Posts Tagged ACEP
By Constance Doyle, MD, FACEP
She came in with a chief complaint of “needs rabies shot”
Her story: She said she was placing clothes in the washer when something bit her on the hand. She looked to see if her cat was in the washer and seeing that she was not, slammed the lid and ran the wash twice to be sure that whatever animal it was dead.
Then carefully looking through the clothes while putting the clothes in the dryer, she found a limp and dead bat which she fished out with kitchen dishwashing gloves. At that point, she pulled a paper sack out of her handbag and set it on the counter. We went on with the physical and discussion of rabies testing and vaccine, when I noticed the bag was slowly moving in and out like something was breathing and the sack was rattling. I had visions of the creature getting out and flying all over the ER, being a nightmare to catch, exposing both staff and other patients as well as becoming a liability for the hospital. The normal bat containers, empty paint cans were in storage, and I knew that someone would have to go to the locker and get one taking at least 15 minutes. I needed a container now. I ran next door to the trauma room and grabbed a large suction canister and lid and put the sack in it. Now to humanely be sure that the bat was not a threat, we found a bottle of alcohol and poured it in through the suction hose connection. At least it could die in an alcohol stupor. The bag stopped moving and the paint canister arrived and the whole canister fit inside without opening it and off to the health department.
You just can’t make this stuff up!
Although ACEP has previously reviewed the Choosing Wisely Campaign and agreed not to participate, due to continued questions and comments from our members, I convened a workgroup to re-review the campaign and ACEP’s participation. The workgroup consisted of a wide and diverse representation of ACEP members and Committees.
The group was overwhelming in support of not joining the Choosing Wisely Campaign. Although the issue of cost control is crucial for emergency medicine’s future, the Choosing Wisely Campaign is not the vehicle for ACEP’s participation.
Several important points were made during the workgroup meeting:
- The College needs to be viewed by CMS, payers, and the public as proactively addressing cost containment and overuse.
- ACEP needs to be seen as proactively providing solutions rather than appearing to be against any cost cutting or savings suggestions.
- The College developing and communicating a plan with proactive proposals/solutions will mitigate some cost cutting measures from those that do not understand the unique position of emergency care. It was noted part of the success of the Washington State initiative was the ability to come to the table with a plan, rather than push back against the plan of action presented by the State.
- Whatever is developed should showcase the specialty in a favorable light and not contradict or conflict with current advocacy efforts.
- There was support for identifying over-use and developing a positive message on cost savings and efficiencies in the emergency department.
- To come to consensus on a certain number of tests or services that have limited use would require so many caveats that it would be almost impossible to develop lists as found in the Choosing Wisely Campaign.
- Ideally any recommendations should include some liability reform/recommendations in using guidelines that may suggest certain tests or procedures are not effective or necessary.
It was recommended that ACEP develop a task force from committees, sections, and members with expertise in these areas to develop a proactive campaign that recognizes the role the emergency department and emergency physicians can play in controlling costs while improving efficiencies and quality patient care.
The process has already begun with the task force being constituted with the goal of developing messages and strategies for cost control in the emergency department. The task force will make their recommendations at the October ACEP Board of Directors meeting.
We also will be educating our members about cost savings programs from other specialties, such as the Image Wisely and Image Gently programs from the American College of Radiology.
DAVID SEABERG, MD, FACEP
President, American College of Emergency Physicians
Sandra Schneider, MD, FACEP, ACEP Past President
I would like to personally invite you to become a member of the Emergency Medicine Practice Research Network – EM-PRN. Becoming a member is simple; just click on this link and answer a brief survey. It will take less than five minutes. We want to know if you are seeing patients with chronic pain, we want to know if you are experiencing medication shortages and how you are coping. We want to know how you practice. YOUR ANSWERS will provide ACEP with essential information for our advocacy in Washington and improving emergency care. To stay a member, all you need TO DO is to agree that you will complete 3-4 surveys, five minutes or less, each year.
Membership at this time is only open to ACEP members, residents, attendings and life members. Sorry, we cannot as yet accommodate non-members or medical students. Many other specialities have built practice research networks. Pediatrics has had one for more than a decade. They started small, like us. They have found that getting data from physicians on the front lines is often very different than getting it from inner city, teaching hospitals. Once you join EM-PRN, you will be able to do much more than just give opinions to survey questions. We want to submit ideas for research projects and survey questions that YOU would be interested in. Our group will pick the more interesting and the most popular IDEAS for the next survey. So you not only will be providing answers, you’ll be designing the questions.
Right now and for the next few years, EM-PRN will be largely surveys. Eventually, we will likely want to grow to collect some data. For example, IN THE FUTURE we might want to monitor the number of patients seen with chronic pain in emergency departments. You would simply count the actual number of patients you see during a single shift (no names, no identifiers) and submit it to ACEP.
We could then monitor this number over time to see if it is increasing, decreasing or staying the same. The members of EM-PRN will help direct what research projects we consider and will be acknowledged on any publication. Members will also receive the results of any project ahead of publication. So in the time it has taken you to read this Blog, YOU could contribute to advancing our knowledge of the real practice of emergency medicine. Join now.
ACEP, the National Stroke Association, and Genentech have partnered to develop a FREE stroke education course for EMS professionals. The course covers the basics of stroke, pre-hospital assessment, stroke systems of care, and case studies.
EMS educators may also download the slides and use them in their EMS education.
Access the course today at www.EMS4Stroke.com.
After Apple announced the iPad device, I immediately began to think of all the medical applications that could be used for this device.
Currently the app store has about 140,000 apps and is growing at an amazing rate. The medical app store has about 1,920. Health apps number about 3,100. According to Apple, most of these apps should work on the iPhone and will transfer to the iPad as long as you use the same login. It will be interesting to see what the apps that were created initially for the iPhone will look like on the new iPad device. It is interesting also to note that the device does not have a camera, however the iPod Nano does. My guess is the device would take up more bandwidth if it had a camera.
I am curious to see if the iPad will work with apps like Skype and Google Voice. If they do, then with a $20, 3g plan, you could use the device as a 2nd phone. For example Google Voice allows you to set up a local phone number that others can use to call you. If you do not answer then you will get a transcribed text with the first couple of lines of the missed callers message!
What medical applications can we expect from this device?
Patient education company Blausen makes an amazing product that has short video animations on multiple medical diseases. They are very basic and range from half a minute to two minutes. Electronic medical records would be interesting. You have to wonder how they would work in the ER. I cannot imagine keeping up with an expensive device in the ER. At least one I can’t put in my pocket. I can see myself losing it during a code or dropping it as I run to the floor for a “code blue.”
I am interested in hearing from our readers and seeing how other ER doctors use technology at work. Currently, I use Pepid, although it is expensive, it has almost everything I need in the app.
Feel free to post if you are likely to purchase the next iPhone (new cell phone carrier to be announced in June), iPad wifi only will be out around March 27 and the iPad with wifi/3g service around late April in the United States. The rest of the world will get it after June which will be just in time for the new iPhone.
I look forward to your emails and post,
Harvey Castro MD
Picture from iPhone life magazine.
The system is called “Spaced Education,” and it’s based on the theory that adults learn better in short, repeated “doses” rather than in large, intense bouts of studying. The College is testing it on the ACEP PEER VII Sampler and when you sign up, you’ll get one or two questions by e-mail every day. When you answer each question, you’ll get an in-depth discussion of the correct answer. If you miss it, you’ll get it again in about a week. If you get it right, you’ll see it once more in about 2 or 3 weeks.
This method of questioning and reinforcement has been found in randomized, controlled trials to improve knowledge acquisition, increase long-term retention, change behavior, and boost learner’s ability to assess their knowledge. And you get to decide how often you want to get the questions.
Here’s how to sign up:
- Go to http://acep.spaceded.com
- Click on the PEER VII cover image
- Click “Enroll Now for FREE” and choose your delivery options
All ACEP asks is that you provide feedback. About 10 days or 2 weeks after you sign up, one of your questions will include a link to some evaluation questions. And 40 free PEER questions are yours!
For help using SpacedEd, visit www.spaceded.com/info/support
Last night the U.S. House of Representatives passed a health reform bill, H.R. 3962. Emergency physicians are divided in their thoughts about the consequences of this legislation, as is the house of medicine and the country in general. However, there are many aspects of the bill that are positive for emergency patients and for emergency physicians.
Some of these include:
- Inclusion of emergency services as part of an essential health benefits package
- Statutory authorization of ECCC (Emergency Care Coordination Center) and ECCC Council of Emergency Medicine
- Health and Human services annual report to Congress on ECCC activities, with focus on emergency department crowding, boarding and delays in ED care following presentation
- Emergency care/trauma regionalization pilot project grants
- Trauma stabilization grants
- Health and Human Services incentive payments to states that establish medical liability reforms (Certificate of Merit/early offer)
- Health and Human Services demo project to reimburse private psychiatric hospitals that provide EMTALA services to Medicaid beneficiaries
The American College of Emergency Physicians has worked diligently to represent emergency physicians and emergency patients throughout this volatile process. As the process continues toward final legislation, ACEP will continue to focus on the needs of emergency patients, future emergency patients, and the physicians who care for them.
Don’t forget to take ACEP’s H1N1 survey about how you, your group, and your hospital are preparing for flu season.
ACEP President Nick Jouriles shares his thoughts on President Obama’s speech to the AMA House of Delegates yesterday
President Obama was warmly received by the physicians at the AMA Annual Meeting earlier today. Like many in the crowd, I went with mixed feelings. Our current system is not sustainable, we all know that. But would he actually speak specifically to some- even one – of the critical issues in emergency medicine today? What are his plans, how will our issues be addressed, and where do we go from here?
For starters, the President told us that he is not trying to create a state run plan. “When you hear the naysayers claim that I’m trying to bring about government-run health care, know this–they are not telling the truth,” Mr. Obama emphasized.
But his plan does have a public component and includes: an emphasis on preventative care, widespread use of electronic health records, and changes in the health insurance industry including a new “exchange” where individuals and businesses can purchase a health plan. That “exchange” includes a government option.
Like many in the audience I was wondering about President Obama’s emphasis on wasteful spending in health care. He does not lay the blame at the foot of physicians, but the constant drumbeat coming from his administration on this issue is unsettling. Can inefficiencies be wrung from the system? Can we streamline some of our processes? Can things be done differently? Yes, yes and yes. But to the tune of hundreds of billions of dollars? I don’t see it. Most emergency physicians don’t see it, and neither will most Americans.
But then, he brought up an issue we can all agree on. I am encouraged that he is open to changes in the medical liability system. That was a position I had not expected from this Administration, and although he does not take a strong position, it is a start. President Obama said, “[W]hile I’m not advocating caps on malpractice awards which I believe can be unfair to people who’ve been wrongfully harmed, I do think we need to explore a range of ideas about how to put patient safety first, let doctors focus on practicing medicine, and encourage broader use of evidence-based guidelines. That’s how we can scale back the excessive defensive medicine reinforcing our current system of more treatment rather than better care.”
Like I said, a start.
We will also have to look long and hard at proposals affecting the physician payment system. In addressing the issue, Mr. Obama said, “We need to bundle payments so you aren’t paid for every single treatment you offer a patient with a chronic condition like diabetes, but instead are paid for how you treat the overall disease.”
How that plays out for emergency medicine will be key, but given our 25 year history with EMTALA, where many hospitals receive extra funds for indigent care while we do not , his emphasis on this is not a good sign.
Finally, it was disappointing not to hear emergency medicine mentioned specifically. We saw how our emergency departments were affected with the “worried well” of H1N1. And the New York Times published my letter to the editor addressing that point. But the White House has hit the mute button for now- or until the next epidemic or natural disaster occurs- regarding the crisis in emergency medicine.
It was a good speech and a good start. It was great to be in the audience. Now it’s time for Congress to get down to business and find solutions that we can all believe in. And time for the nation’s emergency physicians to stand up and make our voice heard. Our patients need us.
Welcome to emergency medicine’s newest blog site, TheCentralLine.org. Hosted by the American College of Emergency Physicians, this site will include the opinions, ideas and experiences of emergency physicians.
Right now, health care reform is the hot topic, and on April 22, 2009 more than 400 ACEP members will go to Capitol Hill during the Leadership and Advocacy Conference to lobby their members of Congress. This site will cover that conference and report on the activities and responses of those attending, as well as the statements and positions of the policymakers and legislators who are scheduled to attend. Several emergency physicians will also join the site and tell their stories first hand.
Join us and make The Central Line part of your daily blog experience.