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Hospital Medicine 2015

Hospital Medicine 2015

New research was presented at Hospital Medicine 2015, the annual meeting of the Society of Hospital Medicine, from March 29 to April 1 in National Harbor, MD. The features below highlight some of the studies emerging from the conference that are relevant to emergency medicine. ED Waiting Times for Telemetry Patients The Particulars: Few studies have assessed differences in the time for a bed assignment between telemetry and non-telemetry patients after an ED admission order has been entered. Data Breakdown: Researchers conducted a study that compared the time between a request for a telemetry bed and when that bed was secured between telemetry and non-telemetry patients at a hospital with 84% telemetry capability. Telemetry patients waited an average of 42 minutes, whereas non-telemetry patients had an average wait time of 50 minutes, representing a statistically significant difference. Take Home Pearl: Patients assigned to telemetry do not appear to spend much more time in the ED waiting for a bed when compared with patients assigned to non-telemetry. Syncope in EDs The Particulars: Studies have shown that evidence-based medicine is not always utilized during syncope evaluation, causing unnecessary testing and increased costs. A multi-faceted intervention may help improve the quality and safety of syncope care. Data Breakdown: For a study, a multidisciplinary group developed a syncope evaluation algorithm based on an evidence review that included a risk stratification tool. The algorithm was posted in the ED and on an intranet and accompanied by an ED syncope order set and note template, ED nursing education on orthostatic vital signs, and education of physicians. When comparing pre- and post-intervention data, significant improvements were...
Managing Migraine in the ED

Managing Migraine in the ED

Migraine is one of the most common disorders for which patients seek medical treatment in the ED. Studies show that migraine causes most of the 5 million headache visits to EDs in the United States each year. “The average annual costs for migraine-related ED visits are at least $700 million,” says Mia T. Minen, MD, MPH. “Considering the high costs of ED care of migraines and the fact that the ED environment is typically not conducive to treating these headaches, it’s important for healthcare systems to make efforts to prevent or divert ED migraine visits and take steps to ensure fewer return visits.” Research suggests that the current state of migraine management in EDs is suboptimal. In the journal Headache, Dr. Minen and colleagues reviewed how patients with migraine are managed in the ED. The analysis identified characteristics of patients seeking ED care for migraine and examined guidelines and current practices regarding ED imaging use for migraine. It also explored how current ED care for migraine deviates from recommended treatment practices and investigated potential methods for improving outcomes following ED treatment. Characterizing Patients Few studies have looked at the makeup of patients that utilize the ED for migraine and why these individuals seek care in the ED. Some research has suggested that migraineurs who use EDs are more likely to be female, older, and non-white. Narcotic use, lower socioeconomic status, and overuse of emergency services have also been linked to ED visits for migraine. In addition, mood disorders may contribute to ED visits for migraine. Assessing Diagnostics Imaging practices for migraine in the ED vary widely despite clinical recommendations...

Drug Wars in the Exam Room

As physicians, we have all been faced with patients inappropriately looking for prescriptions for controlled substances. Some are looking to abuse them and some to divert them for profit. It is often hard to distinguish when a patient truly needs these medications or when they are just “drug-seeking.” More experienced doctors have a better sense of which patients are which. Drug-seeking patients often play on our emotions because they know we generally care about patients and may have difficulty turning down a request for opioids from someone in supposed pain. For years, patients have used many ruses to access these medications. Many of them “doctor shop,” use several pharmacies, or frequent various emergency rooms, making it difficult to track their prescriptions. And it’s much harder for a doctor to turn down a request from a new patient in acute pain than from one the doctor knows well and doubts. Having so many controlled substances available and sold on the streets has led to an increase in prescription drug dependency. These patients have a hard time breaking these addictions and often can only stop with help from special rehab programs. It has led to a further resurgence of IV heroin addiction and opioid deaths in many areas. As the states have tightened controlled substance prescriptions, they have become less available for diversion and are now a gateway drug to heroin—which is cheaper than prescribed medications. I am seeing teens in my practice addicted to IV heroin, a habit that started by raiding parents’ or relatives’ medicine cabinets. It has never been more imperative for doctors to step up and do...
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