Advertisement
Patient Preferences on Boarding

Patient Preferences on Boarding

Crowding in the ED has been well-established as a problem that poses a threat to public health. Studies show that ED and hospital crowding leads to ambulance diversions, medical errors, delayed care, and increased mortality rates. “Many strategies have been tried to alleviate ED and hospital crowding, some of which involve the entire institution,” explains Peter Viccellio, MD. Using a Full-Capacity Protocol One strategy that aims to reduce ED crowding is the use of a full-capacity protocol (FCP), in which admitted ED patients are redistributed to inpatient unit hallways while they wait for regular hospital beds to open up. Some studies have shown that an FCP can decrease ED wait times, ambulance diversions, and overall hospital length of stay. A potential concern with this approach, however, is that it could reduce patient satisfaction. Recently, Dr. Viccellio and colleagues had a study published in the Journal of Emergency Medicine that examined patient preference and satisfaction with boarding in the ED versus inpatient hallways during times when there were no inpatient beds available for admitted patients. All patients were initially boarded in the ED in a hallway before their transfer to an inpatient hallway bed. “No more than two patients in our study were placed on any inpatient unit and all patients received direct care from inpatient physicians and nurse specialists,” adds Dr. Viccellio. “We didn’t compare a room versus a hallway. Rather, we looked at making decisions about where patients can receive the best care and greatest attention in difficult circumstances when a normal room is not available.” Overwhelming Results According to the results, the overall preferred location after admission...
Stroke Guidelines for Women

Stroke Guidelines for Women

Both men and women share many of the same high-risk predictors for stroke, such as smoking, family history, and physical inactivity. However, some risk factors are either exclusive to women or affect women disproportionately. The American Heart Association (AHA) and American Stroke Association (ASA) recently convened a panel of experts in neurology, obstetrics, cardiology, epidemiology, and internal medicine to review and assess the literature on stroke risk in adults. This resulted in the publishing of the first gender-specific AHA/ASA guidelines for stroke prevention in women. “The development of these guidelines is important because women differ from men in many ways with regard to stroke,” explains Cheryl B. Bushnell, MD, who chaired the AHA/ASA writing group that developed the document. Several characteristics can influence stroke risk and impact outcomes, including genetic differences in immunity, coagulation, hormonal factors, reproductive factors (eg, pregnancy and childbirth), and social factors. “Many of the unique risk factors for women present at younger ages due to things like oral contraceptive use and pregnancy complications,” Dr. Bushnell explains. “Recognition of stroke risk and identification of prevention strategies could start early in at-risk women.” Highlighting Key Recommendations Based on available evidence, the AHA/ASA guidelines categorized risk factors by those that were sex-specific, more prevalent in women, or similar between women and men (Table 1). Dr. Bushnell says it is critical to recognize that women with a history of hypertension or preeclampsia during pregnancy are at risk for stroke and hypertension later in life. “Before this guideline emerged, few providers and women knew about this risk,” she says. “The evidence for this relationship is strong, and multiple meta-analyses have...
Is There A Mental Healthcare Crisis In The U.S.?

Is There A Mental Healthcare Crisis In The U.S.?

We are all shocked when we see news stories of multiple people being killed by someone who seems to have gone off the deep end. While these events are extremely rare, it is a true tragedy to have them happen at all. It is often found that the guilty parties were suffering from some mental illness. These are the extremes of mental illness. However, milder forms of mental illness, such as anxiety and depression are very prevalent in the U.S. The unfortunate reality is that for many of these patients, they just cannot get mental healthcare even if they want access to it. How big is the problem? According to a survey of physicians on Sermo, the number one social network exclusively for physicians, approximately 84% of the doctors polled believe there is a mental healthcare crisis in this country. Often times, the primary care physician is left to care for these patients whom they may not feel comfortable taking care of, just because they cannot get an appointment for the patient with a psychiatrist. I often times have a patient who I believe needs to see a psychiatrist but is unable to get an appointment for up to 6 months. If a patient is having a mental healthcare urgency, they usually end up in the ER for lack of access to outpatient healthcare. But, psychiatrists are not to blame. This is rather due to a broken system that is in need of major reforms. Why is there a mental healthcare access crisis in the U.S.? 1. In the 1960’s, psychiatric hospitals closed their doors, making inpatient services very...
Get Connected

Get Connected

Get the edge on your colleagues by receiving updates directly from the Physician’s Weekly editors in multiple ways. Sign up for our weekly e-newsletter Subscribe to our RSS Feed Like us on Facebook Check us out on Google+ Follow us on Twitter Join the conversation on...
[ HIDE/SHOW ]