September 23rd, 2011 by Lucy Hornstein, M.D. in True Stories
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Got a call from a long-time patient over the weekend. Hearing a not overly alarming story but one that was not terribly reassuring either, I suggested she go to the Emergency Department.
Later that morning, sitting at an internet cafe with DSS eating breakfast, each of us surfing on our respective laptops, he says conversationally, “So I see Miss LTP is in the ER.”
My heart stopped and my stomach dropped. Had he managed to access the voicemail program I use for after hours calls? My EMR? Had I left shortcuts up to any patient-related materials on that machine? When had I last used it anyway? My mind was racing. I wasn’t all that concerned specifically about him knowing that a particular person was in the ER, since he understands confidentiality. But if he was able to access confidential patient information, did that mean I had a security breach?
“How do you know that?” I asked him carefully, after a very long pause, during which all of the above ran through my head. Read more »
*This blog post was originally published at Musings of a Dinosaur*
August 25th, 2011 by Shadowfax in Research, True Stories
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Well, this is satisfying. Over the years, in our ER we have mirrored the nationwide trend and have significantly increased the utilization of CT scans across the board. The reasons are manifold. Some cite malpractice risks, and indeed in our large group we have had one lawsuit for a pediatric head injury and another for a missed appendicitis which probably did contribute. But, in my opinion, there have been many other drivers of the increased use. For one, CTs have gotten way, way better over the last 15 years, which quite simply has made them a better diagnostic tool. They’ve also gotten way faster. As the facilities have invested in CT scanners, they have increased their capacity and increased their staffing, so the barriers to their use have rapidly diminished. I am so old that I remember when ordering a CT involved calling a radiologist and getting their approval! No more of that, I can tell you.
But a couple of years ago, we really started paying attention (perhaps belatedly) to Read more »
*This blog post was originally published at Movin' Meat*
August 16th, 2011 by Happy Hospitalist in Opinion, Research
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Association of Hospitalist Care With Medical Utilization After Discharge: Evidence of Cost Shift From a Cohort Study.
That’s the title of the latest medical study making the viral rounds. I had an opportunity to read the study in full. I called Happy’s hospital library and Judy had the pdf article in my email in less than 24 hours. Now, that’s amazing. Thanks Judy for a job well done. You deserve a raise.
Presented in the August 2nd, 2011 edition of the journal Annals of Internal Medicine, Volume 155 Number 3 Page 152-159, the study concludes that decreased length of stay and hospital costs associated with hospitalist care are offset by higher medical utilization and costs after discharge.
In summary, hosptitalist patients had an adjusted length of stay 0.64 days shorter and $282 less than patients cared for by primary care physicians, but total 30 day post discharge costs were $332 higher. These additional charges were defined as 59% from rehospitalization, 19% from skilled-nursing facilities, and 22% from professional and other services.
OK fair enough. Let’s come to that conclusion. Let’s say Read more »
*This blog post was originally published at The Happy Hospitalist*
August 12th, 2011 by Emergiblog in Opinion
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You want to be a registered nurse?
Let’s cut through the B.S. and get real about it.
Put a hold on all this soft-focus “I live to care!” or “It gives my life meaning…”
Here’s the reality.
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You will study your butt off.
Nursing science is based on biology, chemistry, microbiology, anatomy, physiology, psychology, sociology and philosophy. Yeah, every single one of them. You will incorporate those into every decision you make in your practice. It’s called critical thinking. You master it and become a professional, or you don’t and you become a robotic technician.
Bottom line.
Your choice.
Oh, and the studying doesn’t stop after you graduate. Nursing school is just the warm-up.
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The work is physically exhausting and emotionally demanding. Read more »
*This blog post was originally published at Emergiblog*
July 12th, 2011 by Emergiblog in Opinion, True Stories
1 Comment »
Ah, the benefits of sand therapy!
Time for little Bettina’s daily afternoon face plant!
Not only does it appear my colleague is about to lose her grip on her patient, I’m concerned about her choice of body mechanics.
I predict a lumbar strain in 3…2…1……
(This photo is from the Library of Congress collection.)
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I love my pediatric patients. While it is hard to see children feeling sick, they can be bright spots in occasionally hellacious shifts.
I’ve blogged before on my observation that the kids seem to be the adults in the some families.
- They don’t want to undress for an exam, so they fight the parents who are helpless in the face of taking a shirt off a three-year-old.
- They have to be restrained so they don’t run rampant in the ER, and they slap their parent across the face. The parent doesn’t respond.
- They are told they need to cooperate with a procedure and they answer their parent with a loud, clear, “F*** YOU!” At the age of five. The parent retreats. Read more »
*This blog post was originally published at Emergiblog*
