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The “July Effect” & ED Length of Stay

The “July Effect” & ED Length of Stay

Throughout the medical community, the “July effect” or “July phenom­enon” is a well-known entity in which it is believed that the month of July is a poor time to be cared for in the hospital because trainee doctors are beginning their new roles. As medical students move up the ranks in July, their amount of collective experience in the hospital is less than the months before this time. “Anecdotal evidence suggests that the July effect may be responsible for higher rates of errors, resulting in poor outcomes,” explains Christine Riguzzi, MD. Previous studies have looked at morbidity and mortality, surgical outcomes, hospital length of stay (LOS), and hospital charges early in the academic year as compared with other times of the year, but these investigations have yielded mixed results. “The July effect has been examined in various clinical settings, such as surgery, but little is known about it with regard to the ED setting,” Dr. Riguzzi says. A Retrospective Analysis Dr. Riguzzi and colleagues conducted a study to assess if LOS varied throughout the year at teaching and non-teaching EDs. Published in the Western Journal of Emergency Medicine, the retrospective analysis involved a nationally representative sample of 283,621 ED visits from 2001 to 2008. The study compared July to the rest of the year, July to June, and July and August to the remainder of the year. According to the results, there was no significant difference in the average LOS for the month of July versus the rest of the year, July and August versus the rest of the year, or July versus June at teaching hospitals with residents....
Telemedicine Adoption in the ICU

Telemedicine Adoption in the ICU

ICU telemedicine uses audiovisual technology to provide critical care services remotely, typically with fixed installations that can be used continuously or during nighttime hours. “Research has shown that telemedicine can potentially improve ICU outcomes by increasing access to expert physicians,” explains Jeremy M. Kahn, MD, MS. “It can also potentially facilitate the early recognition of physiological deterioration and prompt providers to implement routine evidence-based practices at the bedside.” However, studies that have evaluated the effects of telemedicine on ICU outcomes have yielded mixed results. Complicating the matter is that adoption of ICU telemedicine is associated with major organizational barriers to overcome, such as high technological and staffing costs. Clinicians also lack consensus about how to best use this technology and where it is best applied. Considering these potential barriers, it is important to understand the patterns of ICU telemedicine adoption and implementation in the United States. “Research is needed to examine the pace of adoption and the degree to which telemedicine has been adopted in smaller, rural hospitals, where it may have the greatest potential to improve outcomes,” Dr. Kahn says. Use & Patterns In Critical Care Medicine, Dr. Kahn and colleagues published a study that examined the extent of use and patterns of adoption of ICU telemedicine in the U.S. from 2003 to 2010. The retrospective analysis combined a systematic listing of ICU telemedicine installations with hospital characteristic data from Medicare. According to the findings, the number of hospitals using ICU telemedicine increased from 0.4% in 2003 to 4.6% in 2010, resulting in an average annual increase of 61.0% per year (Figure). However, most of that growth occurred...

Attack of The Scribes

The emergence of the electronic medical record (EMR) has spawned a new occupation—the scribe. A scribe is someone who accompanies a physician and documents the interchange between the doctor and patient. This enables the doctor to focus on the patient instead of wasting time navigating through the EMR, which has become a tool for hospital finance departments instead of a way for doctors to communicate. Scribes need not have medical backgrounds and may be drawn from the ranks of high school graduates, college students, and medical students. Salaries range from $8 to $16 per hour. Emergency departments currently are most likely to employ scribes, but they have also been hired in clinic or office settings. Is there any proof that scribes really improve productivity or satisfaction of either doctors or patients? A PubMed search using the term “scribe” yielded only 25 papers, most of which were low quality studies from emergency departments suggesting that scribe use indeed did improve productivity and physician satisfaction without impacting patient satisfaction negatively. However one paper, published in Academic Emergency Medicine, concluded the following: This retrospective data analysis suggests that at our institution, ED scribes are associated with an increase of 2.4 billed relative value units per hour, which is primarily gained from the additional 0.8 patients per hour who are seen, but not with changes in turnaround time to discharge. Some residency programs are considering using scribes to ease the burden of charting done by residents, but to date, no studies on the use of scribes on inpatient or resident teaching services have been published. Here are some concerns with the use of...
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