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MU Health Care begins expansion of emergency department | Local … – Columbia Missourian

COLUMBIA MU Health Care began construction on a $16 million expansion of University Hospital’s emergency department Tuesday.

The project will add 6,335 square feet to the emergency department, and 20,972 square feet of the total space will be renovated. By the time the work is done at the end of 2018, the emergency room will include 17 more exam rooms for a total of 38, 10 new fast-track exam rooms and a second triage area, according to an MU Health Care news release.

“One innovative feature of this project is fast-track exam rooms that will help us continue to shorten wait times,” Matthew Robinson, interim chair of the Department of Emergency Medicine at the MU School of Medicine, said in the release. The fast-track rooms will be able to quickly serve patients with lesser injuries such as cuts that require stitches or broken bones.

Jonathan Curtright, interim chief executive officer of MU Health Care, said the project is necessary because of the rising number of patients the ER sees.

“In 2016, University Hospital’s emergency department provided care for more than 49,000 patients; up from 37,000 in 2011,” Curtright said. “That is a 30 percent increase in our emergency department patient volumes in five years, and we expect that growth to continue.”

Curtright said the hospital is on track to provide emergency care to more than 52,000 patients in 2017.

The expanded emergency department will include the only American College of Surgeons-verified Level I Trauma Center in mid-Missouri: the Frank L. Mitchell Jr., M.D., Trauma Center.

University Hospital’s emergency room will remain open at all times during the construction, but there will be some changes. The Missouri Psychiatric Center entrance on Deans Drive will serve as the temporary emergency room entrance. Patients coming to the ER will be able to park in the Tiger Avenue Parking Structure beginning at 7 a.m. next Tuesday, and parking escorts will be available. The current ambulance entrance will remain open.

The hospital is also renovating another 11,355 square feet of space and adding 24 new inpatient rooms for patients with medical and behavioral issues. It will add another 5,108 square feet to the second floor to make room for equipment.

The total cost of the combined projects is about $22.6 million.

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MU Health Care begins expansion of emergency department | Local … – Columbia Missourian


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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Overcharging Common in US Emergency Rooms – WebMD


Private emergency room opens in former Johnny Carino’s building – Waco Tribune-Herald

A privately owned emergency room called Express ER will open Saturday in the former Johnny Carinos building at 1411 N. Valley Mills Drive, where patients can receive treatment for everything from headaches to heart attacks, a spokeswoman said.

Express ER represents an alternative to the Premier ER and Urgent Care locations that have opened in Woodway and on Interstate 35 near University Parks Drive, also owned by private investors.

We considered several sites around Waco and looked hard at the travel counts along Valley Mills Drive, which we believe is an under-served area of Waco, said Paula Hatfield, regional administrator for Express ER, which operates other emergency facilities in Temple and San Antonio and plans another in Harker Heights.

Hatfield said the services of Express ER and Premier ER are similar, but she does not view the two medical providers as competitors.

We have the same model of concierge medicine, but were here for the patient, not to compare ourselves to Premier, she said. There is enough patient volume in Waco for us all to do well.

Five physicians, including three who previously worked in the emergency room of Providence Health Center, pooled their resources to create Express ER in Waco. They spent about $3 million to convert the vacant restaurant space into a 6,500-square-foot, full-service emergency facility, Hatfield said.

We do everything the traditional emergency room can do but we believe we do it more economically and more compassionately, Hatfield said. We usually can get you seen in less than 5 minutes and have you out in under an hour.

She said four to six doctors certified in emergency medicine will rotate through the shifts at Express ER, which will welcome patients 24 hours a day, seven days a week. Express ER does not accept patients transported by ambulance, though Premier ER does.

We will transfer patients to local hospitals if necessary, usually meaning they will need to stay longer than 24 hours, she said.

About 25 support staffers, including registered nurses, imaging technicians and front-office personnel, will join doctors in providing care at the emergency facility. They will have at their disposal an ultrasound machine, CT scanner, digital X-rays and a laboratory, according to information provided by Hatfield.

The facility will take all private health insurance but will not accept Medicare, Medicaid or Tricare, which is a civilian medical benefits program for members of the military, their dependents and retirees.

Doctors who partnered to create and staff Express ER in Waco include Matt Burge, Josh Parker and Chris Nelson, who previously practiced in the Providence ER; Robb Dies, who worked in the emergency room at Baylor Scott & White Hillcrest Medical Center; and Daniel Akers, who serves as general partner for all Express ER locations, including Wacos, Hatfield said.

She said each new Express ER typically has different investors.

Premier ER has opened two privately operated emergency facilities in Greater Waco, the latest arriving in the fall of 2016 next to Twisted Root Burger Co. restaurant and across Interstate 35 from Baylor University.

Like Express ER, it is staffed with physicians certified in providing emergency care. It also offers laboratory services, X-rays, CT scans and ultrasounds, according to Dr. John Hamilton, president and chief medical officer of Premier, which opened its first facility at 9110 Jordan Lane in Woodway in August 2014.

Josh Hamilton said an investment group that includes physicians owns Premier ER and Urgent Care. About a dozen doctors and seven physician assistants, or nurse practitioners, see patients at the two locations.

At Express ER, patients are seen exclusively by doctors, never by a physician assistant, Hatfield said.

Each Premier ER facility represents an investment of between $6 million and $8 million, Josh Hamilton said.

Paul Hamilton, vice president of Premier ER and an investor, said the two facilities in Greater Waco have seen 48,000 patients since the first location opened in 2014. About 70 percent of those were treated in the Urgent Care area that typically sees people suffering from sore throats, coughs, colds and simple lacerations.

Our busiest location is the one near downtown, Paul Hamilton said. Magnolia Market at the Silos had 171,000 visitors over spring break, and there were some minor health issues.

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Private emergency room opens in former Johnny Carino’s building – Waco Tribune-Herald


Overdoses flood area emergency rooms – The Columbus Dispatch

Encarnacion Pyle The Columbus Dispatch @EncarnitaPyle

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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Overdoses flood area emergency rooms – The Columbus Dispatch


Would You Take Uber to the Emergency Room? – Healthline

In a segment on Jimmy Kimmel Live earlier this month, people on the street voiced their opinions about the new healthcare bills various provisions.

However, the segment, called Lie Witness News, was really a sketch made up by shows producers.

Those interviewed approved of proposals like deploying veterinarians to perform surgeries on patients who lacked insurance, and paying people to stitch up their own wounds using YouTube tutorials.

But one suggestion, which elicited peals of laughter from the studio audience, was not actually so far-fetched.

Lets talk about the bills provision replacing ambulances with Uber EMT, the interviewer said. A lot more drivers on the road obviously and time is of the essence. It doesnt really matter who drives.

Yeah, as long as you get to the hospital quick, reliable. I think that could be provided by regular people, said the young man on camera.

You support Uber EMT? asked the interviewer.

Id be in for that, he said.

Read more: The challenge of taking someone with dementia to the emergency room

While the government is not actually proposing that Uber replace ambulances, more and more people do seem to agree that regular people are capable of bringing someone to the hospital in the event of an emergency.

According to Stat News, and other outlets, hard data isnt available to quantify the trend, but Uber and Lyft drivers are encountering riders who need more than a ride home from the bar.

When I got there, to my dismay, I see him literally dragging himself toward my car, hand on his chest, stating he was having chest pains and was getting dizzy, wrote a driver on an online message board.

I offered to call 911, as the hospital he wanted to go to was over 15 minutes away, but he insisted for me to take him, the driver continued. Fortunately, I was able to get him to the hospital and he was admitted, but it made me wonder why someone in that situation would prefer an Uber over an ambulance the only rationale I can come up with is money.

Uber, Lyft, and medical experts would all agree that the mans situation was one that required an ambulance, not a rideshare.

In an ambulance, EMTs can administer treatment en route. Plus, their knowledge of the areas emergency rooms enables them to bring the patient to the hospital best equipped to handle the situation.

But there are occasions when ridesharing services are appropriate, and may even serve to fill a void in access to healthcare.

Last year, Uber partnered with Circulation, a company that arranges rides for people getting medical care.

And Lyft is entering the healthcare market in multiple ways, forging direct partnerships with providers like Blue Cross Blue Shield, and with traditional medical transportation companies like American Medical Response.

For us as an organization, healthcare aligns very, very well with our mission, with our values, Dan Trigub, head of healthcare and elder mobility solutions at Lyft, told Healthline.

People who get insurance through a company that has partnered with Lyft dont request a ride themselves. Their providers schedule a pickup through the companys stand-alone website, Concierge.

So whether they know it or not, a patient covered by one of these services may be taking an Uber or a Lyft to their next doctors appointment.

Read more: Hospitals open emergency rooms specifically for senior citizens

A 2005 report from the National Academies of Sciences estimated that 3.6 million Americans miss or delay healthcare due to lack of transportation.

Minorities, people with low incomes, and those with chronic illnesses are affected disproportionately.

The same report found that paying for transportation to make sure people get to their appointments would cut down on healthcare costs in the long run.

That reasoning fuels the federal requirement that Medicaid pay for its beneficiaries to take a cab, van, public transportation, or other mode of transport to the doctors office if the patient has no other way of getting there.

The Centers for Medicare and Medicaid Services (CMS) spent $2.7 billion on nonemergency medical transportation (NEMT) in 2013, according to the U.S. Government Accountability Office (GAO).

Most companies providing Medicaid services partner with transportation brokers, who in turn contract with cabs or other livery services to arrange rides. They then bill CMS for reimbursements.

But this system has come under scrutiny for being opaque, expensive, and ineffective. GAO officials identified NEMT as an area of high risk for fraud and abuse. Last year, New Jerseys Medicaid program failed an audit of its NEMT services for improper oversight and reporting.

There was clearly a need for something better, Robin Heffernan, chief executive officer of Circulation, told Healthline.

With the traditional service, you had to call several days in advance of the ride and then the broker would go take several hours to figure out whether they could accept your ride, and come back and give you a four-hour window for your patient to be ready, she said.

Its huge to be able to have one platform which can, in a more structured manner, deliver these rides, track them, and account for them, she said.

According to CareMore, a company that serves Medicare beneficiaries, its partnership with Lyft has cut both wait times and per-ride costs by about a third.

People no longer have to wait an hour or more to be picked up after their appointment ends, Dr. Sachin Jain, CareMores president and chief executive officer, told Healthline.

With Lyft, youre working with a driver who is proximate, theyre relatively close to where you are, so that wait time on the pickup ride is shorter, Jain said.

Jain said that CareMore provided senior sensitivity training to Lyft drivers to prepare for picking up a customer base that is not widely associated with using ridesharing services.

Read more: Rural hospitals closing at an alarming rate

But these services are not, however, replacing ambulances. At least not yet.

Unnecessary ambulance rides rose from about 13 percent to 17 percent between 1997 and 2007, according to a study from the University of Pittsburgh.

James Langabeer, a professor of health informatics at the University of Texas, said that people call an ambulance when they dont really need one for all sorts of reasons.

I think the emergency department is a place where you can go and you know youre going to get care, whereas if you call a provider and they say tell me about your insurance, its a barrier, he told Healthline.

Even people with insurance may not have a primary care doctor or medical home they feel comfortable visiting, he added.

Langabeer studied a pilot program run by the Houston Fire Department, called Emergency Telehealth and Navigation (ETHAN).

ETHAN allows EMTs to offer alternatives to patients who call 911 but do not require emergency services.

One solution is to offer cab vouchers for office visits, which the EMT can help schedule. Langabeer said he can imagine ridesharing filling a similar role.

But despite his interest in easing the burden on ambulances, Langabeer stressed that 911 is still the best option for anyone in medical distress.

Were not always as patients the best people to diagnose, or the right people to diagnose our own conditions, he said. On the other hand, we do know our body, and we know whats abnormal. And if you do know this isnt normal, and youre completely convinced, now how do you get there?

In those cases I say, Yeah, call any type of special transportation that can get you to those places and get you in.

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Would You Take Uber to the Emergency Room? – Healthline


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

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

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

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

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

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

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

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

Some states on board

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

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

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

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

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

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

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

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

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

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

Trying to avert suffering

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

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

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

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

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

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

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

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

Measured in minutes

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

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

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

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

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

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

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


EMTs bring the emergency room to the patient – Worcester Telegram

Susan Spencer Telegram & Gazette Staff @SusanSpencerTG

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.”

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EMTs bring the emergency room to the patient – Worcester Telegram


Getting High on Mushrooms Not Likely to Send You to the Emergency Room – Newsweek

If there was such a thing as a safe drug, then magic mushrooms would be itat least thats what a new study by the Global Drug Survey (GDS) found.

Researchers found that of all people who tripped on psilocybin hallucinogenic mushrooms in 2016, only 0.2 percent needed emergency medical attention, according to the annual recreational drug survey released Wednesday. Meanwhile, harder psychedelic drugs such as LSD and MDMA were almost five times more likely to send users to the emergency room in 2016.

The survey analyzed the drug use of nearly 120,000 participants in 50 countries based on questions regarding drug use patterns, effects of drug use and the various substances people use to get high. Of those surveyed, 65.1 percent said they had used illegal drugs recreationally within the last year while 79.3 percent said they used illegal substances at some point in their life.

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A fly agaric (Amanita muscaria) fungus grows in the western city of Thorigne-Fouillard on November 18, 2013. One of the most iconic and distinctive of fungi, fly agaric, with its red cap and white spots, is renowned for its toxicity and hallucinogenic properties. A Global Drug Survey released May 23, 2017, found magic mushrooms to the safest recreational drug. DAMIEN MEYER/AFP/Getty Images

About 24,000 people said they had used shrooms, as theyre commonly referred to, at some point in their lifetime while 12,000 admitted to consuming the substance derived of certain types of mushroomsusually indigenous to areas with tropical climates in South America, Mexico and the U.S.within the last 12 months.

Nearly 82 percent of people who had taken mushrooms in their lifetime said they indulged in the hallucinogenic drug in search of a moderate psychedelic experience and an enhancement of environment and social interactions.

GDS founder Adam Winstock told The Guardian Wednesday that despite its low emergency room rate, the main reason people end up in the hospital after taking psilocybin hallucinogenic mushrooms was because people were picking and eating the wrong types of mushrooms.

Magic mushrooms are one of the safest drugs in the world, he said. Death from toxicity is almost unheard of with poisoning with more dangerous fungi being a much greater risk in terms of serious harms.

Although an illegal drug, there have been studies released claiming that mushrooms have some medical benefits and could help people battling depression and anxiety, including a separate 2016 New York University study in which participants saw decreases in cancer-related demoralization and hopelessness, improved spiritual well-being and increased quality of life.

As for LSD, more than 22,000 people said they had tried the hallucinogen at some point in their lives while almost 11,500 said they had used the drug within the last year, which sent 1 percent of users to emergency rooms, compared to the 1.2 percent of MDMA usersincluding 35,500 people who had tried the party drug in their lifetime and 19,000 users within the past yearwho found themselves in the emergency room following their experience with the drug.

LSD is such a potent drug, said Winstock. Its so difficult to dose accurately when tabs you buy vary so widely. Its easy to take too much and have an experience beyond the one you were expecting.

Drugs including methamphetamine and synthetic cannabis had the highest rates of users needing emergency medical attention, with 4.8 percent and 3.2 percent of users, respectively, being hospitalized in 2016.

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Getting High on Mushrooms Not Likely to Send You to the Emergency Room – Newsweek


UH to open emergency room in Kent – Ravenna Record Courier

Free-standing facility to open this summer at S.R. 43 and 261 By BOB GAETJENS Staff Writer Published: May 21, 2017 4:00 AM

University Hospitals will open a free-standing emergency department in Kent this summer, cutting response times nearly in half for area rescue crews.

From the time of an emergency call to being put back in service, an ambulance can be unavailable for up to 90 minutes, Brimfield Chief Craig Mullaly said. Having the new emergency department at will cut that time in half.

“I think this a good, positive thing, definitely,” he said. “Once they are open, they’re an ER. If, worse case scenario, we have something where we have go to the closest facility, they have that life-saving ability.”

The facility will be at the corner of S.R. 43 and S.R. 261 and is expected to open summer, possibly in July, UH officials said.

According to Kent Fire Lt. Patrick Edwards, the biggest advantage of the new center will be the ability to quickly return ambulances to service.

“The patient obviously will get in quicker, and it will enable us to get back into service quicker,” he said. “That’s a huge benefit to us. You’re talking a 5-minute transfer from basically anywhere in the city.”

Joe Wilson, manager of facilities operations for UH, agrees.

He said ambulances often are called for non-life threatening injuries. During the time an ambulance is serving someone with a minor injury, someone else in the community may be having a stroke or heart attack, cases in which timeliness is important.

Tom Conner, director of ambulatory service for UH, agreed that time is a key factor.

“Easier, faster access to emergency care increases your chances of a better outcome,” he said.

Conner said he believes the facility will get patients from Kent, Brimfield, Tallmadge, Stow and maybe some from Rootstown, although UH Portage Medical Center in Ravenna is about the same distance for Rootstown.

The new emergency department will be located in an existing facility that’s been out of use since about 2009, according to Richard Blasko, director of hospital services for UH.

After undergoing about $6.5 million in renovations, the 14,000-square-foot facility will include a large canopy facing S.R. 43 forfive ambulance spaces, according to William Benoit, chief operating officer at UH Portage Medical Center in Ravenna. In the rear of the building is a large parking lot with an entrance for patients who drive to the facility.

According to Wilson, the facility will include eight beds on the emergency department side and six beds on the urgent care side.

Upon arrival, all cases will be treated as emergencies in compliance with federal guidelines, according to Benoit, but as soon as patients sign in, they’ll enter triage where they will be evaluated. More serious cases will remain in the emergency department and minor problems will be sent to the urgent care side of the facility.

“For urgent care, think primary physicians,” he said. “We’ll be able to treat pretty much anything in the emergency department that we’d be able to treat in the ER and the hospital.”

More serious cases likely will be transferred to other hospitals after patients are stabilized, which is where UH has an advantage, Conner said.

“We can send them to Portage if we can provide that service,” he said. “We can send them anywhere in the UH system, to Ahuja (in Beechwood), to Cleveland; it just depends on the level of service needed.”

According to Wilson, the facility will include two specialized areas, one providing obstetrics and gynecological services, which will serve as a rape crisis center, the other for decontaminating people covered in chemicals or other hazardous materials. That area is completely self-contained so hazardous materials do not get into the rest of the facility. The unit includes a shower and is designed to aid patients who’ve experienced industrial accidents involving things like asbestos, PCBs or other harmful chemicals.

The emergency department’s proximity to the medical arts building next door, also owned by UH, will provide access to an imaging center, including MRI, X-rays, a full CT and other services, according to Wilson. That building will be accessible by a walkway, which will be the final part of the renovation.

Benoit said the new emergency department likely will create about 100 new jobs in Kent. At any one time, there will be one full physician, one mid-level care provider, four or five nurses, several paramedics and various support staff on duty.


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UH to open emergency room in Kent – Ravenna Record Courier


Study: ER docs using smartphones to receive test results can … – MobiHealthNews

Smartphones can make a lot of things faster, like getting a cab, ordering food or finding a date. But they can also shave down waiting time in a situation where every minute can feel like an eternity: getting out of the hospital.

Specifically, patients who came to the emergency room in the University of Torontos system with chest pain could spend nearly a half hour less waiting to be discharged if their doctor received lab results on their smartphone rather than on the hospitals electronic health record system, a new study published in the journal Annals of Emergency Medicine found.

Normally, all patients who come to the emergency room with chest pain must have their blood drawn to test for troponin levels, which, if elevated, can indicate a heart attack. In the study population of 1,554 patients, the median time from result to discharge is nearly 80 minutes. Doctors were randomly selected to receive results on their smartphone (the intervention) versus those who relied on the customary electronic health record notifications via the hospitals computer system. The control group of 551 patients waited more than 94 minutes to be discharged, whereas the smartphone group was out of the emergency room in 68.5 minutes.

For patients waiting for lab results, 26 minutes is significant, even if the smartphone process did not shorten overall length of stay significantly, lead author Dr. Aikta Verma said in a statement. For many patients, waiting for lab results that determine if they stay in the hospital or go home is the hardest part of the ER visit. Physicians who received troponin results on their smartphones made the decision to discharge their patients with chest pain a median of 26 minutes faster than physicians without troponin push-alert notifications.

As the authors point out, reducing wait times in the emergency room is an ongoing challenge, as prolonged stays in the ER are associated with an increased risk of death even for patients who are well enough to be discharged. While the study didnt find the total length of emergency department stays to change much, getting faster results from other tests via smartphones could perhaps bring the total time down someday.

Our study demonstrated reduced time to discharge decision for chest pain patients by pushing troponin results to smartphones. However, there are many other results that could also be pushed: other critical laboratory results, radiology reports, vital signs, etc., the authors write. Future studies could evaluate a combination of these push alerts to determine whether it leads to improvement in length of stay in the broader group of ED patients.

For now, the researchers recommend using the smartphone method to deliver troponin results, but did caution against using smartphones in the hospital without careful consideration.

Discussions with physicians revealed that too many alerts can be problematic, they write. Thus, future studies should aim to elucidate the ideal number and type of alerts that would optimize use of the push-alert program.

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Study: ER docs using smartphones to receive test results can … – MobiHealthNews


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