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Summer months bring rise in emergency room visits – Florida Times-Union

Summertime in Florida brings warm weather, beach trips and outdoor activities as children are out of school and families enjoy vacations.

All can be fun, but also have inherent risks and increases in injuries.

Close to 20 percent of adults and more than 17 percent of children every year visit an emergency room.

About 27 percent of visits are in the summer months, according to the Centers for Disease Control and Prevention.

In Florida, we are faced with a unique set of problems that can result in drownings from rip currents in the ocean to heat-related illnesses and dangerous sunburns.

Some other common injuries and illnesses seen in emergency rooms in the summer include motor vehicle accidents, watersports-related injuries, snake bites, shark bites, bug bites, spinal injuries and other traumatic injuries.

But there are many ways to stay safe while enjoying all the fun summer has to offer.

Wear sunscreen that is SPF 30 or higher and reapply frequently

Limit your time in the extreme heat and direct sun and wear sun protective clothing

The suns rays are most harmful between 10 a.m. and 4 p.m. If youre out during these times, seek shade under a tree, shelter or an umbrella.

Stay hydrated throughout the day

Learn CPR and other life-saving techniques

Be sure to wear your seatbelt at all times

In the summer, the temperature inside a parked car can reach 140 degrees. Never leave a child or a pet inside a parked car even if the windows are cracked or the car is parked in the shade.

Water safety is also essential. The CDC reports that from 2005 to 2014 there were an average of 3,536 fatal unintentional drownings (non-boating related) annually in the United States about ten deaths per day. An additional 332 people died each year from drowning in boating-related incidents.

Drowning is the leading cause of death among children between 1 and 4 and the second leading injury-related cause of death in older children, with nearly 800 children drowning each year nationally, according to Safe Kids Northeast Florida, led by THE PLAYERS Center for Child Health at Wolfson Childrens Hospital. More than half are under age 5.

More than 5,000 children nationally are seen in emergency rooms for injuries from near-drowning incidents.

According to Safe Kids Northeast Florida, studies show that although 90 percent of parents say they supervise their children while swimming, many acknowledge that they engage in other distracting activities at the same time like talking, eating, reading or taking care of another child. Even a near-drowning can have lifelong consequences.

With all the water activities in Florida, its important to also know that Floridas drowning death rate of children ages 1 to 4 has historically been the highest in the nation.

Children need to be watched carefully and at a close distance while also avoiding any distractions. Use life jackets when boating and ensure that yourself and children know basic swimming skills. If you have a pool, be sure it is fenced off and safeguards are in place to protect children from getting inside unsupervised.

When it comes to the outdoors, children and adults also need to be careful where they walk and play because they may come face-to-face with critters, including snakes.

Summer is snake season and Florida is especially dangerous with several poisonous snakes commonly roaming the area.

Avoid high-brush areas and if you see a snake, do not approach or pick it up.

If you are bitten, seek help immediately. Do not apply a tourniquet and do not attempt to suck venom from the wound. Often times, people try to capture and bring in the snake when they go to the emergency room. But that is actually more dangerous and does not help with treatment. Instead, remember the snakes color and shape to describe to medical personnel.

The key to summer fun is to just be cautious and take necessary precautions to keep you and your family safe.

Brandi Gilchrist, MD, is board-certified as an emergency medical specialist. She is medical director of Baptist Emergency at Town Center and assistant medical director of the emergency department at Baptist Medical Center Beaches, 1350 13th Avenue South, Jacksonville Beach, FL 32250.

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Herman: How my drinking problem sent me to the emergency room – MyStatesman.com

I had a little (real little) medical incident the other day. All is well, and, more importantly, I did prove a medical theory of mine. This all stems from a drinking problem: Apparently, I dont drink enough.

I recently opined to friends and family that it is my semi-informed belief that before you reach the point of dehydration youll get thirsty. Kind of like youll get hungry before you starve. The body is a wonderful thing, equipped with all kinds of warning devices were free to ignore.

So it was fortuitous that I recently had the opportunity to test whether one indeed will get thirsty prior to getting dehydrated. Obviously, one has to reach the point of dehydration (which I maintain is beyond thirst) to run this test. So, in the name of research, I reached the point of dehydration. Youre welcome. And the short answer is yes, I did get thirsty before I was pushed on a gurney dehydrated into the ambulance.

RELATED: 10 tips for staying cool while running in the summer

This excitement went down when I couldnt get up last Saturday during a morning bike ride that started at 8 a.m. in Northwest Hills and ended in early afternoon in North Austin Medical Centers efficient (and well air-conditioned) emergency room.

Just over 28 miles into what would have been a 28.2 mile ride a routine distance for me and, lest you judge my mph, this ride included a leisurely breakfast stop at Sweetish Hill (and lest you judge my breakfast, it was eggish, not sweetish) fellow American-Statesman staffer and cyclist Ralph K.M. Haurwitz and I turned into Anderson High School to take a look at the new robotics building. After rolling by that, we dismounted to watch an inning of the adult baseball league game underway at the high school.

I felt a bit fatigued, hot and thirsty after a westbound, mildly uphill stretch of Steck Avenue, but nothing serious. Things got more serious when I tried to stand up and felt my field of vision narrowing like a curtain closing as nausea brewed within. I told Haurwitz to give me a few moments and Id be fine. I wasnt. I actually got less fine pretty quickly as seated on the bleachers advanced to prone on the ground. I still thought Id be OK, though I was pretty sure Haurwitz would not offer mouth-to-mouth resuscitation if needed.

So there was that.

Haurwitz quickly realized this was not going to end with me getting back on the bike and pedaling the few blocks back to my house. And I quickly realized I was on the verge of a Saturday nap. Dont get me wrong. Im pro-Saturday naps, but the scheduled, voluntary kind watching televised baseball in a comfy chair, not the unscheduled, involuntary kind watching live baseball prone on the ground.

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One thing led to another, though I dont remember all of them. Haurwitz later told me the real action began when he yelled Emergency! and called 911. Folks on hand for the baseball game gathered to help as I sat in a chair, apparently un- or semiconscious for a few seconds. (And here is where its OK for you to say, Oh, kind of like when you write columns?)

I recall some conversation, not including me, about the approaching ambulance. And I recall the two friendly and helpful EMS guys (I wish I got their names; thanks, guys) moving quickly to assess my situation by asking three questions, including one intended to shock my heart back to pumping if it had stopped:

Who is the president of the United States? he asked.

I answered correctly, somehow opting not to offer editorial comment. (Imagine the battery of psychological exams that would have ensued if, a mere three years ago, youd have answered that question with Donald J. Trump.) He also asked me what city we were in and, attempting to trip me up, added a math question: How many dimes in a dollar? Not bragging here, but I aced the exam.

They hooked me up to some fluids as I shared with them the coincidence of this happening a few days after my official pronouncement of my theory about thirst and dehydration. By the way, they agreed that youll get thirsty en route to dehydration.

I felt much better by the time we got to the hospital, where, shortly after being wheeled into a chilly ER treatment room, I quickly realized my next challenge might be frostbite. I got to meet lots of helpful ER folks, all of whom were affable and relaxed. Must be nice to go to work in your pajamas. They ran some tests and pronounced a diagnosis of dehydration and syncope. Id never heard of syncope until I saw it in the discharge paperwork.

You have been diagnosed with syncope (pronounced SINK-uh-pee). This is the medical term for a rapid loss of consciousness or a fainting episode. There are many causes of syncope. Some of these are life-threatening and others are not serious, it said, adding, Patients without life-threatening conditions may be sent home.

I was pleased to qualify for that. And I didnt need the hospital definition of dehydration. I know what that is. And I was correct. Its that thing beyond thirsty.

Now, having proven my point that youll get thirsty before you get dehydrated, Im working on my acceptance speech for the Nobel Prize for Medicine.

Friends, its hot out there. Youve probably not heard this from anyone, but, having road-tested this theory, let me recommend the introduction of orally administered liquids when youre thirsty. And sometimes water isnt enough. Electrolytes, yes. Alcohol, no (ever).

And, despite how you feel about it, endeavor to give the right answer, sans editorial comment, when a health care professional asks you whos the president of the United States. This is about your state of consciousness, not your state of confusion about how this particular president got to be this particular president.

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Overcharging Common in US Emergency Rooms – WebMD

By Robert Preidt

HealthDay Reporter

FRIDAY, June 2, 2017 (HealthDay News) — Americans are routinely overcharged for emergency room care, and minority and uninsured patients are most likely to face this “price gouging,” a new report suggests.

For the study, researchers analyzed 2013 billing records for more than 12,000 emergency medicine doctors nationwide.

On average, adult emergency department patients were charged 340 percent more than what Medicare pays for care ranging from stitches to a CT scan, the investigators said.

“Our study found that inequality is then further compounded on poor minority groups, who are more likely to receive services from hospitals that charge the most,” said study senior investigator Dr. Martin Makary. He is a professor of surgery at Johns Hopkins University in Baltimore.

Overall, charges ranged from 1 to 12.6 times ($100 to $12,600) more than what Medicare paid for services, the study findings showed.

Emergency departments with the highest fees were most often in for-profit hospitals in the southeastern and midwestern United States. These facilities were also more likely to serve higher numbers of uninsured, black and Hispanic patients, the researchers said.

“There are massive disparities in service costs across emergency rooms, and that price gouging is the worst for the most vulnerable populations,” Makary said in a university news release.

“This study adds to the growing pile of evidence that to address the huge disparities in health care, health-care pricing needs to be fairer and more transparent,” he said.

The findings also show the need for legislation to protect uninsured patients, the study authors said.

According to first author Tim Xu, “This is a health-care systems problem that requires state and federal legislation to protect patients.” Xu is a fourth-year medical student at Johns Hopkins.

“New York has passed a law that requires hospital and insurance companies to agree on a cost for the care so patients are not billed egregious amounts. Patients really have no way of protecting themselves from these pricing practices,” Xu added.

Makary said at least seven states have passed some form of legislation to protect uninsured patients, but he believes national regulation is needed.

The study was published May 30 in the journal JAMA Internal Medicine.

WebMD News from HealthDay

SOURCE: Johns Hopkins University, news release, May 30, 2017

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Spike in opioid visits at ECMC pushes ER doctors to front lines of epidemic – Buffalo News

Opioid-related emergency room visits at Erie County Medical Center more than doubled from 2009 to 2016, a startling rise reflective of the addiction epidemic in Western New York and across the country.

The growth mirrors an increase in opioid deaths and, like the fatalities tied to drug abuse, the patients come from every corner of the region urban, suburban and rural.

An examination of nearly 17,000 opioid-related patient visits at one of Buffalo’s busiest hospitals offers a snapshot of the epidemic, and suggests current estimates of hospital visits connected to opioid use in the region are underestimated.

Data from ECMC also reveal the central role emergency departments have come to play in the wake of the extraordinary expansion in the use of narcotic pain relievers in the United States and the growing abuse of heroin.

Among the results:

In recent years, as the opioid epidemic swept the nation, emergency room doctors have been pressured to reduce their prescribing of addictive painkillers for chronic pain.But now, so many patients arrive in emergency rooms with a history of opioid use that emergency rooms are coming to be seen as a potentially ideal place to start addiction treatment.

This represents a fundamental change for a hospital service focused on stabilizing patients with immediate medical concerns and referring them elsewhere for follow-up care.

“Emergency departments can be a real-time source of information on public health problems like this one. They can also be a foot in the door to getting people addicted to drugs the care they need,” said Dr. Ronald Moscati, an emergency room physician and co-leader of a seven-year study of opioid-related visits at the medical center. “It’s a horrible disease and very difficult to treat.”

More visits from outside the city

The review by Moscati and his colleagues attempted a truer accountingof the ways opioid use ispushing people into hospitals. Most hospitals track opioid-related visitsby looking at counts of addicted patients who arrive in emergency rooms seeking detoxification, suffering from withdrawal symptoms or having overdosed. But in many other cases such as patients who injure themselves or feel ill for other reasons opioids turn out to be a contributing factor.

ECMC sought to track allthe reasons opioid users land in the emergency room.

Of the462,983 patient visits to the ECMC emergency departmentfrom June 2009 through June 2016, 3.6 percent, or16,712,had anopioid connection, particularly patients who overdosed on drugs or requested detoxification treatment.

As the years went on,a greater share of theopioid-related visits came from outside the City of Buffalo, jumping from 42 percent in 2009 to a high of 62 percent in 2014.

Whites represented 59 percent of the patients in 2009 but, otherwise, accounted for about 82 percent of opioid-related cases each year afterward. Most of the patients 63 percent on average were male.The median age grew from 28 to 31.

The statistics include patients who may have visited the emergency room multiple times. But the researchers say the trends at ECMC represent those in the larger community because the emergency department receives a majority of the opioid overdose patients in the region, and is the only emergency department to offer specialized services for trauma, psychiatric emergencies and acute substance abuse detoxification.

Opioid-related emergency room visits at Erie County Medical Center more than doubled from 2009 to 2016. (Derek Gee/Buffalo News file photo)

“There is no mystery to what we found,” Moscati said. “We’ve confirmed in an objective way what was an impression of what is happening, and that gives us better insight for targeting education and treatment.”

The chart review, which was organized by the University at Buffalo emergency medicine department, suggests a way to improve regional surveillance of opioid trends, much like the flu and other communicable diseases are tracked. It also argues for greater involvement in addiction care by emergency medicine doctors.

“We see this as a potential way to see the changes in the overall picture over time,” said Heather Lindstrom, research director of UB Emergency Medicine and a co-author of the study.

Starting addiction treatment in the ER

Addicts looking for help confront a health system with a shortage of treatment options, especially access to buprenorphine, a medication also known as Suboxone that is used to reduce cravings. In 2015, fewer than 20 percent of people in the United States who needed addiction treatment received it, according to the National Survey on Drug Use and Health sponsored by the Department of Health and Human Services.

Emergency room doctors focus on evaluating and stabilizing seriously ill and injured patients. But as physicians, advocates and public health officials grapple with the challenges of how to deal with a mounting number of opioid addictions and overdoses, they are looking at the emergency department as a place to start addiction treatment.

“Historically, in the emergency department, we’ve given people with addiction problems a list of phone numbers for treatment at discharge after their immediate concerns have been taken care of. But too many of them leave, use again and overdose again,” said Dr. Joshua Lynch, an emergency room doctor at ECMC and Kaleida Health involved in an initiative in Erie County to establish medication-assisted addiction treatment in emergency rooms.

Opioids include the illegal drug heroin, as well as powerful pain relievers available by prescription, such as oxycodone, hydrocodone and fentanyl. Experts say an explosion in the use of prescription opioids in the past few decades led to increased use of heroin.

“There is no overnight fix. Policies have to change. The stigma of addiction has to change. Doctors need to be trained,” he said. “But we should be treating addiction like any other medical problem.”

The idea of starting treatment in the emergency room got a big boost from a 2015 Yale University study thatfound that individuals with opioid addiction who were treated with the medication buprenorphine in the emergency room were more likely to stick with treatment beyond the emergency room by a large margin 78 percent compared to 37 percent of patients who were seen in the emergency department and given a referral for care elsewhere.

Dr. Joshua Lynch in the emergency room at Millard Fillmore Suburban Hospital. (Mark Mulville/Buffalo News)

Lynch, who also chairs the hospital group in the Erie County Opiate Epidemic Task Force, said the project here will take that idea a step further with formal links between emergency departments and addiction treatment services, such as Evergreen Health and others in Buffalo. For most opioid-users, the goal is to screen potential candidates, and ensure they leave the hospital with a treatment plan and a definitive link to a place to get treated. A smaller portion who need medication would receive short-term supplies of buprenorphine or other medications, and linkage to addiction services.

None of this will be easy.

Overcoming health system challenges

Doctors must be trained and certified to prescribe buprenorphine, which is also an opioid. Currently, there are only about four emergency doctors in the area with such training, and addiction patients can be difficult to treat in a busy emergency room. To get physician buy-in, referring treatment services must be reliably available at all hours. To truly succeed, more primary care doctors must be certified in buprenorphine prescribing and willing to follow opioid-addicted patients once they have completed addiction treatment.

There are more than 900,000 doctors in the U.S. who can prescribe addictive painkillers, but only 37,000 who can prescribe buprenorphine.

“This is not just an emergency room or addiction doctor issue. The entire medical community needs to step up,” said Lynch, who anticipates starting addiction treatment at ECMC and Millard Fillmore Suburban Hospital later this year once about a dozen emergency doctors receive training to prescribe buprenorphine.

The county is seeking funding to operate the initiative as a study that will involve UBMD emergency medicine doctors affiliated the University at Buffalo and Columbia University, which has experience in designing research on substance abuse and counseling.

“We have the one study from Yale that looks promising. We want to see if the strategy is effective,” said Dr. Gale R. Burstein, county health commissioner. “But you first need to build capacity for medication-assisted treatment. There is no sense in screening people for possible treatment if there is no treatment.”

Meanwhile, the county continues to maintain a 24-hour addiction hotline, and is making slow but steady progress training primary carephysicians, nurse practitioners and physician assistants to use buprenorphine. That effort moves forward against a strong headwind. Primary care physicians have been reluctant to take on patients with drug addiction problems, especially with the need to perform regular drug testing and a common perception, real or not,that they may be held criminally liable if a patient dies of an opioid overdose.

Patient advocates like Debra Smith applaud the effort.

“One of the biggest situations families face is that someone goes to the emergency room to be stabilized, but they are released after the medical emergency is addressed. That’s their job. They save someone and then release them. The problem is it does not meet the needs of the addiction,” said Smith, whose 26-year-old son, Nathaniel, died in 2015 from an opioid overdose.

Smith, who also serves on the county’s opiate task force, said she’s impressed that physicians and public health officials here have taken the concern seriously and are doing something about it.

“They don’t have all the answers, but they’re trying to deal with this,” she said.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Allergy and Asthma Patients Flock to Emergency Rooms – Scientific … – Scientific American

The sneezing, watery eyes and runny noses from seasonal allergies are poised to land more people in the emergency room as temperatures rise, researchers have found.

In astudypublished online yesterday inGeoHealth, scientists reported that warmer winters resulting from climate change will lead to more intense pollen from oak trees, spelling more misery for allergy sufferers.

We believe that this is a health risk that has been underappreciated and is likely worsening, said lead author Susan Anenberg, an environmental scientist at Environmental Health Analytics LLC, a health research and consulting firm.

Several previous studies have shown that allergy seasons are continually getting worse as pollen gradually emerges earlier each year with greater vigor and longer duration (Climatewire, Aug. 25, 2016).

Increased carbon dioxide levels around plants like ragweed also leads to greater pollen production. For allergy sufferers, this pollen can trigger an immune response ranging from mild symptoms like headaches to severe problems like difficulty breathing.

Anenberg and her team sought to quantify the impact of this alarming allergy accrual.

The researchers looked at emergency room visits related to asthma, a common allergy complication, stemming from exposure to pollen from oak trees. This already leads to more than 20,000 emergency room trips in the United States each year, mostly for children younger than 18, with damages estimated at $10.4 million.

We picked oak pollen as a model simply because we had enough underlying data about how oak pollen is influenced by the climate, Anenberg said.

The researchers calculated emergency room visits between 1994 and 2010 across the Midwest, Northeast and Southeast in the United States. They then projected how these patterns would change under different climate scenarios.

Under a severe warming scenario, the researchers found that emergency room visits could increase 10 percent by 2090 in the studied regions as oak pollen seasons grow. A moderate warming scenario would avert half of that increase.

Anenberg acknowledged that there are some limitations and uncertainties in the study. The analysis only looked at the eastern portion of the continental United States, so its unclear whether the trend would happen farther west.

The researchers were also unable to obtain baseline daily emergency room visit rates for some of the regions in the study, so they used an annual average that likely underestimated the daily rates during pollen season.

In addition, asthma is not the only allergy-related complication that lands people in hospitals; evidence shows that cardiovascular disease worsens with pollen exposure.

The population itself is also becoming more sensitized to pollen, and asthma rates are on the rise.

For these reasons, the results likely underestimate how many hospitalizations from allergies will result from climate change.

Anenberg said the next step is to conduct similar assessments in other regions. Wed like to expand this beyond the eastern United States to other parts of the country and also around the world, she said.

Reprinted from Climatewire with permission from E&E News. E&E provides daily coverage of essential energy and environmental news atwww.eenews.net.

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Emergency Room – Highlands Health Systems

In May 2016, Highlands became the first hospital in the state to be recognized as an acute stroke ready facility by DNV Healthcare, one of the leading accrediting agencies in the United States. Acute Stroke Ready Facilities are recognized for establishing evidence based processes that ensure the finest care to patients experiencing an acute stroke.

Highlands underwent a rigorous onsite review where DNV experts evaluated compliance with stroke-related standards and requirements, including program management, the delivery of clinical care, and performance improvement.

At Highlands, we strive for the greatest level of commitment to the care of stroke patients, said Bud Warman, President & CEO, Highlands Health System. We are incredibly proud of this achievement and our ability to better meet the needs of the region.

The certification of Comprehensive Stroke Care ensures that a hospital can provide the services necessary for treatment of stroke patients. Certification involves a rigorous two-day survey, during which the program’s quality and care requirement are reviewed. In some states, including Kentucky, the level of certification determines where EMS providers will transport patients for the most appropriate medical care within state guidelines.

As part of the accreditation process, DNV surveyors will visit Highlands annually to monitor the hospital’s adherence to patient safety criteria established by CMS and to evaluate processes that impact patient care across various departments and facilities of the hospital.

Stroke is the number fourth cause of death and a leading cause of adult disability in the United States, according to the American Heart Association/American Stroke Association. On average, someone suffers a stroke every 40 seconds; someone dies of a stroke every four minutes; and 795,000 people suffer a new or recurrent stroke each year.

About The DNV DNV Healthcare Inc. is based in Cincinnati, Ohio, and is a part of Det Norske Veritas, a global independent foundation dedicated to safeguarding life, property and the environment. For more information about DNV Healthcare and its NIAHO hospital accreditation program, visit DNVAccreditation.com.

About Highlands Highlands Health System, a community-owned, not-for-profit health system, is the parent company for Highlands Regional Medical Center, the Highlands Center for Autism, Highlands Foundation, and Highlands Home Health.

Highlands serves the Big Sandy region and will develop a healthier community by providing a safe hospital environment, health education, and the promotion of wellness. Highlands provides healthcare services to a number of counties including Floyd, Johnson, Martin and Magoffin with a combined population of over 100,000 residents. The reach extends much farther however, to more than ten surrounding counties whose residents travel to Highlands to receive specialty medical services available at Highlands Regional Medical Center and numerous Highlands clinics.

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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: dx.doi.org/10.1016/j.jamcollsurg.2017.02.016

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.

Antibiotics are advised in most guidelines on diverticulitis, which arises when one or more small pouches in the digestive tract become inflamed or infected. Results from a randomized trial question the effectiveness of this …

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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