CDC: “Visits to U.S. Emergency Departments at AllTime High…”

It must be official, the CDC confirms it: U.S. Newswire : Releases : "Visits to U.S. Emergency Departments at AllTime High…".

WASHINGTON, May 26 /U.S. Newswire/ — Visits to the nation’s emergency departments (EDs) reached a record high of nearly 114 million in 2003, but the number of EDs decreased by 14 percent from 1993 to 2003, according to a new report released today by the Centers for Disease Control and Prevention (CDC).

The report attributes the rise in ED visits to increased use by adults,65 years old and over. Among people aged 65-74, the ED visit rate was more than five times higher for those residing in a nursing home or other institution compared with those not living in an institutionalized setting. especially those

The report also finds that Medicaid patients were four times (81 visits per 100 people) more likely to seek treatment in from an ED than those with private insurance (22 visits per 100 people.)…

Other findings in the report include:

From 1993 through 2003, the number of ED visits increased 26 percent from 90.3 million visits in 1993 to 114 million in 2003. The U.S. population rose 12.3 percent during this period, and the 65-and-over population rose 9.6 percent.

The average waiting time to see a physician was 46.5 minutes, the same as it was in 2000. The wait time was unchanged despite increased visits. EDs have implemented a number of efficiencies, including "fast track" units, which may have kept the wait time constant. On average, patients spent 3.2 hours in the ED, which includes time with the physician as well as other clinical services.  …

In 2003, patients arrived at the ED by ambulance in 14 percent of the visits, representing over 16 million ambulance transports. More than a third of patients who arrived at the ED by ambulance were 65 years of age and over.

– About 58 percent of all EDs were located in metropolitan areas, and they represented 82 percent of the annual usage. Board-certified emergency medicine physicians were available at 64 percent of EDs and almost half of all EDs had a nursing triage system. …

For a copy of the full report visit http://www.cdc.gov/nchs

Well, this is what we’ve all heard, and anecdotally this fits what I see.  As the nation ages, and the aged get warehoused, the ED visit rate goes way up.  I’m sure there are some truly excellent nursing homes where patients are well cared for, but I don’t see their patients.  I see the ones like the gentleman a few shifts ago: awakened at midnight, told ‘you have pneumonia and CHF and need to go to the hospital’, and tha patient had no complaints.  He also didn’t have pneumonia, and his CHF was at its baseline.  Back to the same nursing home.

The other interesting thing was the finding that "Board-certified emergency medicine physicians were available at 64 percent of EDs…", a stastic that bodes well for patients and the Specialty both.  The actual quote from the study is:

"Board-certified emergency medicine (EM) specialists were available 24 hours a day and 7 days a week in the majority ofEDs (63.5 percent), and pediatric EM specialists were only found in 18.1 percent of EDs."

I’m assuming they mean EM Boarded here, and I hope that’s the case.  Good for us, but the Peds EM market looks wide open.

Marines are landing — on silver dollars

USMC gets coin(ed): Marines are landing — on silver dollars – May. 26, 2005.

NEW YORK (CNN/Money) – On the eve of Memorial Day, the U.S. Mint is remembering America’s fighting men and women.

Wednesday in Philadelphia, Mint director Henrietta Holsman Fore led the ceremonial first strike of a new series of commemorative coin: a silver dollar honoring the U.S. Marine Corps. The piece will be minted at the Philadelphia facility, and is scheduled for release this summer.

The front of the coin features an engraving modeled on Associated Press photographer Joe Rosenthal’s picture of victorious Marines raising the U.S. flag after the battle of Iwo Jima. …

The back side of the coin bears the Marine Corps insignia and the words "Semper Fidelis" (Always Faithful), the Corps motto.

"The coin design is simple and heroic," said Fore in a statement. "The Iwo Jima image is the storied symbol of the Marine Corps’ heroism, courage, strength and versatility. It exemplifies Semper Fidelis to an appreciative nation every day around the world."…

The price of the new Marines coin was not announced, but profits from the sale of each dollar will help pay for the creation of a National Museum of the Marine Corps at Quantico, Virginia.

More info on military unit coining, though not with silver dollars that’ll no doubt retail for more than the $35 the article suggests. 

A Relocation and a Review

This evening I took care of a young man with a shoulder dislocation.  It has happened to him so many times he doesn’t know the actual number.  That’s not the unusual part.

As I was preparing him for the relocation procedure (I use etomidate, a drug from the gods of medicine), I was explaining what I was going to do,
RBA, etc., and there was a brief slack period.  That’s when I looked up at the TV (a few of our rooms have TVs in them, mounted well up the walls). 

It was The Quiet Man, and I said (without prompting, and with pretty much a captive audience): "That movie must be pretty cheap.  I’ve seen it about 5 times in the last two months.  One of John Wayne’s least known films, and perhaps some of his best acting".   Given the silence, I was aware that my comment was odd, so I told him the Movie Review was on the house.

The patient was enjoying the movie as he drifted off to sleep.  His relocation was more smooth than the dialog, though he’ll never know it.