ACEP News - June 2008 - (Page 33)

JUNE 2008 • ACEP NEWS PRACTICE TRENDS British Expert’s Lessons Learned Can Help Hospitals Survive a Surge B Y A L I C I A A U LT Else vier Global Medical Ne ws S A N F R A N C I S C O — You can’t have a surge plan set in stone, but you should at least establish a response agenda, said Lt. Col. Rob Russell, a veteran of natural disasters, bombings, and war zones worldwide. “Your plans will need constant updating and improvement,” added Dr. Russell, the lead emergency physician at Peterborough (England) Hospital. When starting to plan, it is crucial to make contingencies. Incidents can be natural or man made; simple, with no infrastructure damage; or compound, with damage to roads, transportation, and health facilities. Incidents may be compensated by the government, or could end up being a long drag on hospital finances. What spectrum of casualties can be expected? Will there be a mass trauma with a sudden, big influx, or a medical incident, such as a bioterrorist attack, where casualties may stream in for hours or days? What’s the emergency response system? Is the prehospital response plan adequate? How will the patients get to the hospital? Finally, are there collaborative agreements with other facilities? At the prehospital level, the goal is to keep the disaster in the field and not transfer it to the emergency department, Dr. Russell said at the 12th International Conference on Emergency Medicine. Command and control in the field should be well established. Communications are absolutely vital—among physicians and rescuers at the scene, and between the scene and the hospital. Hospitals should be prepared to send physicians or nurses to the scene and have plans for replacing them in the facility, said Dr. Russell. Plans should also be in place for getting supplies to the scene. Triage should be aggressive, with liberal and appropriate use of the T4 designation, said Dr. Russell. T4 means an expectation of death. Treatment expended on these patients diverts attention from other patients in greater need. Many U.K. first responders are adopting the British Army’s treatment approach: Control hemorrhage first, and then move to the airway. This approach also will likely prove useful in civilian disasters, said Dr. Russell. Responders should consider pulsing patients to many different hospitals, and sending appropriate patients—such as burn victims—to specialty hospitals. Hospitals should employ damage control surgery with the initial wave, but planning should begin immediately for later surgeries. A control team should be in place, and the overall command should not be dependent on a single individual, he said. What if that person is on vacation when disaster strikes? Consider the facility’s key “pinch” points. Resuscitation is likely to be a bottleneck. There should be a ready-to- go department stocked with fluids, pharmaceuticals, and a predesignated staff that includes an emergency physician, a surgeon, and a critical care specialist, he said. Hospitals should also have a readily available route of supplies—a potentially large hurdle, given that most facilities now operate with a just-in-time ordering system, he said. Because it may not be possible to transfer patients, hospitals in the midst of a surge could create a “disaster” ward to concentrate patients in a single area. How can such a ward be created when most hospitals are at near capacity on a normal day? Usually, free beds can be found, he said. Call general and family practitioners in the community, and put out a call for volunteers—but be sure to have staff to check credentials. It may take more drastic action. In Singapore, an entire hospital was cleared to take on patients with severe acute respiratory syndrome. In Israel, empty wards are maintained for surges, he said. How can a facility assess surge capacity? Consider the tool developed by Johns Hopkins University in Baltimore to assess disaster drills, available through the Agency for Health Care Research and Quality at www.ahrq.gov/ research/hospdrills/hospdrill.htm. The best choice, however, is to conduct drills, said Dr. Russell. Most likely, they will show that the staff has no idea what to do, and that nothing goes according to plan, he said. ■ MedPAC Gives Final Backing To Bundled Pay WA S H I N G T O N — The Medicare Payment Advisory Commission has given its backing to bundling payment for hospitalization, which would essentially give hospitals and physicians an incentive to control costs and avoid readmissions. At its April meeting, the commission (MedPAC) unanimously voted to include a bundling recommendation in its June report to Congress. As a first step, physicians and hospitals should be required to report to the Centers for Medicare and Medicaid Services (CMS) on resource use and readmissions during an “episode of care,” which is proposed to include the first 30 days post hospitalization. The data would be confidential initially, but by the 3rd year, should be made public, MedPAC commissioners recommended. Once the resource and readmission data are in hand, CMS should start adjusting payment to hospitals, according to the recommendation. There would be the possibility for gainsharing among hospitals and physicians. The commissioners also voted to direct CMS to study the feasibility of “virtual” bundling. With virtual bundling, the payment would be adjusted based on aggregate use of services over an entire episode of care. Finally, MedPAC voted to recommend that CMS create a voluntary pilot to test actual bundled payment in selected disease conditions. The pilot could throw some light on how the hospital or accountable care organization receiving the payment decided to share funds, and how Medicare might share in any savings, according to MedPAC staff. —Alicia Ault CLASSIFIEDS A l s o a v a i l a b l e a t w w w. e l s e v i e r h e a l t h c a r e e r s . c o m MONTANA, Northeast Hospital employed Emergency Medicine position available with flexible hours and schedule located in rural northeast Montana associated with financially stable two hospital health system with large Native Indian population. Negotiable $180K salry with bonus and excellent benefit package including malpractice insurance. National Health Service loan repayment site. DONOHUE AND ASSOCIATES 800-831-5475 F: 314-984-8246 E/M: donohueandassoc@aol.com DONOHUE AND ASSOCIATES Timothy L. Donohue President 1149 Lockett RD St. Louis MO 63131 Phone:1-800-831-5475 Fax:314-984-8246 Western Maine Emergency Department Director Stephens Memorial Hospital in Norway, Maine, a member of MaineHealth, the premier healthcare system in Maine, has an opportunity for a BC/BP Emergency Physician Director to join their state-of-the-art, Level II Emergency Department. ED volume is 19,000 with high acuity and double physician coverage There is in-house access to advanced imaging technology, 24/7 lab, Lifeflight capability for major trauma transports and ED ultrasound. The ED Director staffs the ED (clinical hours flexible). We offer an excellent compensation package including paid malpractice, medical school loan payback assistance, CME allowance, family paid health/dental, 403b retirement, and much more. Norway is 2-1/2 hours from Boston and one hour from Portland and the ocean. Enjoy the arts, skiing, hiking, boating on pristine lakes and other recreation that this four season resort community has to offer. For more information contact: Tracey J. Frye Administration Office Tel: 207-743-1562 x321 Email: fryet@wmhcc.org Fax: 207-743-1566 www.wmhcc.org TEXAS, Huntsville Innovative group seeks experienced EM physician for 17K annual volume ED just outside The Woodlands, TX. Excellent compensation as an Independent Contractor. This community offers a family friendly atmosphere and outdoor activities at Huntsville State Park. Within driving distance to Dallas and Houston for dining, shopping, sports and entertainment. Must be BC/BP in a primary specialty with significant EM experience. Contact: Erika Pourrajabi at 979/220-4542. Send CV to erikapourrajabi@affilion.com or fax to 361/288-2515. www.affilion.com http://www.ahrq.gov/research/hospdrills/hospdrill.htm http://www.ahrq.gov/research/hospdrills/hospdrill.htm http://www.elsevierhealthcareers.com http://www.choosesoutheast.com http://www.wmhcc.org http://www.affilion.com

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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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