WA/ACEP News
Barriers to Primary Care Doubled in a Decade Leading to Continued Rise in Emergency Department Visits
A shortage of primary care may lead to ever-increasing rates of emergency department use, even for people who have health insurance, according to a new study released today by the Archives of Internal Medicine.
“Coverage does not equal access,” said Sandra Schneider, MD, FACEP, president of the American College of Emergency Physicians. “People come to the ER because it’s the only place they are guaranteed to get the help they need. It’s time to recognize the tremendous value that people place on having access to emergency care. And that it’s not a realistic objective to prevent emergency visits -- at least for the foreseeable future -- not only because of physician shortages, but because of the nation’s growing elderly population. It’s time to start focusing on new ways of providing medical care in the United States. For example, emergency departments are fully staffed 24/7, and the marginal costs of caring for a non-urgent patient are actually the same as a visit to a primary care physician.”
Researchers analyzed National Health Interview Survey data of approximately 317,000 adults across the United States from 1999 to 2009. They found that people with one or more barriers to primary care are more likely to visit the emergency department and that barriers to primary care have doubled over the past decade. Those barriers include: limited physician office hours, wait times for appointments, difficulty in getting in touch with a primary care physician’s office to make an appointment and transportation issues.
In 1999, 6.3 percent of adults reported at least one barrier to primary care. By 2009, that number had risen to 12.5 percent. Among adults with at least one emergency department visit, the prevalence of having at least one barrier to primary care increased from 12 percent to 18.9 percent during that decade. (08/12/11)
Higher Spending on Emergency Care Associated with Lower Mortality Rates
Washington, DC — Patients who experience medical emergencies far from home in areas that spend more on emergency care have significantly lower mortality rates compared with those in low-spending areas, according to new research published in the American Economic Journal: Applied Economics. High-spending areas are also associated with higher staff-to-patient ratios, greater reliance on intensive care unit services and a higher likelihood of treatment in teaching hospitals.
“More intensive and expensive treatment leads to better outcomes,” said Joseph Doyle, an economist with the Massachusetts Institute of Technology and author of the study. “The higher-spending hospitals use more ICU service, and they have higher staff-to-patient ratios, so they use more labor, and that’s expensive.”
Doyle focused his research on patients in Florida, examining tens of thousands of out-of-state visitors with heart-related emergencies who were admitted to hospitals from emergency rooms over a 7-year-period. He also said, according to an MIT news article, the per capita income of an area also is not correlated very well with hospital spending, citing Fort Lauderdale hospitals, which spend 30 percent more on heart patients than nearby, affluent West Palm Beach hospitals.
Total U.S. expenditure on emergency care was $47.3 billion in 2008, according to the Agency for Healthcare Research and Quality, representing about 2 percent of the nation’s $2.4 trillion in health care spending. The nation’s emergency departments treat nearly 124 million emergency patients each year.
“This study shows the critical value of emergency medicine and how people’s lives are saved,” said Dr. Sandra Schneider, president of the American College of Emergency Physicians. “It demonstrates that the focus of health care policy must be on preserving our nation’s emergency care system and strengthening it to serve more people.”
Dr. Schneider said emergency visits are going to increase, despite health care reform. Reasons include the nation’s growing elderly population and the millions of Medicaid patients who can’t find doctors to treat them.
“America’s emergency departments are under severe stress, facing soaring demands,” said Dr. Schneider. “They are essential to every community and they must have adequate resources.”
For a copy of this study, contact the American Economic Journal: Applied Economics at 412-432-2310. (08/12/2011)
Methylene Blue: Drug Safety Communication - Serious CNS Reactions Possible When Given to Patients Taking Certain Psychiatric Medications
FDA has received reports of serious central nervous system (CNS) reactions when the drug methylene blue is given to patients taking psychiatric medications that work through the serotonin system of the brain (serotonergic psychiatric medications). A list of the serotonergic psychiatric medications that can interact with methylene blue can be found in the Drug Safety Communication. Safety information about this potential drug interaction and important drug usage recommendations for emergency and non-emergency situations are being added to the drug labels for serotonergic psychiatric medications. FMI: Click here. (07/28/2011)
Severe Pain Is Not Related to Likelihood of Heart Attack
Patients coming to the emergency department with severe pain are not any more likely to suffer heart attack or death than those with mild or moderate pain. A study published online in Annals of Emergency Medicinecontradicts the widely held assumption that high pain scores indicate a high risk of acute coronary syndrome (“Relationship Between Pain Severity and Outcomes in Patients Presenting with Potential Acute Coronary Syndromes”).
Researchers examined the records of 3,306 patients who went to the emergency department with symptoms of acute coronary syndrome. Three percent of the patients with a mild or moderate pain score and 3.9 percent of patients with severe pain score had a cardiovascular event during hospitalization. Looking at 30-day outcomes, researchers found 5.8 percent of patients with mild or moderate pain score and 7.3 percent of patients with severe pain score had an outcome of either death, revascularization or acute myocardial infarction (AMI or heart attack). However, when adjusted for sex, race, TIMI risk score and mode of arrival, pain score was not an independent predictor of 30-day cardiovascular events. FMI: www.annemergmed.com (07/28/2011)
Emergency Visits Are Increasing, New Poll Finds; Many Patients Referred By Primary Care Doctors Health Care Reform Law Will Not Solve Crisis in Emergency Care — Coverage Doesn’t Equal Access
Washington, DC — More than 80 percent of emergency physicians responding to a poll said emergency visits are increasing in their emergency departments, with half reporting significant rises, and more than 90 percent expecting increases in the next year. Almost all (97 percent) reported treating patients on a daily basis who were referred to them by primary care doctors, going against a widely-held assumption that people are choosing to go to the emergency department instead of seeking primary care.
At the same time, 97 percent of emergency physicians also report treating Medicaid patients on a daily basis who could not find any other doctor to accept their health insurance. If the new health care reform legislation provides insurance coverage that reimburses doctors at Medicaid rates, this could exacerbate a lack of access to medical care.
“This poll confirms what we are witnessing in Massachusetts — that visits to emergency rooms are going to increase across the country, despite health care reform, and that health insurance coverage does not guarantee access to medical care,” said Dr. Sandra Schneider, president of the American College of Emergency Physicians. “Emergency medicine provides lifesaving and critical care to millions of patients each year and yet only represents 2 percent of the nation’s health care expenditures. Emergency physicians command the resources of a hospital to provide the best care for patients, but we must be prepared for increasing numbers of patients, not fewer, especially given our growing elderly population.”
ACEP conducted the poll from March 3 to March 11, 2011. E-mails were sent to 20,687 emergency physicians, and 1,768 responded. The survey has a theoretical sampling error range of ± 2.23.
While 79 percent of responding emergency physicians said their emergency departments use resources efficiently, nearly half of respondents (44 percent) said the fear of lawsuits was the biggest challenge to cutting emergency department costs. More than half (53 percent) of emergency physicians reported that fear of lawsuits is the main reason for ordering the number of tests they do.
“Emergency departments need more resources, not fewer, and medical liability reform would help reduce overall costs by reducing the need for defensive medicine,” said Dr. Schneider.
Two-thirds of emergency visits occur after business hours, when doctor’s offices are closed and patients have nowhere else to turn. Visits to ERs reached an all-time high of nearly 124 million in 2008, according to the Centers for Disease Control and Prevention (CDC) and are expected to rise nationwide.
Physicians responding to the poll attribute the overall increase in emergency patients to patients without health coverage (28 percent) and a growing elderly population (23 percent) are seen by physicians as the most important reasons for the overall increase in ER patients.
An overwhelming 89 percent of physicians believe the number of visits to the emergency department will increase as health care reforms are implemented with 54 percent of them expecting to see a significant increase.
“Emergency visits have increased at twice the rate of the U.S. population, and less than 8 percent of those patients have nonurgent medical conditions, meaning the vast majority need to be there, said Dr. Schneider. “At the same time, hundreds of emergency departments have closed. The new health care reform law does not address these problems and with the elderly population and more emergency departments forced to shut down, this crisis will only get worse.”
More than 1,400 (82.5 percent) responding to the poll said that lives were saved every day in their emergency departments. “Emergency medicine is critical at any hour of the day. It must be there when you need it,” said Dr. Schneider. (05/09/11)
ACEP Announces 38th Annual National EMS Week, May 15-21 With the Theme “Everyday Heroes”
Washington, DC—The American College of Emergency Physicians (ACEP) kicks off the 38th annual Emergency Medical Services (EMS) Week starting May 15th with events in communities across the nation, as well as several national events organized around the theme, “Everyday Heroes.
“As we approach the 10th anniversary of 9/11, these ‘everyday heroes’ deserve special recognition for their willingness to face danger in order to help people in trouble,” said ACEP’s president, Sandra Schneider, MD, FACEP. “All emergency physicians salute the brave men and women who sometimes put themselves in harm’s way in order to assist the sick and the injured. Their selflessness sets an example for all of us.”
EMS providers include paramedics, emergency medical technicians, first responders, fire fighters and police, some paid, some volunteer. National EMS Week will feature hundreds of grassroots activities coast-to-coast, including safety demonstrations, EMS essay and poster contests, CPR classes and at least one auto extrication demonstration.
The 19th annual National EMS Memorial Service will take place on June 25th at its home in Colorado Springs, Colorado. This event honors those responders who died while in the line of duty. This year, 43 honorees from 18 states will be added to the 538 honored in years past. The Stars of Life celebration, in which selected ambulance professionals are honored for their service to their community, took place in Washington D.C. this week. In addition, Child Safety and Injury Prevention Day will be celebrated on May 18th.
Here are some tips on when to call EMS. Always call EMS if someone needs immediate medical treatment. To make this decision, ask yourself the following questions:
- Is the person’s condition life-threatening?
- Could the person’s condition worsen and become life-threatening on the way to the hospital?
- Does the person require the skills or equipment of paramedics or emergency medical technicians?
- Could the distance or traffic conditions cause a delay in getting the person to the hospital?
If your answer to any of these questions is “yes,” or if you are unsure, it’s best to call EMS. Paramedics and EMTs can begin medical treatment at the scene and on the way to the hospital and alert the emergency department of the person’s condition en route.
When you call for help, speak calmly and clearly. Give your name, address and phone number; give the location of the patient and describe the problem. Don’t hang up until the dispatcher tells you to, because he or she may need more information or give you instructions.
EMS Week 2011 sponsors include Genentech, MedicAlert Foundation, American Medical Response, EmCare, EZ-IO, Masimo, Physio Control, Graham Professionals, American Heart Association, American Stroke Association, EMS World and NHTSA. (05/09/11)
FDA MedWatch: Acetadote (acetylcysteine) Injection: Recall - Particulate Matter Found in a Small Number of Vials
AUDIENCE: Hospital Risk Managers, Pharmacy, Emergency Medicine
ISSUE: Cumberland Pharmaceuticals Inc. recalled 6 lots of Acetadote (acetylcysteine) Injection, 20% solution (200mg/mL) in 30 mL single dose glass vials as a precautionary measure based on observed particulate matter found in a very small number of vials. The source of the particulate matter was from the glass vial produced by a former supplier.
BACKGROUND: Used in the emergency department, Acetadote is administered intravenously within 8 to 10 hours after ingestion of a potentially hepatotoxic quantity of acetaminophen, is indicated to prevent or lessen hepatic injury. This product was distributed to U.S. wholesalers and distributors nationwide, please refer to the firm press release for lot numbers being recalled.
RECOMMENDATION: Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program: Complete and submit the report Online
Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178
Read the complete MedWatch 2011 Safety summary (01/04/2011)
FDA Med Watch: Sodium Bicarbonate Injection - Recall Due to Particulates in Some Vials
American Regent and FDA notified healthcare professionals of the nationwide recall of specific lots of Sodium Bicarbonate Injection, USP, 7.5% and 8.4%, 50 mL Single Dose Vials because some vials of these lots contain particulates. Potential adverse events after intravenous administration include damage to blood vessels in the lung, localized swelling, and granuloma formation. More (12/30/2010)
FDA MedWatch: Recall of Penumbra System Reperfusion Catheter for Stroke
FDA and Penumbra notified healthcare professionals of a Class I recall due to a manufacturing error. Mid-shaft joint failures were occurring in some Reperfusion Catheters 032 produced from lot F15020. The Penumbra System Reperfusion Catheter 032 is used to re-establish the blood supply to the brain in patients experiencing stroke. The company is advising customers to discontinue use of the product. More (12/10/2010)
Doctors Take Fight Over ER Bills to State High Court
Emergency-room doctors want the state Supreme Court to force insurers to fully pay the amount they bill for treating insured patients — even if the doctor is not in the insurer's network. More (12/10/2010)
FDA Med Watch: Needleless Pre-Filled Glass Syringes
FDA is notifying healthcare professionals, especially those working in emergency and critical care settings, of reports of compatibility problems when certain needleless pre-filled glass syringes are used with some needleless intravenous (IV) access systems. These syringes may malfunction, break, or become clogged during the process of attempting to connect to needleless IV access systems. More (11/18/2010)
Emergency Room Wait Times (11/02/10)
Whether by Droid, website, text message or billboard, hospitals are advertising the wait times in their
emergency rooms with greater visibility than ever, as consumers press for ways to comparison shop for all
types of care. More
Prescription Painkillers A Widespread Addiction (11/02/10)
Prescription painkiller abuse is on the up rise and keeps continuing to grow according to a study done by Substance Abuse and Mental Health Services Administration (SAMHSA) and Centers of Disease Control (CDC).
More
Drug Safety Labeling Changes: 24 products with safety labeling changes to the following sections: CONTRAINDICATIONS, WARNINGS, PRECAUTIONS, ADVERSE REACTIONS, PATIENT PACKAGE INSERT, and MEDICATION GUIDE. http://www.fda.gov/Safety/MedWatch/SafetyInformation/ucm225299.htm
The following drugs had modifications to the CONTRAINDICATIONS and WARNINGS sections:
Advil Allergy Sinus (ibuprofen, chlorpheniramine maleate, and pseudoephedrine)
Aleve (naproxen sodium)
Atripla (efavirenz/emtricitabine/tenofovir disoproxil fumarate)
Biltricide (praziquantel)
Childrens Advil Cold (ibuprofen and pseudoephedrine)
Cubicin (daptomycin)
Exelon Patch (rivastigmine)
Flagyl (metronidazole)
Heparin Sodium in the 5% Dextrose injection and in the 0.9% Sodium Chloride injection
Meridia (sibutramine hydrochloride)
Plavix (clopidogrel bisulfate)
Risperdal (risperidone)
BagEasy Manual Resuscitation Devices by Westmed, Inc.: Class 1 Recall
Westmed, Inc. is initiating a nationwide recall of 24,384 units of BagEasy Manual Resuscitation Devices. The BagEasy device have been found to have a potential for disconnection at the retention ring of the patient port manifold. Disconnection causes the unit to be inoperable, which potentially could result in treatment delays while another unit is obtained or technician switches to a different method of resuscitation. FMI: Contact the company at 1-800-975-7987. For the affected part numbers and lot numbers please see the firm press release.
Health Advisory - September 13, 2010:
Updated Influenza Reporting Requirements, Testing Guidelines, and Vaccination Recommendations for the 2010-2011 Flu Season
Action requested:
- Recommend influenza vaccine for all persons 6 months of age and older who do not have a medical contraindication in accordance with new ACIP recommendations*.
- Healthcare providers and hospitals should report the following to Public Health:
- Laboratory-confirmed influenza deaths in persons of all ages (within 3 business days).
- Pregnant women with laboratory-confirmed influenza admitted to an intensive care unit (within 3 business days).
- Suspected and laboratory-confirmed infections due to a novel influenza virus*, including avian influenza A (H5N1) virus (immediately).
- Outbreaks of influenza-like illness or laboratory-confirmed influenza in an institutional setting, e.g., long term care facility or hospital (within 24 hours).
- Unexplained critical illnesses or deaths in persons < 50 years old (immediately; influenza testing is encouraged for those with unexplained respiratory illness).
- To request influenza testing and subtyping on specimens from the following patients, contact Public Health at 206 296-4774:
- Deceased patients suspected to have influenza.
- Patients suspected to be infected with a novel strain, including H5N1 influenza.
- Patients associated with outbreaks.
- To request oseltamivir resistance testing for clinical purposes on specimens from the following patients, contact Public Health:
- Patients who develop laboratory-confirmed influenza while taking antiviral prophylaxis.
- Patients in intensive care units AND severely immunocompromised patients with prolonged excretion of influenza virus despite antiviral treatment.
Influenza activity has remained very low in King County and Washington state throughout the summer. The intensity and timing of the upcoming influenza season cannot be predicted. During the past several months, three influenza viruses have been circulating in the world: influenza A (2009 H1N1), influenza A (H3N2) and influenza B. All three circulating viruses are similar to those contained in the 2010-11 trivalent influenza vaccine.
*An inactivated trivalent influenza vaccine (Fluzone High-Dose, Sanofi Pasteur) that contains an increased amount of influenza virus antigen compared with other inactivated influenza vaccines was licensed in 2009 for use in persons 65 years and older only. ACIP has not expressed a preference for Fluzone High-Dose or any other inactivated influenza vaccine for use in persons aged 65 years and older. Whether or not Fluzone High-Dose vaccine recipients will receive greater protection against influenza illness is not known.
Resources
*Novel means a new or re-emergent influenza virus not known to be currently circulating widely in human populations; 2009 H1N1 is no longer considered novel.
_____________________________________________
Jeffrey S. Duchin, MD
Chief, Communicable Disease Epidemiology & Immunization Section
Public Health - Seattle & King County
Associate Professor in Medicine, Division of Infectious Diseases, University of Washington
401 5th Ave, Suite 900, Seattle, WA 98104
Tel: (206) 296-4774; Direct: (206) 263-8171; Fax: (206) 296-4803
E-mail: jeff.duchin@kingcounty.gov
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