that knowing at home whether you have an emergency is more challenging than it seems. In many instances, patients evaluated in the emergency room and initially judged to have an ailment that could be treated on an outpatient basis were ultimately found to have required emergency management. All too often, for instance, physicians struggle to initially differentiate between gastrointestinal tract discomfort and more serious and even fatal conditions. Financially punishing patients after the fact for not having a heart attack or stroke or appendicitis only encourages other patients to avoid emergent care until it is too late.

In my practice as an ED radiologist, I have seen many cases where an imaging test is ordered almost as an afterthought (such as an abdominal computed tomography scan in an elderly patient), but then surprises the emergency-medicine physician with a consequential result (such as bowel obstruction) that requires surgery or other interventions. If physicians cannot presciently tell who will and who will not ultimately require lifesaving interventions just from their complaint, we should not make such a demand of our patients. A patient with chest pain may just have heartburn or they may also be experiencing a myocardial infarction (a heart attack), and they should not be discouraged by insurance companies from seeking emergency-room assistance.

Fortunately, theres an alternative approach to addressing emergency-room overuse: focusing on supply-side strategies. These include providing telephone consultation services, more accessible primary-care services (including extended and urgent care hours), and integrated delivery of health care, which certain health systems offer. These measures can reduce the demand for emergency care while meeting the immediate needs of the population. Health plans are evolving to recognize this, and integrated delivery systems are reliably lower-cost due to this attention to patient-centered care delivery. For the truly nonemergent patient, the peace of mind alone from knowing that there is an accessible voice or consultant available may be enough. Early evidence suggests that telemedicine (including telephone consultations) can decrease costs by reducing ED visits.

Public and private insurance plans are changing their models of reimbursement to physicians and hospitals to incentivize higher-value care; this, in turn, is changing practice patterns and care delivery strategies. Emergency-medicine physicians and nurses did not go into this field to take care of non-urgent patients, since it distracts from their mission to provide immediate attention to acute emergencies. They, too, would prefer that integrated care delivery models are in place to best care for every patient in a timely, high-quality and accessible way. Demand-side strategies that potentially delay life-saving care will punish patients. Instead, supply-side innovation must lead the charge for better and more responsive care delivery.

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How to Keep Emergency Rooms Focused on True Emergencies – Wall Street Journal (subscription) (blog)


Orange hospital builds new kind of emergency room for growing mentally ill population – OCRegister

Theres a new model for hospital emergency rooms and given the pressures on the health care system it appears to have arrived just in time.

Most hospital emergency care centers are ordered chaos a kid with a broken leg and a worried parent in one room, a mountain biker with a concussion in another, a muttering and bleeding homeless man in a third.

Glenn Raup, right, Executive Director of Emergency Nursing Services at St Joseph Hospital in Orange, chats with psychiatrist Ernest Rasyidi and nurse practitioner Cindy Illescas in the hospitals psychiatric strategy room. This is where the patients course of treatment is planned.(Photo by Mindy Schauer, Orange County Register/SCNG)

Nurses David Barone and Kearylyn Stanton work inside the temporary Emergency Clinical Decision Unit at St Joseph Hospital in Orange, where psychiatric patients are treated. (Photo by Mindy Schauer, Orange County Register/SCNG)

Glenn Raup, center, Executive Director of Emergency Nursing Services at St Joseph Hospital in Orange, chats with nurse Kearylyn Stayton, psychiatrist Ernest Rasyidi and a psychiatric patient. The hospital will get a new Emergency Clinical Decision Unit in one-to two-years.(Photo by Mindy Schauer, Orange County Register/SCNG)

Glenn Raup, Executive Director of Emergency Nursing Services at St Joseph Hospital in Orange, is reflected in a mirror outside what will be the temporary Emergency Clinical Decision Unit for psychiatric patients.. (Photo by Mindy Schauer, Orange County Register/SCNG)

Security officer Anthony Davila works inside the Emergency Clinical Decision Unit at St Joseph Hospital in Orange, where psychiatric patients are treated. (Photo by Mindy Schauer, Orange County Register/SCNG)

Glenn Raup, Executive Director of Emergency Nursing Services at St Joseph Hospital in Orange, outside the hospital where psychiatric patients are usually brought in for treatment. St Joseph, the busiest ER in OC and the second busiest in the State, is completely revamping the way it triages patients to help reduce wait times and is building a new and completely different model of care.(Photo by Mindy Schauer, Orange County Register/SCNG)

But at St. Joseph Hospital in Orange one of the busiest ERs in Orange County there now are two separate emergency areas that administrators say allows all patients to receive faster triage while providing mentally ill patients with tailored, comprehensive treatment.

When a patient is admitted, a mental health assessment is made. Those with mental illness are treated for their physical condition, but also are seen by a special team that includes a social worker, nurse practitioner, a psychologist and a psychiatrist.

Emergency and behavioral health treatment at St. Joseph is expected to improve even more with a combined $13 million-plus fundraising effort to expand facilities for mentally ill ER patients.

The needs of the mentally ill are different, explains Glenn Raup, executive director of emergency nursing and behavioral health services at St. Joseph. Yet few if any other hospitals in California, he reports, offer a separate ER for mentally ill people.

In regular emergency care centers, bright lights help doctors and nurses make fast diagnoses, orderlies move swiftly, people confer in hallways, machines beep and blink.

But for many mentally ill patients, noise, lighting and movement can be frightening.

St. Josephs new ER facility for mentally ill patients is like no other. Lighting is low, machines work in a whisper, caregivers speak in hushed tones, visitors are limited.

Theres also a very sturdy guard.

But transforming hospital care doesnt come easy or cheap. If St. Joe was a retail store, creating an ER for the mentally ill would be called a loss leader.

Instead of being a money maker, the move took morality and moxie. It also took vision.

Raup is either obsessed with degrees or he loves learning. Spend some time with this man who recently rappelled off a 16-story building to raise funds to fight addiction and its clear its the latter.

The director also loves serving and, yes, challenges.

Hes been on the front lines as well as behind a desk. Hes performed an emergency tracheotomy with a pen. The patient lived. And hes massaged a heart that stopped beating during surgery. The patient died.

Still, the experiences, however painful, informed both his thinking and his confidence. The registered nurse realized, I can do this.

He admits to two masters degrees and a Ph.D. Before becoming an administrator at St. Joe, he was a police officer in Kansas, a registered nurse, a SWAT paramedic in Houston and a college dean in Colorado.

Raup and his wife announced their move to Denver with relatives by Skyping from the front porch of the house where his relatives lived.

But the reason for the move was serious. Raups brother, Greg, was diagnosed with severe multiple sclerosis. He died two years later at age 40.

Now 50, Raup spends much of his time thinking about the larger issues of treating people. We take people from a death situation, to a life situation, he says. But the bigger question is why are these people coming into my ER?

ER is an example of the total failure of the whole system. All social ills end in ER.

Pause for a moment and ponder his points.

Raup isnt saying ERs are a failure. Rather, he is saying that if things were designed better perfectly, really health care wouldnt be handling so many emergencies.

Consider cellphones. Yes, cellphones.

The inventors and designers of cellphones dont consider the spiritual and mental health impacts of people texting rather than talking, Raup says. They dont take into account the physical hazards of texting while driving.

If cellphones were designed differently, there could be fewer patients in emergency rooms.

We need to look upstream, Raup explains, to where all these failures occur.

Stay with me here because it is this kind of thinking that led to St. Joseph Hospital agreeing to revamp triage.

When a typical patient arrives in the ER with chest pains, the job is to treat the problem. Raup says, Hes one and done.

But diagnosis and treatment for a mentally ill patient often is more complicated. Theres a psychiatric component, he says. Some have anger, others are bipolar, others have eating disorders.

Before the new ER facility was built, regular physicians treated all patients. Now, mentally ill people homeless as well as people with homes are treated by a special team.

Administrators say this allows physicians in the main ER to focus on the stream of strokes, heart attacks and trauma.

Raup walks through the area for mentally ill patients. There are eight beds with another three-dozen beds elsewhere in the hospital for longer-term mentally ill.

Four beds are empty on this day an example of swift, efficient care, Raup offers. Staff, he says, are rocking it.

Raup also points out it is mid-morning, a typically quiet time of day. ERs heat up in the afternoon and peak hours usually run from about 8 at night to early morning.

About 5 percent of ER admissions involve mentally ill patients, and an estimated 80 percent to 90 percent are treated and released. Yetthe numbers are staggering.

Raup reports that St. Joe averaged 330 mentally ill patients a month before the new facility was built. Since it opened, that number has jumped to 420 patients a month because of the shift in function.

Im still band-aiding, the director admits.

Getting the facility up and running hasnt been easy. Along with grants and the fundraising campaign, there also had to be a cultural change for separating out mentally ill patients.

In some places theres a philosophy of, Build it and they will come, Raup allows. I say, Build it because they are already here.

Orange hospital builds new kind of emergency room for growing mentally ill population – OCRegister


Emergency room | Children’s Hospital of Wisconsin

If your child is experiencing a medical emergency, call 911 for help now!

Children’s Hospital of Wisconsin is a Level I pediatric trauma center, providing the best care to all injured kids. The American College of Surgeons only grants Level I verification to hospitals that provide the highest quality of care and deliver injury prevention, research and education programs to professionals and the public.

The American College of Surgeons, in making the announcement, commended Children’s Hospital on its continued commitment to provide quality care to all of its trauma patients.

Verified trauma centers must meet certain criteria. Key elements of a Level I Trauma Center status include:

Some facts and figures:

A co-payment will be collected at the time of service.

We care for more injured kids than any otherhospital in Wisconsin – from simple cuts and broken bones tocomplicated, life-threatening injuries. We see more than 60,000patients in our Emergency Room/Trauma Center every year. Of those visits, more than 10,000 are for trauma and we admitapproximately 1,000 of those patients to the hospital.

Injuries we see are a result of things such as:

The trauma team in the ERtreat the most critically injured patients 24 hours a day, 7 days a week. We respond to care for the child’s immediate crisis. A pediatric trauma surgeon leads the team that includes pediatric nurses and physicians from the Emergency Room, critical care,transport teamand operating room.Children’s Hospital has a surgeon on call 24/7 to consult with care providers at other hospitals.

Other team members includepediatric anesthesiologists, respiratory care practitioners, pharmacists, social workers, lab technicians, radiology technicians and security officers.

The trauma medical director, an advanced practice nurse and quality improvement nurse monitor care of every injured patient. They discuss all the critical issues with the care team and refer patients to a trauma physician or a trauma committee made up of experts from multiple specialties to review and identify opportunities for improvement.

The Children’s Hospital trauma program follows protocols developed to minimize radiation in injured children. We monitor the use of the protocols and have decreased the number of CT scans performed in children brought directly to Children’s Hospital from the scene of injury by 10 percent in two years. In two years, we have increased adherence to guidelines by 31 percent. CT scans are performed according to our guidelines in 97 percent of patients brought to Children’s Hospital directly from the scene of injury. If your child requires imaging tests likeX-raysor aCT scan, we make sure your child is exposed to the smallest amount ofradiation as possible.

We have the latest technology and equipment to offer the lowest doses of radiation. We shield and protect sensitive body parts from radiation. We check dose levels on equipment before each scan and inspect dose reports every month. Physicists adjust our equipment every year.

If you want your child treated at Children’s Hospital, ask your local hospital to transfer him or her before any non-urgent diagnostic care is provided.

Learn more about ourImaging Department.

More than 95 percent of pediatric spleen, liver and kidney injuries resulting from trauma can be treated successfully without going to the operating room. Children’s Hospital meets or exceeds this benchmark. In fact, 95 percent of spleen injuries, 99 percent of liver injuries, and 100 percent of renal injuries are treated successfullywithout surgery.

The Children’s Hospital trauma team is concerned about the entire well-being of your child. A child can have emotional trauma or acute stress symptoms from any injury. We screen injured children for possible stress symptoms and teach you what to watch for at home. We offer psychology intervention as needed.

We know that drug or alcohol use can increase the potential for injury. We screen your child for the risk for drug or alcohol use. Understanding that peer pressure pushes many children to use drugs or alcohol, we provide a brief motivational intervention to help them say “no.”

Our Trauma Center staff works closely with Children’s Hospital of Wisconsin Community Health – the lead agency forSafe Kids Wisconsin. We also work closely with theInjury Free Coalition for Kids.

We help reduce the cycle of violence through Project Ujima, which focuses on breaking the cycle of violence by reducing the number of repeat victims.

Transport Team Each year, our Transport Team brings more than 1,000 critically ill or injured children to Children’s Hospital by ambulance, helicopter and fixed-wing plane. Read more>>

Urgent care Children’s urgent care sites are the area’s only walk-in clinics just for kids. The urgent care clinics are open nights and weekends when regular doctors offices are closed. Appointments never are needed. Read more.

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Emergency room | Children’s Hospital of Wisconsin


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


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