ACEP News - June 2008 - (Page 1)

VOL. 27 • NO. 6 • JUNE 2008 AN OFFICIAL PUBLICATION OF T H E AMERICAN COLLEGE MEDICINE OF EMERGENCY PHYSICIANS CREATIVE COMMUNICATIONS/WAKE FOREST UNIVERSITY SCHOOL Despite the study’s findings, “you need to look at what is best for patients” first when considering an off-site strategy, cautioned Dr. Michael A. Kutcher. Medicaid Cuts May Threaten Emergency Surge Capacity Emergency physicians warn Congress. B Y J O E L B. FINKELSTEIN INSIDE Focus On Dengue Fever What to do when the global epidemic shows up in U.S. emergency departments. • 17 OF Else vier Global Medical Ne ws Is PCI Without On-Site Surgical Backup Safe? BY MITCHEL L. ZOLER Else vier Global Medical Ne ws C H I C A G O — Percutaneous coronary interventions done without on-site cardiac surgery backup were as safe as procedures done with on-site backup in a registry of more than 300,000 total patients treated during 2004-2006. Despite this positive showing for percutaneous coronary interventions (PCI) done without an on-site safety net, several experts voiced skepticism about how widespread the practice should become, including the advocates for this form of PCI who ran the study. The results “confirm the safe- ty of an off-site strategy at existing PCI centers where rigorous clinical, operator, and institutional criteria are in place and are monitored to ensure high-quality outcomes,” Dr. Michael A. Kutcher said at the Innovation in Intervention (i2) Summit. But, he added, “the findings of our study should not be extrapolated to encourage the widespread proliferation of off-site PCI programs. You need to look at what is best for patients,” said Dr. Kutcher, lead investigator in the study and professor and director of interventional cardiology at Wake Forest University in Winston-Salem, N.C. See Backup • page 5 WA S H I N G T O N — Cuts to the Medicaid program will hinder emergency departments’ ability to cope with a surge of patients resulting from a terrorist attack or natural disaster, physicians and other experts warned a congressional committee last month. Witnesses told the House of Representatives’ Committee on Oversight and Government Reform May 5 that planned regulatory changes would result in hospitals’ losing billions of Medicaid dollars that they currently use to sustain day-to-day operations. In particular, limiting payments to only public providers, dropping funding for graduate medical education, and limiting dollars for services in outpatient settings would have a devastating effect on emergency preparedness, said Colleen Conway-Welch, Ph.D., dean of the school of nursing at Vanderbilt University, Nashville, Tenn. “If Medicaid dollars are reduced in these three areas, a reduction in personnel and readiness will occur in our hospitals and emergency departments across this country,” she told the committee. The cuts would come at a time when emergency departments and trauma centers are struggling to keep up with demand. At the hearing, the committee’s chairman, Rep. Henry Waxman (D-Calif.), released the results of a survey conducted by Democratic congressional staff showing that emergency departments are already regularly overwhelmed by patient loads. Of 34 level I trauma centers surveyed, more than half were operating above capacity. The findings appeared to be particularly dire in Los Angeles, where three of the area’s five centers were on diversion, and See Surge • page 5 ACEP-APPROVED CME News Time to Move Transferring post-thrombolysis STEMI patients to PCI centers topped the conventional wait-and-see approach. • 4 Tricks of the Trade Revealing Tips Ultrasonography can help find retained foreign bodies. • 9 Practice Trends EMTALA Results The Technical Advisory Group’s recommendations are finding their way into practice. • 3 4 ACEP Unveils Boarding Solutions Report B Y N A N C Y C A L A W AY ACEP Communications Manager VITAL SIGNS “Emergency Department Anew ACEP report, Crowding: High-Impact Solutions,” recommends several low-cost or no-cost solutions to reduce the time patients are boarded in the emergency department. ACEP’s nine-member Boarding Solutions Task Force, chaired by Dr. Peter Viccellio, developed the report’s recommendations over 8 months. A common thread in the report is that boarding, the primary cause of overcrowding, is a systemic, hospital-wide problem. Some of the solutions include simply moving patients out of the emergency department as Surgical Backup Status for Sites Performing PCI No PCI without on-site Primary PCI without cardiac surgery on-site cardiac surgery Primary and elective PCI without on-site cardiac surgery soon as they are admitted, coordinating the discharge of hospital patients before noon to free inpatient beds, and distributing elective and surgical patients throughout the week. “Our members put together some great boarding solutions that have been proven to work, not just in theory, but in practice at several hospitals across the country,” explained Dean Wilkerson, ACEP’s Executive Director. “Our hope is that other emergency physicians can use the report, apply the recommendations to their own specific situations, and solve the daily challenges at their hospitals,” he added. See Report • page 20 DC ELSEVIER GLOBAL MEDICAL NEWS Note: Based on July 2006 data from the Society for Cardiovascular Angiography and Interventions. Source: Catheter Cardiovasc. Interv. 2007;69:471-8

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ACEP News - June 2008 Contents News - Time to Move Tricks of the Trade - Revealing Tips Focus On - Dengue Fever Practice Trends - EMTALA Results

ACEP News - June 2008

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