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Jump reported in opioid-related emergency room visits – WWSB ABC 7

Jump reported in opioid-related emergency room visits
There was a 99 percent increase in emergency room visits in the United States for opioid-related illnesses from 2005 to 2014. That's according to the Agency for Healthcare Research and Quality. These ER visits reached 1.27 million in a single year.

Jump reported in opioid-related emergency room visits – WWSB ABC 7


Heroin, opioids hit Maine emergency rooms harder than all but one state – Bangor Daily News

Emergency rooms in Maine have seen the impact ofthe nationsopioid crisismore acutely thananywhere but Massachusetts.

Data from the Healthcare Cost and Utilization Projectreveal that trend and amore detailedlookatopioid-related hospital visits by age, sex, location and income levels, showing thatlower-income Mainershave higher rates and that rural ER visits are about on par withurban areas.

The figuresinclude visits caused by heroin and other synthetic opioids such as fentanyl.

The data showMaine wassecond-highest, out of 32 states, for the rate of opioid-related ER visits in 2014, after topping the nation in 2009 and 2010. The2014data is the most recent available for most states and Maine.

[A deadly record: Maine averaged more than an overdose death per day in 2016]

Mainehas been near the top for opioid-relatedER visitsince 2006, when it was ranked fifth in the countryby itsER visitrate. In 2014, that rate was more than 3 out of every 1,000 Mainers.

The data show about 4,250 peoplewentto a Maine emergency room foropioid-related illness and Maine hospitals admittedabout 4,000as inpatients.

The figures count each visit and not each patient, so one person could be counted in the data multiple times. Thereport does not count anER visit if the patient is later admitted to thehospital.

The total of 8,250 combined ER visits and inpatient stays works out to an average of 22.6 hospitalizations per day in Maine.

[Opioid overdoses are killing more Mainers than car crashes]

Maine and Massachusetts were also outliersin 2014 for having moreER visitsthan inpatient admissions for opioid-related illnesses.Nevada and Vermontwere also in that group and Ohio was close to even by that measure.

Forthe rate of inpatient admissions, Maine ranked 10th out of 45 states, in 2014.

Thegovernment data published Tuesdaydoesnt describe causes for the trends and leaves out states that have not yet submittedtallies to researchers.

[In just one year, nearly 1.3 million Americans needed hospital care for opioid-related issues]

Femalesweremore likely toget inpatient treatment in Maine. Maleswere more common in the ER.

Thenumber of malesshowing up inMaine emergency rooms for opioid-related illnesses spiked in 2014, averaging a little more than 6 visits per day for the year. The rate for females was closer to 5 per day.

The trend flipped for inpatient admissions.

The epidemicaffects people in their prime, between ages 25 and 44.

The data show that peopleages 25 to 44 have thehighest rates of inpatient and ER visitsby far in Maine,in line with national trends. While inpatient rates for that group declinedin 2014 from 2013, ER visit rates jumped dramatically.

Rural admissions were about as common as those in urban areas.

The data shows little divide between the impactof opioid-related illnesses in Maines urban and rural areas through 2013, though ER visitsin the states biggest cities spiked in 2014.

ER visits were more common than inpatient treatment in those urban areas and at the states rural hospitals.Hospitals in smaller metro areasdelivered moreinpatient care than ER care in 2014.

ER visits becamemore common for people of all incomes, butrates are much higherin low-income areas.

Patients from the states lowest-income ZIP codes hadgenerally higher rates of ER visitsand were more likely to go the ER than be treated as an inpatient for opioid-related illnesses.

The data showed ER and inpatientrates rose across all income levels (defined by median household incomeof the patients ZIP code), but ratesremained highest in lower-income areas.

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Heroin, opioids hit Maine emergency rooms harder than all but one state – Bangor Daily News


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


Major Insurance Company’s Payment Decision Angers ER Doctors –

It hurts when you take a deep breath. Is it a heart attack? A blood clot in the lung? An infection?

Emergency room doctors are questioning letters than have gone out to some Anthem Blue Cross/Blue Shield members in three states that threaten a crackdown on reimbursements.

“Save the ER for emergencies or cover the cost,” reads a letter sent last month to Blue Cross and Blue Shield of Georgia members.

“Going to the emergency room (ER) or calling 9-1-1 is always the way to go when it’s an emergency. And we’ve got you covered for those situations,” it reads.

“But starting July 1, 2017, you’ll be responsible for ER costs when it’s NOT an emergency. That way, we can all help make sure the ER’s available for people who really are having emergencies.”

Similar letters have gone out to members of plans owned by Anthem, Inc. in Missouri and Kentucky.

Anthem, Inc. said it’s trying to steer patients to proper care. “What we are really trying to do is make sure that people are seeing their doctors first,” said Joyzelle Davis, communications director for Anthem, Inc.

She said patients are inappropriately showing up to emergency departments with itchy eyes and other non-emergency symptoms.

Dr. Becky Parker, president of the American College of Emergency Physicians (ACEP), said it’s about money.

“The insurance company is not on the same plane. They are not here to take care of people. They are here to make money. It’s clear that the insurance companies are looking to make money. It is about the dollar. It is not about high quality care,” Parker said.

“Our concern is that the insurance industry is trying to push this nationally.”

Related: Doctors Make Case for Obamacare or Something Like it

The 2010 Affordable Care Act lays down strict rules for covering emergency room visits. ACEP said the insurance industry is taking advantage of the Trump administration’s disregard for the ACA to push the boundaries.

“Health plans have a long history of not paying for emergency care,” Parker said.

“For years, they have denied claims based on final diagnoses instead of symptoms. Emergency physicians successfully fought back against these policies, which are now part of federal law. Now, as health care reforms are being debated again, insurance companies are trying to reintroduce this practice.”

Davis denies this. “It is reinforcing language that has been in the contract that has not necessarily been enforced before,” she said. She said policies still apply what is known as the “prudent layperson” standard.

Anthem defines it in the letter:

“Emergency” or “Emergency Medical Condition” means a medical or behavioral health condition of recent onset and sufficient severity, including but not limited to, severe pain, that would lead a prudent layperson, possessing an average knowledge of medicine and health, to believe that his or her condition, sickness, or injury is of such a nature that not getting immediate medical care could result in: (a) placing the patient’s health or the health of another person in serious danger or, for a pregnant woman, placing the woman’s health or the health of her unborn child in serious danger; (b) serious impairment to bodily functions; or (c) serious dysfunction of any bodily organ or part. Such conditions include but are not limited to, chest pain, stroke, poisoning, serious breathing problems, unconsciousness, severe burns or cuts, uncontrolled bleeding, or seizures and such other acute conditions as may be determined to be Emergencies by us.

But Parker said the letters and the new policies have a chilling effect on patients and could leave some with bills in the thousands of tens of thousands of dollars.

Related: You Thought it Was an Urgent Care Center Until you Got the Bill

“The ‘prudent layperson’ standard requires that insurance coverage is based on a patient’s symptoms, not their final diagnosis,” ACEP said.

“If patients think they have the symptoms of a medical emergency, they should seek emergency care immediately and have confidence that the visit will be covered by their insurance.”

Blue Cross and Blue Shield may potentially deny a claim from someone who shows up with chest pain, ACEP said. Davis said a sharp pain with a deep breath could be a symptom of the common cold, and is not an emergency.

Parker said it’s not reasonable to expect a patient to know the difference. “I don’t know and you don’t know if that is a heart attack, a blood clot, or a collapsed lung unless I see you in the emergency room,” she said.

The last thing a doctor wants is for a potentially dying patient to hesitate, worried about a bill.

“It’s really dangerous for our patients,” Parker said.

“I had a woman the other day who was in her early 40s who came in for having a stroke,” added Parker, an emergency physician at West Suburban hospital in Oak Park, Illinois.

“She had had severe dizziness, vertigo symptoms.”

The patient had waited until office hours to come in because the co-pay on her health insurance plan to see a primary physician was $50 but it was $250 for an ER visit. The patient missed an important early window for treating her stroke, Parker said. “She told me, ‘I can’t believe I risked my life for $200.'”

Dr. Howard Forman, an expert in health policy and medical imaging at Yale, said both sides are right.

“To me, this is a problem of the system,” Forman said. “This is not about bad actors.”

Related: People Get Surprise Medical Bills in 22 Percent of ER Visits

Doctors want to work 9 to 5 and patients have few other choices outside of those hours, he said.

“There are a lot of people who go to emergency rooms for things that are not true emergencies,” Forman said.

Many may simply go because they are anxious. “That incurs a significant cost to the healthcare system,” he added.

“I don’t believe insurance companies hold down costs so they can make more profit,” Forman said. Many insurance companies simply manage programs for employers who are self-insured, meaning they pay their employee health costs themselves.

Related: ER Visits Hit Record High in 2005

That said, Forman added, ACEP has a point.

“It is really difficult to know in advance which patient is really having an emergency,” he said. “Doctors aren’t even great at predicting which patients have something terrible.”

And you cannot blame patients for using ERs. “The emergency room has become the multi-specialty clinic of the 21st century,” Forman said. “You can go to the emergency room with blood in your stool, which for most people is not an emergency, and four hours later not only be diagnosed with colon cancer but you could have already met with the oncologist,” he added.

“We provide a level of service in the ER now that is extraordinary.”

And that drives up costs. What the insurance companies say they want to do is direct people to less expensive and more appropriate options.

“If a member can’t get an appointment with their primary care doctor, most non-emergent medical conditions can be easily treated at retail clinics, urgent care clinics or 24/7 telehealth services such as LiveHealth Online,” the Anthem letter advises.

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Major Insurance Company’s Payment Decision Angers ER Doctors –


IC in Care Series The Emergency Department – Infection Control Today

By Kelly M. Pyrek

Competing priorities, life-and-death situations and a vast quantity of unknown variables are the hallmarks of the emergency department (ED), and compliance with infection prevention and control (IPC) principles and practices can be challenging. Katherine West, BSN, MSEd, CIC, points to the directive from the Occupational Health and Safety Administration (OSHA) — CPL 02-02.069 — that indicates that the delivery of healthcare should not be delayed. “Trauma response is more important than infection control compliance, and even OSHA recognizes that fact,” West says. “We have a duty to meet the patient care needs.”

That being said, abdication of IPC is not acceptable, and infection preventionists and ED personnel must work toward a manageable compromise that can still protect patients and healthcare professionals to a reasonable degree. Researchers are currently endeavoring to study the IPC needs of the ED and determine best practices for better outcomes, as well as determine standardized methods and definitions of compliance monitoring in order to be able to compare results across settings.

In their review, Carter, et al. (2014) examined published literature addressing adherence rates among ED personnel to selected infection control practices, including hand hygiene and aseptic technique during the placement of central venous catheters and urinary catheters, as well as rates of ED equipment contamination. Suitable studies revealed that hand hygiene compliance ranged from 7.7 percent to 89.7 percent, while other studies indicated that aseptic technique practices during urinary catheterization was lacking, and equipment contamination in the ED was persistent.

As Carter, et al. (2014) summarize, “The emergency department is an essential component of the healthcare system, and its potential impact continues to grow as more individuals seek care and are admitted to the hospital through the ED. Invasive procedures such as central lines are placed with increased frequency in certain EDs, but adherence to best practices (e.g., maximum barrier precautions) varies. ED clinicians also face numerous workflow challenges that may foster the spread of infections including crowding, frequent interruptions to care delivery, use of nontraditional care areas such as hallways and conference rooms, and close proximity of patients, who are often separated only by curtains. Given that many of these barriers have been identified as infection prevention threats, it is critical to understand the infection prevention practices of ED providers and their potential role in the risk of HAIs.”

West points to a number of factors that complicate IPC in the emergency department. “The ED is a very challenging area for infection control because it is often a contracted services and staff miss many of the laws and procedures that are important. For example, many are not aware of the HIV testing laws in their state or that HIPAA does not prevent the release of source patient test results to the exposed employee. Rapid patient turnover may impede cleaning compliance. So, compliance monitoring is important. In many facilities, staff is temp staff and that adds to the issues.”

She also emphasizes the need to balance healthcare personnel safety with the need to protect patients. “There is a need to protect patients from infection as well as staff,” West says. “For too long the duty to the patient has often been forgotten. With the new healthcare law, patient protection from infection becomes more important. Patient who develop infection two days after admission, that will be termed healthcare-associated and there may be no government reimbursement for the cost of extended stay and treatment. Staff training needs to focus on proper IV site prep, etc. Training is often not in accordance with requirements for infection control. Attendance at training is important and often not deemed as important.”

Additionally, West emphasizes that “Infection preventionists often do not have enough time to do training in person, which is ideal, so there is time for questions to be answered and items clarified. Paperwork seems to take up so much time. Making rounds and observing care rendered in the ED is very important. Compliance monitoring is key to risk and liability reduction and will also identify training needs. Rounds and training are the best way to interact with ED staff and identify problems.” Let’s take a closer look at several key IPC areas in the ED.

Hand hygiene Carter, et al. (2014) found that hand hygiene was the most commonly observed infection prevention practice in the studies they reviewed, and adherence rates varied widely. For example, several studies examined hand hygiene practices before and after interventions; Haas and Larson used WHO guidelines to assess the impact of a wearable alcohol hand sanitizer dispenser among ED personnel in a New York hospital. The researchers observed 757 hand hygiene opportunities; the adherence rate improved from 43 percent to 62 percent during the first intervention month of the study but was not sustained, with a 51 percent adherence rate after the second quarter.

Scheithauer, et al. (2013) acknowledges that the ED “represents an environment with a high density of invasive and thus infection-prone procedures,” and sought to define the number of hand-rubs needed for an individual patient care at the ED and to optimize hand hygiene compliance without increasing workload. In this prospective tri-phase (6-week observation phases interrupted by two six-week interventions) before after study to determine opportunities for and compliance with hand hygiene per WHO protocol, the researchers evaluated 378 patient cases with 5674 opportunities for hand-rubs (HR) and 1664 HR performed. They found that compliance significantly increased from 21 percent (545/2,603) to 29 percent (467/1,607), and finally 45 percent (652/1,464) in phases 1, 2 and 3, respectively. The number of HR needed for one patient care significantly decreased from 22 to 13 for the non-surgical and from 13 to 7 for the surgical patients due to improved workflow practices after implementing standard operating procedures (SOPs). In parallel, the number of HR performed increased from 3 to 5 for non-surgical and from 2 to 3 for surgical patients. Avoidable opportunities as well as glove usage instead of HR decreased by 70 percent and 73 percent, respectively.

Venkatesh, et al. (2011) conducted an observational study to identify predictors of hand hygiene in the ED. Compliance was 89.7 percent over 5,865 opportunities. The researchers found that observation unit, hallway or high-visibility location, glove use, and worker type predicted worse hand hygiene compliance. Hallway location was the strongest predictor (relative risk, 88.9 percent).

In their study at two university hospital centers, Martel, et al. (2014) found that 53 percent of nurses washed their hands after seeing the patient, and only 40 percent applied recommendation before. However, the researchers note, “given a great turnover of patients, nurses may have just washed their hands after the last patient assessment and be already decontaminated for the next. Some handwashing may have been missed because nurses often left our site of observation immediately before and after seeing the patient.”

Aseptic technique during catheterization In their review, Carter, et al. (2014) identified one study that observed aseptic technique during urinary catheterization. In this study, medical students used standardized observation tools to observe aseptic technique in one ED in the UK and another ED in New Zealand. Procedures observed included urinary catheterization, wound examination or closure, injections or intravascular cannulation, lumbar puncture, and pleural aspiration. Overall, 27 percent (UK) and 58 percent (New Zealand) of invasive procedures were performed using aseptic technique. Adherence to aseptic technique was reported in aggregate and not categorized by procedure type.

Regarding aseptic technique during central venous catheter insertion, Carter, et al. (2014) identified seven studies that examined central venous catheters inserted in the ED or by emergency medicine residents. One study examined the effect of a video review on the sterile technique practices of surgical and emergency medicine residents during the placement of central lines. Compliance to aseptic technique was higher among those who received the video-based online training than those who received paper-based training or no training (74 percent vs 33 percent, respectively). In a separate evaluation, the same research team also assessed maximum barrier precautions among primary and secondary operators through a video recording. Among elective central lines, maximum barrier precautions were used by 88 percent (99/113) of primary operators and 69 percent (31/45) of secondary operators or senior medical staff.

Contact precautions Researchers have found variability of contact precaution policies in U.S. emergency departments. A study published in Infection Control and Hospital Epidemiology in 2014, Daniel J. Pallin, MD, MPH, and Jeremiah D. Schuur, MD, MS, both from Brigham and Women’s Hospital, surveyed a random sample of U.S. EDs confirmed substantial variation in the adoption of policies relating to contact precautions. While most EDs have policies relating to contact precautions when specific organisms are suspected, a minority have such policies for the symptoms often caused by those organisms. This indicated that institutional policies do not mirror consensus recommendations by the Centers for Disease Control and Prevention (CDC), the Society for Healthcare Epidemiology of America (SHEA) and other national bodies. The authors write, “The variation in policy that we observed leads us to recommend that emergency medicine organizations, such as the American College of Emergency Physicians, should enact policies addressing contact precautions in the ED.”

Respiratory hygiene As Rothman, et al. (2006) remind us, “The participation of emergency physicians and nurses is critical for effective responsiveness to respiratory threats in hospitals. ED personnel represent a critical link in the chain of communication and response, along the continuum from the community to the inpatient unit. Policies should anticipate responses to the complex spectrum of possible respiratory illnesses, from highly transmissible and unexpected emerging global diseases such as SARS to yearly influenza epidemics.” They add, “Concerns about the potential spread of respiratory pathogens begin at the point of entry into the healthcare system and continue to the inpatient setting. Emergency personnel need to be aware of the potential for infection, illness, and transmissibility in a variety of potentially high-risk environments, including (1) emergency medical services (EMS) and triage settings (in which historical and clinical information may be limited and risk underestimated), (2) during performance of high-risk invasive airway procedures, and (3) during patient transport to the various inpatient units throughout the hospital.”

Fusco and Puro (2012) observe that “The role of emergency departments in disease transmission dramatically emerged during the outbreak of severe acute respiratory syndrome (SARS). Subsequently, the Centers for Disease Prevention and Control and the World Health Organization issued new infection control guidelines that introduced respiratory hygiene and cough etiquette measures (e.g., covering of nose and mouth possibly with disposable surgical mask, adequate distancing among patients and careful application of hand hygiene) as part of standard precautions to be applied in all health care settings, to all patients with cough and other respiratory symptoms. A rigorous application of this set of infection control measures, including isolation if indicated, may significantly reduce the risk of disease transmission in emergency departments, thus protecting healthcare workers, patients and visitors. Mention about it should be included in all basic sets of indications for the management of community-acquired pneumonia in emergency departments.”

Martel, et al. (2014) sought to determine the compliance with respiratory hygiene of triage nurses at two university hospital centers and to identify factors influencing compliance to the respiratory hygiene principles of emergency healthcare workers. An anonymous observation of compliance with respiratory hygiene by triage emergency nurses was performed, and a self-administered, voluntary questionnaire on attitudes, perceptions, and knowledge of respiratory hygiene guidelines was distributed to the healthcare workers in the ED. The researchers found the average compliance with respiratory hygiene measures of triage nurses was 22 percent; compliance of healthcare workers was 68 percent. Overall, 91.9 percent of respondents believed that a mask was an effective preventive measure. The main barriers to mask use by healthcare workers were tendency to forget (37.8 percent) and discomfort (35.1 percent). Despite clearly visible respiratory hygiene posters in both hospital sites, necessary materials such as masks and tissues were missing in 9.6 percent of the cases. Patient isolation and decontamination measures were rarely or never applied.

As Martel, et al. (2014) observe, “The emergency department is the point of entry into the hospital for many patients and as such constitutes a prime location for the propagation of respiratory infections. These communicable diseases can then be further spread into the hospital as well as back into the community, creating a significant societal burden.” Martel, et al. (2014) found that nurses frequently asked about fever and cough (82 percent), which could be explained by the fact that the emergency room evaluation sheet included an inquiry regarding cough and fever, but they rarely informed the patient of the need to wear a mask (18 percent). The researchers say this could be explained by a lack of knowledge regarding the increased transmission risk in the presence of fever and cough. However, despite the fact that the self-applied questionnaire was not completed by the same healthcare workers, 94.1 percent of them reported that they would recommend mask wearing to a patient with fever and cough. Even though hygiene equipment (such as masks) was present 94.4 percent of the time, only 18.3% of patients had applied the mask recommendations prior to triage.

Martel, et al. (2014) also point out that in spite of CDC recommendations, patient handwashing measures were never met. The absence of posters focusing on this measure, in contrast to the importance of wearing a mask by patient, may result in the slightly higher adherence to the mask precaution (18% vs 0%, respectively). The researchers note, “Several factors could explain that only 9% of nurses informed patients about proper mask technique. Some nurses were seen to request isolation precautions instead. Also, when masks were well positioned, nurses did not further address proper application. Moreover, some nurses may have overestimated patient knowledge regarding the need for mask to cover both nose and mouth and be changed when wet. Despite evidence that spatial separation can reduce droplet spread of infection, we showed a very low compliance to patient isolation (12%).We know that implementation of these measures in many crowded waiting rooms remains particularly difficult. However, both hospitals sites had well-identified areas for this purpose.”

Martel, et al. (2014) recommend the following measures to standardize adequate practices: 1. Visual tools specifically designed for the emergency waiting room displayed prominently (e.g., on the door of the room), encouraging the following basic steps: disinfection of hands and wearing of mask by patient with fever and cough. 2. Modification of present visual tools in waiting rooms to mention real indications for mask wearing: coughing, sneezing, and runny nose and not only fever and cough because they are common. 3. Modification of the emergency department sheet, reminding nurses of the association between fever and cough and the need for patients to wear a mask. 4. Positive reinforcement of respiratory hygiene compliance by supervisors and training on respiratory hygiene/respiratory etiquette of emergency personnel with creation of measures such as online courses aimed at facilitating learning and improving accessibility and flexibility as well as reducing costs.

Equipment contamination In their review, Carter, et al. (2014) identified four papers described equipment contamination in the ED: “Of primary focus was contamination with methicillin-resistant Staphylococcus aureus (MRSA). In one large ED from a United States tertiary care hospital, 7 percent (5/69) of environmental surfaces (chairs, keyboards, telephones, and others) were positive for MRSA compared with no positive sites (0/63) in an outpatient clinic. Another research team took 63 samples of computer mice in an ED in over a one-year period and found only normal skin flora, with no MRSA. In a United States ED, Frazee et al took surveillance cultures of ultrasonographic probes used in the ED; approximately two thirds (111/164) were contaminated with skin or environmental flora, eight samples had heavy growth of skin or environmental flora, and 3.7 percent (6/164) grew organisms including methicillin-sensitive S aureus, Aspergillus, Acinetobacter spp, and mixed Gram-negative rods. Finally, a researcher cultured the stethoscopes of ED nurses and physicians in three Canadian EDs. Of the 100 stethoscopes samples, 70 percent were contaminated. A majority of specimens grew coagulase-negative staphylococci (54/100).”


Carter EJ, Pouch SM and Larson EL. Common infection control practices in the emergency department: A literature review. Am J Infect Control. 42 (2014) 957-62.

Fusco FM and Puro V. Infection control in the emergency department. CMAJ. 184(9):1065. Jun 12, 2012.

Martel J, Bui-Xuan EF, Carreau AM, Carrier JD, Larkin E, Vlachos-Mayer H and Dumas ME. Respiratory hygiene in emergency departments: Compliance, beliefs and perceptions. American Journal of Infection Control 42 (2014) 957-62.

Rothman RE, Irvin CB, Moran GJ, et al. Respiratory hygiene in the emergency department. Ann Emerg Med 2006;48:57082

Scheithauer S, Kamerseder V, Petersen P, Brokmann JC, Lopez-Gonzalez LA, Mach C, Schulze-Rbbecke R and Lemmen SW. Improving hand hygiene compliance in the emergency department: getting to the point. BMC Infectious Diseases 2013, 13:367.

Venkatesh AK, Pallin DJ, Kayden S and Schuur JD. Predictors of Hand Hygiene in the Emergency Department. Infect Control Hosp Epidemiol. 2011 Nov;32(11):1120-3.

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IC in Care Series The Emergency Department – Infection Control Today


Northwest Healthcare breaks ground on Marana emergency department – Tucson Local Media

Northwest Healthcare has broken ground on a new free-standing emergency department adjacent to the Tucson Premium Outlets at Twin Peaks and I-10. The facility is expected to open in early 2018.

At a May 21 ceremony to commemorate the project, Marana Town Manager Gilbert Davidson said project was part of a very exciting time in the town of Marana.

We love watching dirt get turned, Davidson said. We literally have projects from the southern end to the northern end and this is a nice compliment in the middle.

The move to the new facility represents a shift in philosophy for Northwest Healthcare as it responds to a growing need. Over the past five years, there has been a 20 percent volume increase in emergency room visits. Although Northwest has two hospital-based emergency facilities in the area, the organization wants to get emergency care to areas with growing populations.

Our goal is to provide the communities of Marana, Picture Rocks, Red Rocks, Oro Valley and surrounding areas to easy access to emergency care, Northwest Healthcare Market CEO Kevin Stockton said.

The new facility, which has been named Northwest Emergency Center Marana, will be the healthcare companys second free-standing emergency department, joining a similar facility in Vail which opened in 2015. The Marana location will be open 24 hours a day, seven days a week to serve patients who experience medical emergencies.

The new emergency care center will be just like a hospital emergency room, equipped to treat patients with illnesses and injuries that require a higher level of care than urgent care facilities offer.

The facility will have 12 private patient rooms with radiology and lab services on-site. If a higher level of care is required, patients can be transported quickly to nearby Northwest Medical Center or to Oro Valley Hospital.

Marana leaders have an innovative vision for the future of the town and we are happy to be part of that growth, Stockton said. We have provided healthcare services in Marana for more than 11 years, and this new emergency center reinforces our long-term commitment to caring for this community.

As part of the move, Northwest Healthcare will close the Continental Reserve Urgent Care when the lease ends at the end of the year. The family medicine physicians currently located in the Continental Reserve Urgent Care building will move to new offices at Silverbell and Cortaro and, as Marana grows, Northwest Healthcare will continue to explore other options in the area.

The company also own 58 acres near Tangerine and Moore roads, but currently does not have plans to utilize the property.

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Northwest Healthcare breaks ground on Marana emergency department – Tucson Local Media


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.”


The rest is here:
Overdoses flood area emergency rooms – The Columbus Dispatch