Posted by Guest Blogger on Fri, Dec 04, 2009 @ 12:47 PM
By Marty Ogle, M.D.
As a practicing emergency department physician, I've been following the nation's healthcare reform debate very closely. I'm sure doctors, nurses and healthcare professionals in hospitals and emergency rooms throughout the country are doing the same.
While I certainly have my opinions on how I would like the healthcare reform issue to play out, I've also been taken aback by the news coverage - which has often been inflammatory at best and hysterical at its worst. Just give me the news and forget about the rant, please. What I want to know is: are we going to get healthcare reform? And if so, what's it going to look like?
If you're as frustrated with the quality of the news coverage as I am and would like a great source of information, go online to the NPR site. It's thoughtful, unbiased and provides excellent coverage and debate. You'll find it at: http://tinyurl.com/NPRhealthcare where you'll have access to a variety of articles, a blog, and videos on everything from "what healthcare reform means to consumers" to following the healthcare debate in congress. No hysterics, just the facts. And facts are what we need most these days.
I urge you to visit the site - and please forward any of the sites or resources that you think provide good, solid non-biased healthcare reform news. We're all in this together, so let's stay informed
Posted by Guest Blogger on Thu, Dec 03, 2009 @ 05:08 PM
By Nancy Burghart-Hall
With the ever-increasing demands put upon this nation's emergency departments, the challenge of implementing information technology has never been greater. And the challenges will continue to grow if the H1N1 pandemic comes to pass.
During "normal times", IT is touted to enable an ED's administrative and managerial systems to function more efficiently. In addition, software vendors tell us how clinical applications can lead to systems that more quickly capture patients' data into an electronic medical record - including the diagnosis coding, medications, and discharge summary. However, practical experience is showing us different, and the administrative overhead added to the workload by information technology often times slows down a productive ED.
Taken a step further, what will happen during extraordinary circumstances like a natural disaster or the predicted H1N1 pandemic - both of which create an onslaught of new patients?
Will our information technologies prove themselves as useful tools to help keep emergency rooms from being overwhelmed, or will our systems be even more disruptive and clog the ED during times of stress? Will your ED be able to effectively manage a pandemic using your current IT infrastructure?
The answer is "probably not". In which case, I have a couple of suggestions that are not necessarily "high tech" but have been shown to be helpful in expediting the online documentation and EDIS systems process.
Scribe programs:
A scribe is "a physician collaborator who fulfills the primary secretarial and non-medical functions of the busy emergency physician." Scribe programs have been shown to benefit ED doctors and their patients tremendously, expediting the ED process by as much as 30%-40%. During times of high stress, having a scribe program in place can be beneficial. For a thorough overview of how scribe programs work, visit: http://bit.ly/30wWLi
Voice Activation:
Medical records serve many crucial purposes. Besides a description of the clinical scenario and therapy, they serve to justify care to insurance companies and managed care organizations. It's important to note that hospitals and physicians are paid not by what they do for the patient, but how well what they do is documented. Voice Activation can support the documentation process, creating a higher quality chart.
So during a pandemic, how can an emergency physician quickly generate a comprehensive, accurate and legible medical record? Both Scribes and Voice Activation are tools to help you do this.
Is your ED's IT infrastructure up to the task? I'd love to hear your thoughts and learn about the systems you have in place. I'm also happy to share more information - just ask!
Posted by Guest Blogger on Thu, Dec 03, 2009 @ 05:05 PM
By Dan Culhane, M.D.
Is your emergency department ready for the H1N1 pandemic? It's back in the news and for most ED physicians and nurses it's most likely back in our minds. If the numbers are correct and your ED isn't prepared, this could be a very trying flu season in America.
According to a recently released presidential advisory report, The H1N1 virus could cause up to 90,000 U.S. deaths this fall - mainly among children and young adults.
The report states that the H1N1 virus, commonly known as swine flu virus, could infect between 30% and 50% of the American population during the fall and winter. They're saying 60 million to 120 million Americans could be infected, 30 million people infected but without symptoms, and up to 1.8 million Americans may be hospitalized. Visit http://www.ostp.gov/cs/hometo read the complete report.
H1N1 resurgence may happen as early as September at the beginning of the school year, and infections may peak in mid-October. However, the H1N1 vaccine isn't expected to be available until mid-October, and even then it will take several weeks for vaccinated individuals to develop immunity, the report says.
Infections may increase as early as August as some pupils return to school, according to the Centers for Disease Control and Prevention in Atlanta.
So what does it all mean to emergency rooms across the country? We could well be seeing a huge influx of sick or "think they're sick" people. And though the report urges speedier production of the H1N1 vaccine and the availability of some doses by September, the virus will likely get to a lot of people before the vaccine does. In fact, hospitals could suffer "severe disruptions", the White House warned.
While the focus on H1N1 prevention is good, the problem is, once the media frenzy gets into high gear, it's going to cause panic - when in fact people need to exercise common sense and go to the emergency room only if they need that level of care. Otherwise, it's going to overload a system that's already overloaded.
So prepare yourself and your emergency department. Perhaps doctors need to create their own campaign around avoiding the ER - "if you're not sick, it's a lot easier to catch germs in a waiting room than if you stayed home".
Please let me know your thoughts
Posted by Guest Blogger on Thu, Dec 03, 2009 @ 04:57 PM
By Joel A. Stettner MD.
Now that the healthcare reform discussion has taken center stage, what about the "Major Healthcare Issue" that preceded it last year? By that I mean the novel H1N1 outbreak, more popularly known as "swine flu".
With fall quickly approaching, the issue will likely be on the front burner again. But a recent article in the Washington Post states that most Americans are not very concerned about swine flu.
While we Americans are well known for our short attention spans, should we be more worried? Or are we too entranced by other distracting issues such as Sarah Palin and her "Death Panel"?
The CDC reports that from April 15, 2009 to July 24, 2009, there were a total of 43,771 confirmed and probable cases of novel influenza A (H1N1) infection in the U.S. Of those, 5,011 people were hospitalized and 302 people died.
The tone of the report does not convey a sense of concern by the CDC. In fact, they have completely discontinued their confirmed and probable case counts, though aggregate national reports of hospitalizations and deaths are continuing. Their recommendations for avoiding the pitfalls of an H1N1 outbreak include avoiding sick people, washing hands frequently and covering faces with tissue when sneezing. Final recommendations on vaccination are still pending, as are details on vaccine availability.
However, the World Health Organization sees it differently. According to a recent report http://bit.ly/FYdVF the global spread of H1N1 swine flu will endanger more lives as it speeds up in the coming months. They're telling governments to boost preparations for a swift response and are predicting an explosion in case numbers.
So which is it? Should we be concerned or should we consider the current H1N1 outbreak to be simply business as usual? My feeling is that this is a potentially serious disease (especially for the at-risk groups). I think that preparation for likely patient visit surges is very important; we must find ways to more rapidly see those with mild infections and quickly move admitted patients out of the ED. Preparation now could be critical as the traditional flu season approaches.
I look forward to your comments!
Posted by Guest Blogger on Thu, Dec 03, 2009 @ 11:26 AM
By David Englander, M.D.
I wanted to add my two cents to Dr. Borger's blog in the ER Forum on Tuesday re: potential funding losses to emergency health care by the Feds.
In California alone, more than 70 hospitals have closed in the past ten years due to financial pressures, even though demand for emergency care has dramatically increased.
Our state actually had the lowest national ranking (51st) in access to Emergency Care and received very low grades in other categories of the ACEP National Report Card on the State Of Emergency Medicine.
In 2003, both Democrats and Republicans came together and passed the Medicare Modernization Act (Section 1011), which included federal funding for mandated emergency care - $250 million per year to help hospitals and providers recoup a portion of the costs they incur for providing emergency medical care to patients who cannot pay their bills. This federal reimbursement has been particularly helpful to participating hospitals and providers in border states like California that are disproportionately burdened with providing care to undocumented immigrants. Unfortunately, this funding was temporary and recently expired.
Hospitals and emergency care providers should not be responsible for absorbing the costs of health care for undocumented immigrants. The federal government should bear this responsibility, as it is responsible for securing our borders.
As noted, last year the campaign to extend Section 1011 had bi-partisan support, evidenced in a May 2008 letter to legislative leaders endorsing a two-year extension of the provision under 15 signatures, including those of Barack Obama and John McCain. But that support has been supplanted by other issues.
Extending Section 1011 funding is an important issue that needs to be addressed before it "falls through the cracks". With increased overcrowding, state budget cuts (especially in California) and likely facility closures, it's impossible to believe that quality care will be there if another source of funding for hospitals and providers is withdrawn. Our legislators need to know that this is an important issue involving a wide range of people.
To read the complete article on the topic, visit http://tinyurl.com/moos4n. For insights into ways to reach your representatives, please read a very helpful blog re: Advocacy by Carlos Medina MD. Simply click on this link: http://www.cepamericablog.com/2009/08/be-an-advocate-get-to-know-your-legislators/
I look forward to your support and to seeing any comments you may have.
Posted by Guest Blogger on Thu, Dec 03, 2009 @ 11:23 AM
By Rodney Borger, M.D.
Well, the August Congressional recess has temporarily quieted the health care debate in Washington, D.C. But many doctors like me remain focused on how possible health care reform could affect our local public hospitals.
Lawmakers will soon resume the battle over how to expand coverage and how to fund it, but there is another pressing issue that doctors like me are very concerned about. It involves making sure our hospitals, doctors and nurses can continue to provide timely, quality emergency care to anyone who is admitted to one of our emergency rooms.
Right now, our ERs are in jeopardy of losing an important funding source from the federal government - funding that it has an obligation to provide.
Without the federal reimbursement that the 2003 Medicare law provides, our hospitals and health providers will simply not be able to offer the quality of care expected in our emergency rooms. That means patients will no doubt have to wait longer for treatment in increasingly overcrowded waiting rooms because of facility closures and staff and supply shortages.
Last year the campaign to extend Section 1011 had bi-partisan support. Today (a year later) I fear the issue may be overshadowed in the larger health care debate. I'm urging our representatives to consider the consequences of halting federal reimbursement for emergency care at a time when the need for care is greater than ever.
Extending Section 1011 funding is an issue that affects everyone who works in emergency rooms as well as those who may one day need emergency care. Your help is needed.
We need to act now! Please contact your federal representatives and urge an extension of Section 1011, so that we can continue to provide quality emergency medical care to anyone who needs it. If you have additional thoughts or suggestions, please send a comment - I'd love to hear them.
Posted by Guest Blogger on Thu, Dec 03, 2009 @ 11:16 AM
By Nancy Carlson, RN, MBA.
One more thing this recession has done is to temporarily mask the symptoms of a problem that's two decades old. That is, with older nurses staying in the work force longer and delaying retirement - and other nurses who left and then came back due to recessionary times - the trend toward nursing vacancies appears to have been reversed.
But there's still a nursing shortage. In fact, CINHC projects California will have a shortfall of 108,000 nurses in California alone by 2020. So even with fewer openings, there's a real need to increase capacity to educate and prepare new nurses.
Today, the positions are being filled by experienced nurses back in the market due to the economy. The average age of an RN in California is over 47, so when they start retiring, the statewide shortage will jump. According to the California Institute for Nursing & Health Care (CINHC) 90% of RN's under the age of 55 are working, which tightens the market for new grads more than usual.
The good news is that educational capacity for RNs statewide has increased 55% since 2004, bringing younger nurses - including men - into the workforce. But despite these successes, we can't pull back in our efforts to overcome the nursing shortage.
Increasing funding for nursing-education programs is still very important. And we can't become complacent when looking at recent economic data that indicate we've solved the nursing shortage. With an aging population and continued growth in the demand for caregivers, the need for new nurse graduates is as great as ever.
So where can new graduates get the needed "first job" experience if hospitals are not hiring them? (At least until the economic tide shifts and baby boomer nurses retire).
There are nursing jobs available. Opportunities are growing in ambulatory and non-acute settings as care shifts away from hospitals. Apply for any open position, be persistent in calling employers and consider moving to states such as Texas or the Midwest with more demand. New graduates may not get their first choice of a job or location, but there are still openings.
What ideas do you have to encourage our new nurses? Should hospitals hire more staff than they really need (or can afford to have on the payroll)? What has YOUR hospital done to keep graduate nurses in the employment pipeline?