Press Ganey’s Invalid Statistics
This report which was sent to me by a reader shows that the involved doctor was in Press Ganey’s 99th percentile! Oh. Too bad that the rankings were based on a single survey result. Kind of like electing the mayor of a town based on one vote. But don’t forget, everyone … Press Ganey CEO Patrick Ryan says that we need to just “suck it up” and apparently accept that most of their surveys have no rational basis.       (Source: WhiteCoat's Call Room)
Source: WhiteCoat's Call Room - May 30, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Press Ganey Source Type: blogs

Healthcare Update Satellite — 05-29-2013
More HealthCare Updates from around the web are at my other blog at http://drwhitecoat.com. Next on the FDA hit list … sleeping pills. Number of ED visits related to Ambien prescriptions triples between 2005 and 2010. Connecticut emergency department declares influx of intoxicated patients from nearby concert venue a “scheduled mass-casualty situation” and a public health issue as sometimes more than 90 patients are taken to local emergency departments in various states of drunkenness. I used to work at a trauma center near a concert venue. The worst concerts during those days were “OzzFest” and Jimmy Buffet...
Source: WhiteCoat's Call Room - May 29, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Facebook use in the Emergency Department
New study shows that emergency department workers are on Facebook quite a bit. They spend an average of 4.3 minutes per hour on Facebook during day hours, which is just under an hour out of every 12 hour shift. However, during night shifts when the study hospital was busier, the staff spent an average of almost 20 minutes per hour — just on Facebook. So are the results good news based on other studies showing that engaging in brief mindless tasks decrease worker fatigue and stress while increasing worker productivity and happiness? Or are the results bad news suggesting that patients aren’t getting full attention? ...
Source: WhiteCoat's Call Room - May 24, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Medical Studies Source Type: blogs

Healthcare Update Satellite — 05-15-2013
More HealthCare Updates from around the web are at my new digs at http://drwhitecoat.com. “Dear ER staff. Our friend is drunk. Fix him.” Unconscious Arizona college student who was “turning blue” left in hospital lobby with Post-It note stuck to his body after losing “drinking contest” at frat house. Nice friends. If you decide to follow the link, turn down the volume on your computer. Gannett’s KSKD.com has an auto-start video ad that will blow your ears out. Irish emergency department so crowded and busy that it has to pull an ambulance up to the front door to act as an extra resuscitation room for a patie...
Source: WhiteCoat's Call Room - May 15, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Healthcare Update Satellite — 05-07-2013
More HealthCare Updates from around the web are at my new digs at www.drwhitecoat.com. Annals study shows clinical signs that necessitate admission in patients with ALTE (when newborns appear to stop breathing): “obvious need for hospitalization (they used persistent hypoxia as one example of this), significant medical history, and more than one ALTE in 24 hours. Dual energy CT scan can diagnose knee ligament tears more effectively in the emergency department. Is it necessary to definitively diagnose ligament tears in the emergency department, though? And how long will it take until government officials blast doctors f...
Source: WhiteCoat's Call Room - May 8, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Alarm Fatigue
For those of you who don’t know what alarm fatigue is, think of a car alarm. The first time you hear it going off, you run to your window to see who’s breaking into a car. Maybe you run to the window the second time and the third time, too. By the tenth time the alarm goes off, you’re thinking that the alarm is broken and someone needs to get that fixed. After about thirty false alarms, you’re feeling like going out there and busting up the car yourself – especially if the car alarm wakes you when you’re asleep. So alarms can be good, but if there are too many “false positives̶...
Source: WhiteCoat's Call Room - May 1, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Policy Source Type: blogs

Healthcare Update — 04-23-2013
More HealthCare Updates from around the web are at my new digs at www.drwhitecoat.com. Diagnostic errors account for most paid claims in medical malpractice cases. Errors in diagnosis were the most common type of claim and also amounted to the highest proportion of total payments. The total inflation-adjusted amount of diagnosis-related payouts was $38.8 billion over 25 years. Remember, these statistics represent just the payouts. On average, two of three medical malpractice lawsuits end in no payment to the plaintiff. And we still wonder why doctors do so many “unnecessary” diagnostic tests? Missing bamblance. Univ...
Source: WhiteCoat's Call Room - April 23, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Do Hospital Policies to Deter Potential Drug Seekers Violate EMTALA?
Interesting issue brought to my attention by a reader in South Carolina. One of the hospitals in South Carolina wanted to post a sign in its emergency department waiting room stating the following: Prescribing Pain Medication in the Emergency Department Our Emergency Department staff understands that pain relief is important when one is hurt or needs emergency care. However, providing pain relief is often a complex issue, especially when pain is a chronic or recurrent process. Mistakes or misuses of pain medication can cause serious health problems and even death. Our Emergency Department will only provide pain relief opt...
Source: WhiteCoat's Call Room - April 18, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: EMTALA Source Type: blogs

Healthcare Updates — 04-15-2013
See more HealthCare Updates from around the web at my new digs at www.drwhitecoat.com. More of a free market approach to medical care. Australian private hospitals noting a large uptick in emergency department patients as patients opt to pay for emergency services rather than wait for care at the public hospitals. Some emergency departments are recruiting highly regarded specialists to further increase patient demand for services. Another article about Australian medical care. Patient goes to hospital complaining of the “worst headache of his life.” In many cases, that translates into doctor speak for “order a head C...
Source: WhiteCoat's Call Room - April 15, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Dear Diary
So much to rant about today. The girls are doing a dance competition this weekend. I’m trapped in my own little version of Dance Moms. Aaaaauuuuuggghhh. Somebody help me. One daughter complains because she’s in the back of one dance the whole time. Another daughter is upset because people are mad at her because she’s in front during one of her dances. Glitter is all over our fricking kitchen and it doesn’t come up with wet wipes, either. We have to purchase hair extensions with curls for $25 for the girls, and we have to make SURE to purchase the color that most closely matches the girl’s hair...
Source: WhiteCoat's Call Room - April 12, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Random Thoughts Source Type: blogs

Proving a Negative
A young lady comes to the emergency department and wants to be evaluated for a … somewhat nonurgent … problem. Chief complaint: “I’ve lost 50 lbs in the past month.” She felt a little weak as well, but she had just lost too much weight. No other symptoms. The patient weighed 132 pounds. Her skin wasn’t sagging. Her jeans didn’t appear to be new and they seemed to fit pretty well. Nothing about her seemed abnormal on exam. But she insisted that she weighed 180 pounds just a month earlier. No old records in the computer. I asked her if she could show me a recent picture of herself on...
Source: WhiteCoat's Call Room - April 11, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Patient Encounters Policy Source Type: blogs

Time for a New Roommate
Second time in a week. The first episode, the patient from the assisted living facility came in with sharp anterior chest pain. She said that she was sleeping and woke up with sudden onset of pain. When she opened her eyes, her roommate was standing over her with a crazed look in her eye. Sticking out of her right breast was a ball point pen. Fortunately, the injury was to adipose tissue only and didn’t require any surgical intervention. On her most recent visit, the same patient returned after waking to her roommate’s friend beating her with a cane. She tried to fend off her attacker and fell to the floor wher...
Source: WhiteCoat's Call Room - April 11, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs

Healthcare Update — 04-08-2013
Columbus, OH paper compares hospital wait times from 15 different hospitals throughout central Ohio. Metrics include minutes until diagnostic evaluation, minutes until pain medication, minutes until admission decision, and minutes from admission to room placement. I just wonder how accurate the metrics are. It isn’t like self-reported data like this can’t be manipulated. Evanston Northwestern Hospital in Chicago suburbs also making news because of its wait times – nearly twice the national average. The problem with providing patients with insurance: When the insurer cuts payments, what happens if providers won’...
Source: WhiteCoat's Call Room - April 8, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Unnecessary Testing?
A patient was sent to the emergency department to have an ultrasound of her uterus performed. She had been having abnormal bleeding which coincided with about the time her period was due – only it was a little heavier and lasted a little longer than usual. She decided the best course of action would be to make an emergency appointment with the gynecologist. She was seen the day before she was sent to the ED and the gynecologist performed an ultrasound in his office … which was normal. The patient called the gynecologist the following day and said that the bleeding was still there, so the gynecologist told her t...
Source: WhiteCoat's Call Room - April 5, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Patient Encounters Random Thoughts Source Type: blogs

My Secret Addiction
By an Anonymous Emergency Physician Hi. I’m Anon. I’m a 44 year old emergency physician. And I’m an addict. My addiction came to light when my Press Ganey scores plummeted after I started to stand up to the chronic pain and frequent ER patients. The fact that I have an addiction was reaffirmed when I went to my state’s Prescription Drug Abuse Summit. When I saw so many professionals from varying fields (medicine, law enforcement, pharmacy, education, etc…) assembled, I realized my problem: I’m addicted to prescribing pain medications. As with any addiction, the first step in treatment re...
Source: WhiteCoat's Call Room - April 3, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Guest Posts Source Type: blogs