All posts tagged mental-health

Hooked on heroin, she sat 2 days in an ER. Hospitals say you pay for this stay, too. – Charlotte Observer

A 25-year-old Gaston County woman who is addicted to heroin waited two days in a hospitals emergency department, in a psychiatric observation room with no bed.

She needed help for her drug addiction, her family says, but local treatment centers were full.

They dont have any place to put them. Theyre so packed, says the womans grandmother.

Instead, the woman was taken to an emergency room by police last month, under a judges order to involuntarily commit her. The womans family says she had threatened to kill herself and theyve been concerned about her health and behavior after learning shes been using heroin for several years.

The ER, according to the family, was the only option.

A growing opioid and heroin epidemic has escalated a problem that health care professionals have been raising concerns about for years: North Carolina has inadequate services for people with mental and behavioral health diseases.

Doctors in North Carolina confirm theres an increasing demand for help and patients are turning to emergency rooms an expensive and ineffective place for treatment.

Often, patients wait days a process called boarding. Hospitals say it takes a toll on their budgets and leaves fewer beds available for other people who need the emergency room.

Most ERs cant provide full substance abuse or psychiatric health treatment. Instead, they can assess patients and offer some medical care then work to transfer patients to specialized treatment centers.

But, when the treatment centers are full, hospitals end up keeping patients inside emergency room departments.

Recently, the North Carolina Hospital Association reported 30 to 80 percent of emergency beds are used for boarding. The result is higher costs for all patients and delays for patients who are in a mental or behavioral health crisis.

For privacy reasons, the Observer is not publishing the name of the Gaston County patient or her grandmother.

Her family says they grew concerned in the past year about changes in the womans behavior. Then, they learned she had started using heroin while she was in college in western North Carolina a few years ago. After graduating from college, she got a job but she stayed hooked on heroin, her grandmother said.

Heroin is an opioid, a class of drugs that now kills more people in North Carolina each year than car wrecks.

This familys experience of a long stay inside an ER and difficulty finding a treatment bed is a common one in North Carolina.

After calling state and local lawmakers to complain about bed shortage, the 70-year-old grandmother called the Observer in late June as her granddaughter waited inside CaroMont Hospitals emergency psychiatric unit in Gastonia.

There, two rooms, separated by gender, house three recliners each for patients. Theres no medical equipment inside and no other furniture, except for an encased television with no wires exposed. Patients may use a wireless phone and are supervised by hospital staff at a nursing station.

This is where the young woman stayed for 48 hours, her grandmother said. Hospitals are required to accept patients in mental health or drug abuse crisis and perform psychiatric evaluation.

CaroMont Hospitals average patient boarding time is four days the same as the states average for adults who are waiting for a transfer to one of North Carolinas three state-run psychiatric hospitals. For a transfer to a taxpayer-supported treatment center, the average statewide wait is 2.5 days.

We will have patients present to our (emergency department) because they have nowhere else to go, said Dr. Tom Davis, chief medical officer for CaroMont.

It is truly a public health crisis and it is really complicated … Our society in general has not funded or put an emphasis on helping to treat and manage mental health problems.

CaroMonts ER sees nearly 90,000 patients a year. When mental and behavioral patients at the ER dont have acute physical medical problems, they can wait in rooms called psychiatric suites.

Davis and other hospital officials said they couldnt talk about the specific case of any patient. When boarding, the hospital prioritizes the patients safety and medical needs, he said. And, if a patient needs follow-up care but not inpatient treatment, hospitals discharge them with a treatment plan.

Patient boarding and gaps in health care services for mental and behavioral health patients are problems nationwide.

But North Carolina, compared to other states, sees nearly twice the rate of psychiatric patients who resort to the ER each year, says Martha Whitecotton, senior vice president for behavioral health services at Carolinas HealthCare System in Charlotte. Carolinas has an emergency room that exclusively serves patients in behavioral health crisis and its often full.

On average, the boarding time at a Carolinas HealthCare emergency room or another facility in the system is about 17 hours.

But we definitely have patients who are there much longer, Whitecotton said, including children and geriatric patients because of fewer beds for those populations.

In Charlotte, both Carolinas HealthCare System and Novant Health told the Observer they board up to 40 patients daily, with some fluctuation, including those who go to the ER in crisis, with mental health and substance abuse issues.

At Novant, the average boarding time varies by location from 10 hours in Huntersville to close to 17 hours at Presbyterian Medical Center in Charlotte.

Many hospitals in the state including Novant, Carolinas and CaroMont are trying to cut down on the boarding wait times by using telemedicine services that include psychiatric consultations by phone and video.

Each time boarding happens, hospitals stand to lose thousands of dollars.

Its draining the system, said Julia Wacker, vice president for community and behavioral health with the North Carolina Hospital Foundation. Its counterproductive in every way.

Nearly 80 percent of mental health and substance abuse patients in North Carolina are covered by Medicaid or dont have insurance, which means tax dollars pay for some of their costs and hospitals absorb the rest.

Hospitals lose money by the hour when they board uninsured and Medicaid or Medicare patients because expenses past the first day of their stay cant be fully reimbursed. Some experts estimate this type of boarding costs about $100 an hour, per patient.

These extended stays in the ER burden hospital budgets, and those costs are being shifted to other patients and payers.

Some doctors and health care administrators say boarding is happening at higher rates because North Carolina doesnt have enough treatment and psychiatric beds. Others say patients are turning to the ER because preventative care for mental health disease and drug addiction is too expensive or inaccessible. Data shows about half of the states counties dont have enough psychiatric doctors.

The stakes are high, with nearly 1,100 opioid deaths annually in North Carolina a death rate higher than murder rates in the state. That figure from 2015 is a 73 percent spike compared to opioid deaths in the state 10 years ago.

Over the same time period, the wait for treatment beds and the number of patients resorting to the emergency room for mental and behavioral health care has gone up fourfold, the hospital association reports.

North Carolinas Department of Health and Human Services is trying to alleviate the boarding problem and related opioid crisis on several fronts. This year, the department introduced new criteria for the groups that manage mental and behavioral health care, and it plans to impose penalties and fees if services arent improved.

Adding beds would reduce some ER boarding but one research project performed in North Carolina suggests the state would need to effectively double the amount of beds it currently has to just ensure patients arent waiting more than 24 hours in a hospital for a transfer a potential solution that would take years to build out and millions of dollars not currently allocated.

Partners Behavioral Health Management is trying to reduce the problem of boarding at ER rooms, said Dr. Michael Forrester, a psychologist and the chief clinical officer. Partners operates in eight N.C. counties, including Gaston, Iredell and Catawba. Its one of seven regional entities that receive state and federal tax dollars to act as a managed care organization for mental and behavioral health needs.

These regional organizations have special care centers for patients who are in mental health or drug addiction crisis, as an alternative to the ER, as well as offering individualized outpatient treatment.

DHHS says many of its solutions for emergency room boarding are routed through Partners and the other regional organizations. One pilot program is running now in 13 N.C. counties, with the aim of diverting patients in behavioral health crisis away from ERs and on to specialty facilities.

A better approach to getting patients the right kind of health care outside of an ER is key, says Billy West, executive director at Daymark Recovery Services, a growing mental health and substance abuse treatment provider, with 32 clinics in North Carolina.

Whether a person is in a mental health crisis, involuntarily committed through court or is personally ready to start drug addiction treatment, West says, doctors and health care providers want to act quickly in that window of time to help a patient. Boarding delays access to long-term health solutions, West said, and may contribute to a dangerous and expensive cycle.

Some statewide statistics suggest this may be happening already.

More than one quarter of Medicaid patients who use an ER for mental and behavioral health issues return to an emergency room the same year with the same problems, North Carolina DHHS statistics show. Of those, nearly 13 percent were return ER visitors within a months time.

In the young womans case in Gastonia, her family worries shell be one of these statistics. After being discharged last month, the woman followed up on outpatient treatment as prescribed by the hospital, says her grandmother, but more waiting may be in the future.

The local outpatient treatment facility shes enrolled in has some wait times for appointments the young woman will need, her grandmother told the Observer Tuesday.

Ill do anything, says the grandmother, who adopted her granddaughter around her first birthday. I want to get her good help now.

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Hooked on heroin, she sat 2 days in an ER. Hospitals say you pay for this stay, too. – Charlotte Observer


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


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


RWJUH’s Emergency Room growing in size, scope –

RWJUH in New Brunswick is hosting a two year $60 million Emergency Department expansion project that will see state-of-the-art advancements and improved privacy, access and flow for patients. Wochit

A redesigned and revamped Emergency Department with three trauma bays is part of the Robert Wood Johnson University Hospital in New Brunswick’s expansion project. RWJUH is undergoing a two-year $60 million Emergency Department expansion that will see state-of-the-art advancements and improved privacy, access and flow for patients.(Photo: ~Courtesy of Robert Wood Johnson University Hospital, New Brunswick)

NEWBRUNSWICK Robert Wood Johnson University Hospitalis going through a growth spurt doubling the size and quadrupling the scope of its Emergency Department (ED). Yet, through these major changes, the EDremains open for business, almost oblivious to the goings-on outside.

In the not-so-distant future, the current RWJUHEDwill becomefocused even more on patient needs andaccess, said John Gantner, CEO and president of RWJUH in New Brunswick. He called the project a “bold undertaking.”

“This is no ordinary community hospital ER,” he said. “A lot of thought has been put into this. It is all about access and unique populations such as behavioral health, infectious disease, trauma patients, pediatric patients and it is what you would expect from an academic health center that is catering at a different level to the communities we serve.The important message is the uniqueness of the project and that is really designed about access and will be an extraordinary ER.”

All services will continue to be offered in a non-disruptive fashion, Gantner said.

“The ER is a source for most of the patients who come into the hospital they come in through the ER,” he said. “So when you entertain a project like this, it disrupts the normal access of flow of patients coming into the facility.There’s some dirt being moved around, but Robert Wood is still in business 100 percent.”

As of June 14, the Emergency Department expansion’s Phase II began. This phase is expected to last six weeks. All vehicles and visitors seeking treatment must access RWJUHs Emergency Department via the intersection of Easton Avenue and Little Albany Street during this time. During this time, this area will be used entirely for Emergency Department and patient-related services. Any non-emergency related drop-offs/pick-ups, deliveries or activities will not be permitted as this project continues. The hospital advises that alternate arrangements should be made. Vehicles entering Rutgers Cancer Institute of New Jersey should access Little Albany Street via Easton Avenue.

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The EDexpansion projectis a direct response to an increasing need for emergency medicine and trauma care services in the greater Central New Jersey area, said Michael Valendo, assistant vice president, nursing and patient services at RWJUH.To cater to this need,RWJUH and RWJ Barnabas Healthlaunched theambitious project, which expands RWJUHs current ED50 percent from 40,000 to 60,000 square feet and its patient load capability from 42to 100 individuals.

“We had outgrown that space,” said Lori Colineri, senior vice president and chief nursing officer at RWJUH.

RWJUH sees about 96,000 pediatricand adult visits each year,said Leigh Anne Schmidt, nursing director for the RWJUH Emergency Department.

“We did some modeling and see it going north of six figures in the next decade,” Valendo said.”To the 110 to 115,000 visit rangebased on demographics in the community and population growth.”

“We have grown every year,” Schmidt said. “It was very important to have the capacity and make sure we are not opening in full the first day.”

Composed of seven different projects, the ED expansion in its entirety is expected to cost $60 million.That includes more than constructionand incorporates movement ofvariousdepartments, including the Respiratory Care Department and some patient units, internally,FaithOrsini, administrative director, construction services at RWJUH. Further, the Rutgers University Clinical Research Department formerly housed in the hospital is movingto the nearby East Tower building.That opened up a great deal of space for the project.

The Emergency Department remains openduring the construction period which is expected to be completed in 2019.

“The majority of the clinical parts of the Emergency Department will be done in two years,” Orsini said. “There will be some tail-end pieces, like offices and back-house space that will go into 2020, but the majority will be done within the firstphases about one-and-a-halfto two years.”

Work is being done to regrade and rework Little Albany Street for new ambulance and front entrances as part of Robert Wood Johnson University Hospital in New Brunswick’s Emergency Department expansion project. RWJUH is undergoing a two-year $60 million Emergency Department expansion project that will see state-of-the-art advancements and improved privacy, access and flow for patients.(Photo: Cheryl Makin/Staff Photo)

The project started in March with exterior construction with thedropping down of 28-inches of Little Albany Street in front of the ED entrance and the establishment of new ambulance and front walk-in entrances.

This work also will allow a new ambulance bay better structured to the needs ofEmergency Medical Services (EMS), emergency and ambulance professionals. The current ambulance bay goes under the building and that areawill be recaptured for interior space, Orsini said.

“The new real estate we get is crucial,” she said. “This allows us to do construction without impacting the operations inside. All of our phasing for the project is on the order of not affecting the daily operations.”

READ:Old Bridge mom loses weight thanks to RWJUH

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A new ambulance bay will accommodate eight ambulances at one time. During the planning phase, several local EMSproviders had the opportunity to giveinput on the design.

“This will help our EMS providers too,”Valendo said. “It is much more efficient area for them than what we currently have. There will be an increase in capacity and we have some dedicated space for them not only for their equipment but for their staff as well. That is something we currently don’t have.”

A redesigned and revamped Emergency Department with private rooms is part of the Robert Wood Johnson University Hospital in New Brunswick’s expansion project. RWJUH is undergoing a two-year $60 million Emergency Department expansion that will see state-of-the-art advancements and improved privacy, access and flow for patients.(Photo: ~Courtesy of Robert Wood Johnson University Hospital, New Brunswick)

Interior construction is expected to begin shortly after a shuffle of departments and offices are complete, Orsini said.

Once complete, the Emergency Department will feature more than 100 private treatment areas for patients with sliding glass doors, as opposed to the current curtained areas. There will be three additional new state-of-the-art trauma bays that can run two traumas at a time if need be.

“That would be six trauma patients at a time,” Orsini said. “And they are being designed pretty close to operating room standard.”

The expanded space also offers patients radiology imaging in the department, adjacentto the trauma area. That detail can potentially reduce wait times for test results, Orsini said.

“The minutes that we can save can potentially save lives,” Valendo said.

A redesigned and revamped Pediatric Emergency Department with sensitivity to special-needs patients is part of the Robert Wood Johnson University Hospital in New Brunswick’s expansion project. RWJUH is undergoing a two-year $60 million Emergency Department expansion project that will see state-of-the-art advancements and improved privacy, access and flow for patients.(Photo: ~Courtesy of Robert Wood Johnson University Hospital New Brunswick)

The Pediatrics ED, already a part of the current facility, will be relocated to near the front door.

“It’s current location is not necessarily ideal,” Orsinisaid. “Your sickest adults come in by way of ambulance, but your sickest pediatric patients come in their parents’ car. So we will be able to peel those patients off almost immediately as they reach the front door.”

The Pediatrics EDalso willberevamped with special consideration given to sensory and visual needs of autistic and special needs patients with different flooring, lighting, furniture and paint. There will be a special room, called a “Snoezelen”room that is a controlled multi-sensory environment.

“A good population of our pediatric patients are special needs and the sensory and the environment is so crucial to keep them in a calm setting and in designing a new pediatrics ED we would miss the opportunity if we didn’t incorporate this into it at this point,” Colineri said. “Environment is key.”

The unit will remain able to see 17 patients at a time but now with private rooms, a play area and a waiting room housed within the Pediatrics ED.

The new ED model will have a dedicatedinfectious disease room that will be able to segregate those patients immediately. It is able to be accessed from outside, Orsini said.RWJUH is designated as the hospital in the state that handlesglobal diseases, such as Ebola, and has specific trained staff to handle such cases.

Another new section is a 12-room dedicatedbehavioral health/mental health suite, which all agreed is a “critical” addition. There are also several internal family support areas that will be situated throughout the ED.

The new ED’s flow model includesa fast-track option for patients who arrive at the department with less emergent diagnoses, Colineri said.

“It will allow patients to get in and out quicker,” she said.

A redesigned and revamped Emergency Department with private rooms is part of the Robert Wood Johnson University Hospital in New Brunswick’s expansion project. RWJUH is undergoing a two-year $60 million Emergency Department expansion that will see state-of-the-art advancements and improved privacy, access and flow for patients.(Photo: ~Courtesy of Robert Wood Johnson University Hospital, New Brunswick)

Colineri said it is important for RWJUH to take into consideration what patients and families need.

“When we listen to the voice of the customer, we listen to things like privacy and flow gettingin and out quickly,getting to see their doctor or the person who is going to treat them the quickest,” Colineri said. “So those are the things in the design the flow and the redesign of the emergency room to meet the needs of our patients and families. Get them the quickest service of the highest quality and the safest care and package that.”

Though valet parking is being encouraged at this time due to the outside construction, the parking deck will remain the same. Consumers can either valet park at the hospital entrance on Somerset Street or self-park through the Easton Avenue entrance. Valet parking is open 24 hours during this phase. New Brunswick police also are on site to aid with the safety and direct consumers in the construction area.

The project has several professionals working on the project including John Huddy of Huddy Healthcare Solutions of Fort Mill, South Carolina for space planning and strategic planning, architect Francis Huddy of Philadelphia, DCC Design Group of Wilmington, Delaware for interior design, Langan Engineering of Parsippanyfor civil engineering, Highland Associates of Summit, Pennsylvaniafor MEP (mechanical, electrical and plumbing) engineering and O’Donnell & Naccaratowith offices inPhiladelphia, Bethlehem, Pennsylvania and Mountainsidefor structural engineering.

For more information about the the hospital system, visit

Staff Writer Cheryl Makin:732-565-7256;

Work is being done to regrade and rework Little Albany Street for new ambulance and front entrances as part of Robert Wood Johnson University Hospital in New Brunswick’s Emergency Department expansion project. RWJUH is undergoing a two-year $60 million Emergency Department expansion that will see state-of-the-art advancements and improved privacy, access and flow for patients.(Photo: Cheryl Makin/Staff Photo)

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RWJUH’s Emergency Room growing in size, scope –


EMTs bring the emergency room to the patient –

EMTs, ambulance crews trained to respond quickly to medical emergencies, trauma situations and accidents, are a critical but often overshadowed component of public safety

By Susan Spencer Telegram & Gazette, Worcester, Mass.

WORCESTER They’ve pulled injured people out of burning buildings, performed ice rescues, delivered babies while on the road, started IVs and intubations in the back of a truck, and revived far too many people who have overdosed on opioids with their ever-present supply of Narcan.

Emergency medical technicians, ambulance crews trained to respond quickly to medical emergencies, trauma situations and accidents, are a critical but often overshadowed component of public safety.

They’ll be found working in what one EMT called “a well-choreographed dance” with firefighters and police officers anytime a 911 call comes in. But often the role of emergency medical services as health care providers gets lost from public view in the tidy news summary that a patient was rushed to the hospital.

May 21-27 is the 43rd annual National EMS Week, in which the National Association of EMTs, in partnership with the American College of Emergency Physicians, seeks to recognize the vital contribution of EMTs to community health and safety.

A Telegram & Gazette reporter and photographer rode along with Worcester Emergency Medical Services paramedics this week, getting a view from the road of calamities large and small. On these days, it was mainly the everyday stuff of age, illness and disability — perhaps not dramatic, but the conditions and events that ultimately take their toll on most people.

Worcester EMS is a clinical department of UMass Memorial Medical Center. With approximately 90 paramedics, EMTs who have the highest level of training, Worcester EMS contracts with Worcester and Shrewsbury to provide around-the-clock coverage.

Seven ambulances drive all day in Worcester and four handle the nights. Shrewsbury has one ambulance assigned during the day and one at night, but Worcester will cover for Shrewsbury if needed.

In addition to the ambulances, supervisors, who are also paramedics, ride the streets in two Chevrolet Tahoes or a Suburban, outfitted with communications equipment and medical supply bags, to direct emergency response, coordinate with police and fire departments, or provide backup.

Serious situations or not, Worcester EMS gets 40,000 calls per year between the two communities, averaging 90 to 115 a day, according to Capt. Mark Wilson, one of four captains in charge of the department.

Capt. Wilson has worked with EMS since 1980 when it was operated out of Worcester City Hospital. It moved in 1991 to what was then UMass Medical Center.

“The whole city has changed. Every intersection is different from when I started,” he said.

What used to be eight hospitals receiving emergency patients is now three. The population has increased too, as has the proportion of people who call EMS.

Capt. Wilson said, “People are using the emergency system more as primary care. It’s a lot more busy.”

Emergency 911 calls go to the Worcester Emergency Communications Center, which dispatches to the appropriate agency — fire, police or EMS. Most calls now come in by cellphone, however, and those first get routed to Massachusetts State Police in Weston and then to the local community.

Worcester Regional Transit Authority buses can also radio EMS.

According to Capt. Wilson, the EMS system is moving in the next year to have cellphone calls go to the closest EMS department. Text messages and FaceTime video calls are also on the horizon.

“You can get 15 calls in 45 minutes,” Capt. Wilson said. And although some people call an ambulance so they don’t have to pay for a cab to the hospital, “We’re required to respond, by the commonwealth. We cannot make that judgment over the phone.”

The high volume and variety of calls Worcester EMS handles have made it one of the most active departments in the state and a place where even paramedics from Boston come to sharpen their skills.

Christian Grant, 25, is one of those who started his career with Worcester EMS, then got a full-time job with Boston MedFlight air ambulance. But he still works 30 to 40 hours a week as a per diem paramedic in Worcester.

Waiting for a call at the former Providence Street fire station, one of three ambulance hubs in the city, he said, “One of the bigger things here is you deal with everything. You are on all the calls.”

Violence, drugs, Mr. Grant has worked on it. “This is a very addicting place to work,” he said.

Worcester EMS crews are stationed at garages at 23 Wells St. and UMass Memorial’s University Campus on Lake Avenue, in addition to Providence Street, to get to calls throughout the city as quickly as possible. In Shrewsbury, the ambulance is based at the Harrington Street fire station.

Driving through Worcester’s narrow streets, including unpaved residential neighborhoods, is a constant challenge. The DCU area downtown “is a nightmare,” Capt. Wilson said, especially in the afternoon and evening when school buses and commuters are on the road.

“Drivers have gotten better (about letting EMS through),” he said. “But the biggest thing is they don’t come to a stop.” And while bicycles haven’t been much of an obstacle, pedestrians who aren’t in crosswalks and aren’t paying attention present another hazard.

The radio crackled as Capt. Wilson drove around the city in the SUV on a recent weekday afternoon. An iPad on the console showed the location of the ambulances.

A call came in from 67 Belmont St., a medical office building at UMass Memorial’s Memorial Campus. An elderly woman had fallen when coming in from the parking lot, suffering a cut over her eye.

Capt. Wilson turned on the siren in bursts, which has been shown to be more effective in gaining drivers’ attention than a continuous siren, and arrived first on the scene. He jumped out of the SUV, medical bag in hand, and started checking the patient’s condition.

Soon police, firefighters and an ambulance arrived, with paramedics Evan Kirby and Eric Laighton, who took over care of the patient. Although the injury didn’t appear life-threatening, the paramedics placed the woman on a stretcher and took her to St. Vincent Hospital.

The scene was quickly repeated with a call to East Mountain Street, where a man in his 40s was suspected of having a stroke.

In addition to police and firefighters, Worcester EMS paramedics Darren Brock and Andrew Person were on the scene, assisting the patient.

Worcester EMS paramedics started an intravenous line in the patient and transported him to UMass Memorial’s University Campus emergency department.

From the second they arrive at the hospital, EMTs have 20 minutes to check the patient in, bring the patient to the treatment room, give the resource nurse all the necessary medical information, and then clean and prepare their ambulance for the next patient. It’s a precision operation, requiring an ability to focus calmly while multitasking.

Another call came in for a combative patient in an altered state, whom paramedics Patrick Ring and Eddie Murphy interviewed and took to UMass Memorial for an emergency mental health referral.

Capt. Wilson said the number of people in police custody has increased over the years, whether they’re intoxicated or having a mental health crisis.

“It’s important to use your persuasion skills and to listen,” he said. Some communities include social workers with EMTs to help with these calls.

Most of the time, though, Capt. Wilson said, “You see a lot of medical issues. With the baby boomer population, there’s an influx of heart, aging, diabetic, respiratory issues. Everyone who’s young thinks it isn’t going to happen to them, until it happens to them.”

And then there are the motor vehicle crashes, such as the next call. A “rollover with entrapment” was on Acton Street. The driver, a woman who was alone in the car, had been wearing her seat belt and was uninjured as she stood up in the car, which was resting on its driver’s side. Firefighters needed to stabilize the car before they could get her out.

Once she was safely extricated, EMTs sat the woman on a stretcher and assessed her condition, but she declined further treatment.

Capt. Wilson said improved safety features and more people wearing seat belts have cut down on serious vehicle-related injuries. “The biggest thing is, you don’t get ejected from the vehicle if you wear a seat belt,” he said. Injuries suffered in the vehicle are usually minor.

On another afternoon, EMS supervisor Bill Humphrey drove around during an unusually quiet spell, after a nonstop morning. A few calls came in, one for an elderly man with a fever and shortness of breath, and another for a middle-aged woman with suspected seizure who was described as “in an altered state.”

Paramedics, firefighters and police officers efficiently did their jobs, with compassion and attentiveness to each patient. Vital signs were checked and IVs were started.

“It’s a version of the emergency room coming to the patient,” Mr. Humphrey said.

Efforts to professionalize emergency medical services took off in 1976, with the passage of a federal law outlining training and equipment standards. The field has been building research to improve pre-hospital emergency care, which means EMTs must keep training and gaining experience. Among the updated practices, for instance, studies found that backboards generally aren’t as important as a cervical collar to stabilize the spine, for patients under age 65.

EMTs have to be recertified by the state Department of Public Health’s Office of Emergency Medical Services every two years, which requires 60 hours of continuing education.

The wage for new paramedics starts around $16 an hour, according to Mr. Humphrey, and it goes up slowly to around $22 an hour.

“EMS is in its infancy,” he said. “It’s still working on itself.” ___ (c)2017 Telegram & Gazette, Worcester, Mass.

McClatchy-Tribune News Service

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7 of the Most Bizarre Reasons People End up in the Emergency Room – The Cheat Sheet

Emergency room staff see some crazy stuff, but you may be surprised to hear its not always the drama-filled scenes you see on TV. Theres a reason shows like Nurse Jackie and ER have such a loyal fan base, after all. A pill-popping ER nurse, fighting her own addiction, and a string of dramatic trauma cases are far more entertaining than patients with headaches and sprained fingers.

But the truth is emergency rooms tend to be a bit more low-key on a day-to-day basis they may even be weirder than you would think. Here are seven of the the most bizarre reasons people end up in the emergency room.

There are some fairly unusual reasons people visit the emergency room. Just take a look at this graph compiled by FlowingData, for instance.The data, which was collected in 2014 by the Consumer Product Safety Commission, shows just how random ER injuries can be. One worth mentioning has to do with ruining an otherwise perfect day of fun in the sun: Emergency rooms across the U.S. saw 1,231 beach chair-related injuries in June alone. Talk about spoiling a day at the beach.

Having any sort of reaction appear on your skin can be cause for concern. But theres no need to take it upon yourself to diagnose it as a much more serious disease, at least not before youve actually heard a doctors opinion.

One Reddit user said, I have patients who develop a rash, look it up on WebMD, and come to me screaming that they must have Stevens-Johnson Syndrome. Fast forward to the exam part of an ER visit, and the most common diagnosis is contact dermatitis from laundry soap. Reddit does go on to say, however, that although Stevens-Johnson syndrome is very rare, you should see a doctor immediately if you develop a rash after taking a new medication.

If that skin rash is due to contact dermatitis, theres no reason to panic. In most cases its not necessarily all that serious, and could even go away on its own. In fact, according to the American Academy of Dermatology, Almost everyone gets this type of eczema at least once. We get contact dermatitis when something that our skin touches causes a rash. Some rashes happen immediately. Most take time to appear. Irritants can include bleach, nickel, and latex gloves.

Foreign objects are a big one, and theres a wide range of them that can cause enough harm where an ER visit is in order. One Reddit usersayshe sees a lot of this one. Ear wax is NOT your enemy. It protects your ears it has antibacterial and antifungal properties, and is absorbent. Not a week goes by without a consultant for blood in the ear due to a Q-tip, or a ruptured drum from puncturing it with a foreign object, or a thermal injury from ear candling. It is NOT DIRT. So, you might want toease up on your cotton swabusage.

If youre cringing right now thinking about getting hooked, or hooking your friend in a not so pleasant place, know it is very possible. According to the American Academy of Family Physicians, fishhooks are right up there with splinters and glass. Most fishhook injuries occur in the hand, face or scalp, upper extremity, or foot, the organization says. Fishhooks in the eyelid or eye require immediate ophthalmologic referral. Just thinking about a hook in the eye is enough to send a person to the ER.

In the same vein, actually ingesting foreign objects can cause a well-deserved trip to the ER. While this may sound pretty ludicrous, it does happen.Vice polled a few medical professionals about some of the bizarre things ER docs see. In one response, the physician mentioned how those with mental health problems often engage in self-harming behavior. Unfortunately, it seems some emergency rooms are no strangers to people who consistently swallow harmful objects; knives, in particular.

Onehealthcare professional told Vice there are lots of well-known people who swallow knives, moving around from one hospital to the next. And interestingly enough, trying to remove such objects can be more dangerous than leaving them. The surgeons wont really operate on them unless theyve perforated some part of their gastrointestinal track, Vice explains. Sometimes they wont even operate on them anyways because theyre just going to do it again. So we just manage their symptoms. Ouch.

You dont often worry about grill tools being cause for concern, but the bristles on wire grill brushes have been known to get stuck on grills, resulting in transfer towhatever you happen to be cooking at the moment. While the numbers arent staggering, it does happen. Using data projections from the Consumer Product Safety Commissions National Electronic Injury Surveillance System, researchers estimate more than 1,600 ER visitswere a result of ingesting wire bristle grill brushes between2002 to 2014. Again, not staggering, but something to keep in mind.

BBQ-goers and chefs alike should be well-educated on the products theyre using. And according to Fox News, there are some precautions you can take to make sure you dont end up in the ER thanks to a bristle-loaded burger.

For instance, only use quality tools, thoroughly clean your grill and tools, and prepare the meat properly. And probably most importantly, make sure youre paying attention. Its easy to throw meat on the grill and walk away to socialize, but keeping a watchful eye on your meal can makea big difference.

Similar to our first point, this one also comes from FlowingDatas visual, which includes injury data collected by the Consumer Product Safety Commission. Injuries relatedbeds or bed frames comes in at No. 3 on the list. (If youre wondering what took the No. 1 and No. 2 spots, it was stairs/steps at 1,135,343 ER visits in 2014 and floors/flooring materials at 1,131,428 ER visits in 2014. But those two seemed a little less unusual, seeing as falling down stairs, or even tumbles due to slippery floors are quite common.)

Beds and bed frames accounted for 620,302 ER visits in 2014,which seems remarkablyhigh. It seemslike more of a user error issue, if you really think about it.

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7 of the Most Bizarre Reasons People End up in the Emergency Room – The Cheat Sheet


Augusta Health eyes $22 million ER expansion | Business … – The Daily Progress

FISHERSVILLE Augusta Health’s emergency room trafficgrew to nearly 62,000 patients last year almost twice the number it was built to serve when the hospital opened more than 20 years ago.

The community hospital’s emergencydepartment was built to serve 35,000 patients, so with the increase in traffic, some patients end up having to be served in hallways or corridors during especially busy times in the ER.

In addition to the increase in patient visits, the past two decades have seen signficant innovations in both medical equipment and technology in the emergency department. That’s been a blessing from a health perspective, but a challenge given the space requirements some of the new devices and procedures require.

But the space crunch will soon be a thing of the past. Augusta Health on Wednesday announced plans for a $22 million expansion and renovation of the emergency department. A groundbreaking adjacent to the existing emergency department was also held Wednesday in conjunction with the announcement.

The plans call for a 33,000-square-foot, two-story addition, along with the renovation of the existing 17,500 square feet. The addition will include 16,288 square feet of “shelled space” for future use. Completion of the project is set for 2019.

“This will give us a better space to take care of patients,” said Dr. Adam Rochman, medical director of the emergency department. Rochman said treating patients in a hallway “is less than ideal.”

The project calls for 48 large, walled, private rooms and dedicated areas for stroke, heart attack and other trauma cases. Family consultation areas for private conversations and meetings with doctors are included in the plans, as is enhanced work space for EMS, police and mental health professionals. A new ambulatory entrance with a canopy will also be built.

Augusta Health President and CEO Mary Mannix said the hospital is not only seeing more patients, but patients of “higher acuity with trauma, strokes and heart attacks.”

Mannix said the addition and renovation will allow the hospital to grow along withe the communities it serves.

“We are really excited to up our game,” she said.

Approximately $20 million of the emergency department upgrade has been approved by the hospital board. And a $2 million capital campaign has been authorized by the Augusta HealthFoundation board of directors.

Leading the $2 million “Moments Matter” campaign is Jim Perkins, the retired president of Blue Ridge Community College.

“This is a very important project forour community,” said Perkins, who saidseveral members of his family havevisited theemergency department over the years, including his 95-year-old mother.

And while Perkins praised “the tremendous care” of the emergency department’s doctors and nurses, he said the present cramped facilityis not indicative of the high standard of care the hospital offers.

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Augusta Health eyes $22 million ER expansion | Business … – The Daily Progress


More patients can avoid hospital admissions after emergency room visits for diverticulitis – Medical Xpress

April 25, 2017

About 150,000 people are admitted to hospitals each year for diverticulitis,1 an inflammation of an outgrowth or pouching in the colon that can cause severe abdominal pain. Furthermore, emergency room (ER) visits for diverticulitis have increased 21 percent in recent years.2 However, these ER visits don’t have to land patients in the hospital as frequently as they do, according to new findings published as an “article in press” on the Journal of the American College of Surgeons website in advance of print publication. A study of patients with diverticulitis who went to emergency rooms in a Minnesota health system found that about half of those admitted could have been sent home at significant savings to not only the health care system, but to the individual patients as well.

Researchers at the University of Minnesota, Minneapolis, reported that most patients with uncomplicated diverticulitis could safely go home with a prescription for oral antibiotics after their ER visits with a very low risk of returning to the hospital. “While that finding may not seem surprising to most surgeons, it is a poorly studied topic in the United States, and gathering some data on this occurrence is important to clarify in terms of whether there are even more people seen in the emergency room who could be safely managed at home,” said lead study author Mary Kwaan, MD, MPH, FACS, assistant professor of surgery, division of colon and rectal surgery, department of surgery, University of Minnesota. National statistics have shown that only 15 percent of patients with diverticulitis who go to the emergency room need an operation right away.1

Complicated diverticulitis involves a small perforation of the pouching or outgrowth of the colon that is visible on a computerized tomography (CT) scan, whereas uncomplicated diverticulitis is defined as no identifiable perforation on a CT scan. Extreme cases involve a large perforation of the colon with peritonitis, which is inflammation of the abdomen. The goal of treatment is to relieve symptoms, typically of abdominal pain and inflammation, and to restore normal bowel function. Severe cases often require surgery. CT scanning is essential in the diagnosis of diverticulitis. “The CT scan provides us with a surrogate for determining the severity of perforation one has suffered,” Dr. Kwaan said.

The researchers evaluated 240 patients treated in five hospital emergency rooms in the Fairview Health System, which includes University of Minnesota Health, from September 2010 through January 2012; 144 (60 percent) were admitted to the hospital and 96 (40 percent) were discharged to their homes on oral antibiotics.

Admitted patients were more likely to be age 65 years or older, have other health problems, take steroids to treat inflammation or agents that suppressed their immune system, have excess air in the digestive system, or have an abscess or perforation in the diverticular area as seen on a CT scan. Among those patients discharged from the emergency room, 12.5 percent returned to the ER or were admitted to the hospital within 30 days, and only one patient required emergency surgery, but not until 20 months later. “That [finding] didn’t seem to be a high rate,” Dr. Kwaan said. For the patients who were admitted from their emergency room visit, the hospital readmission rate was slightly higher, at 15 percent.

Dr. Kwaan and coauthors found that 53 percent of the admitted patients in their study could be safely discharged home. They used a standard that Margaret Greenwood-Ericksen, MD,2 and colleagues at Brigham and Women’s Hospital, Boston, had developed for determining low-risk diverticulitis.

Two key factors the researchers found that determined the severity of diverticulitis were high fever and high white blood cell counts. In low-risk patients, “we found that few patients had high fevers and most patients had normal or mildly elevated white blood cell counts,” Dr. Kwaan said.

While the study is relatively small, Dr. Kwaan noted it is significant because it involved several emergency rooms across one health system. It also confirms findings of an earlier randomized clinical trial in Spain that concluded outpatient treatment is safe in selected cases of uncomplicated diverticulitis.3

Dr. Kwaan said physicians and hospitals could use the Minnesota study findings to develop protocols for emergency room doctors to better treat diverticulitis. “As a result of this study, a checklist approach to patient and CT characteristics can prompt a protocol that allows an emergency room doctor to quickly sort out whether or not the patient needs a surgical consult or whether they need to be admitted to the hospital, and then whether they can be safely discharged home,” she said. She and her colleagues are collaborating with ER physicians to develop such protocols in their health system. The next step would be to create a feedback loop to monitor the effectiveness of the protocol.

Avoiding unnecessary hospitalizations is important for reducing health care costs and applying hospital resources more effectively. “Diverticulitis is quite a common disease, and there is a general movement among hospitals toward being more strategic with their resources,” Dr. Kwaan said. “Unnecessary hospital admissions cost the system and potentially expose patients to hospital-acquired infections.”

Explore further: Antibiotics may be inappropriate for uncomplicated diverticulitis

More information: Diverticulitis diagnosed in the emergency room: is it safe to discharge home? Journal of the American College of Surgeons. DOI:

1. Etzioni DA, Mack TM, Beart RW, Kaiser AM. Diverticulitis in the United States: 1998-2005: changing patterns of disease and treatment. Ann Surg. 2009 Feb;249(2):210-17.

2. Greenwood-Ericksen MB, Havens JM, Ma J, et al. Trends in hospital admission and surgical procedures following ED visits for diverticulitis. W J Emerg Med. 2016 Jul;17(4):409-17.

3. Biondo S, Golda T, Kreisler E, et al. Outpatient versus hospitalization management for uncomplicated diverticulitis: A prospective, multicenter randomized clinical trial (DIVER trial). Ann Surg. 2014 Jan;259(1):38-44.

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Vlad V. Simianu, M.D., M.P.H., of the University of Washington, Seattle, and colleagues examined patterns of episodes of diverticulitis before surgery and factors associated with earlier interventions using inpatient, outpatient, …

(HealthDay)Younger patients do not have worse clinical presentation of acute diverticulitis, according to a study published online April 23 in the Journal of Digestive Diseases.

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More patients can avoid hospital admissions after emergency room visits for diverticulitis – Medical Xpress