Archives for February 2009

Parkland hospital streamlines emergency room procedures | News for Dallas, Texas | Dallas Morning News | Life/Travel: Health

Parkland hospital streamlines emergency room procedures | News for Dallas, Texas | Dallas Morning News | Life/Travel: Health
Parkland hospital streamlines emergency room procedures

09:44 PM CST on Tuesday, February 10, 2009

By SHERRY JACOBSON / The Dallas Morning News

Parkland Memorial Hospital officials on Tuesday announced changes in emergency room procedures to improve care and reduce long waits.

Included is a new process for evaluating patients entering the ER, allowing them to confer immediately with a nurse or paramedic….

The new check-in process already is persuading patients to stay in the emergency room long enough to receive treatment.

Last month, Parkland said, 14 percent of ER patients left without seeing a physician, compared with the 24 percent who walked away in July.

A 14% LWBS rate would cost most ED groups their contract.  Astonishing this is tolerated.

Those drug-interaction warnings sure are irritating | Booster Shots | Los Angeles Times

Those drug-interaction warnings sure are irritating | Booster Shots | Los Angeles Times
Those drug-interaction warnings sure are irritating
10:30 AM, February 10, 2009

One can imagine how electronic drug-prescribing systems could be annoying to doctors — all those warnings about potential interactions and allergies and whatnot when all you really want to do is give a patient a drug he or she needs and be done with it. It’s probably easier to just ignore the blasted alerts and keep going.

That seems to be what’s happening. In a study published in the Feb. 9 issue of the Archives of Internal Medicine, most doctors simply shrugged off the warnings issued by their helpful electronic systems.

Out of almost a quarter-million medication safety alerts produced during the study period, the doctors involved accepted only 9.2% of the interaction warnings and 23% of the allergy warnings. In other words, they ignored more than 90% of the drug interaction alerts and more than 75% of the allergy alerts.

As a fellow practitioner of blog-snark I’m impressed with the slant of the article, that doctors treating patients ‘ignore the blasted alerts’ and ‘shrug[ged] off warnings’.  As a doctor who uses a very good EMR tool daily I can tell you that a terrific number of the medication alerts given by the system are of such exceedingly minimal value they need to be over-ridden for accurate and adequate patient treatment.

For instance, if a patient reports an allergy to ‘Demerol’ in our EMR, giving Zofran (an anti-emetic) yields an allergy interaction.  It’s a theoretical connection and not founded in reality, or practice.  Want to prescribe pain meds for a patient being admitted? We get an alert that the patient has already been prescribed pain meds, even though the earlier meds were given in the ED (only) and the order in question is for inpatient treatment.  Very helpful.

The LATimes article doesn’t indicate if any harm came to any patients (I certainly hope not), but the finding that practicing docs didn’t heed a zillion electronic drug warnings just means the electronic systems need to tell us when the sky is actually falling, and not squawk continuously without cause.

THC and testicles

I’ve been working on a pun for this, but haven’t had any luck.  Yours is solicited, in the comments.

Cannabis could cause testicular cancer – study

Smoking cannabis could increase the risk of developing testicular cancer by 70 per cent, scientists have warned.

telegraph The team interviewed 369 men with testicular cancer, in the Seattle area – mostly in their 20s and 30s – about their history of marijuana use.

They then compared their responses with those from just under 1,000 men without the disease from a similar area and age group.

Even after other "lifestyle" factors such as smoking and drinking as well as risks such as a family history of the disease, cannabis use emerged as a significant possible cause, the study published in the journal Cancer concluded.

Regular or long-term cannabis smokers appeared twice as likely to develop the disease as those who had never used the drug.

Being a regular marijuana smoker at the time of diagnosis was associated with a 70% increased risk.


Or, it could be something in the munchies.  That’s the problem with associations in medical research.

Degree Creep, Indeed

  It was a shot heard ’round the PA world.advanceforpa

The U.S. Army and Baylor University created a stir when they announced their PA clinical doctorate degree residency program in emergency medicine at the Physician Assistant Education Association forum in Tucson, Ariz., in November 2007.

Doctorate degrees have been increasing among health care professionals for more than a decade. Audiology, physical therapy, occupational therapy and pharmacy, for example, have all moved to the entry-level doctorate degree. The nurse practitioner profession adopted the entry-level doctorate degree in 2006, and the DNP will be mandated for all advanced practice nursing graduates by 2015.

Even though the specter of doctorate degrees has been hanging over the PA profession for years, the formal announcement of the Army program brought the controversy to the forefront. News of the Army’s program roiled educators at the PAEA forum and sparked furious debate about clinical doctorate degrees and PAs

It’s a very well-written article, and the included sidebar points out one of the biggest problems with a ‘midlevel doctorate’ for PA’s: they’re dependent on their relationship with Physicians in a way NP’s definitely aren’t.  No support for this from docs=real problems for the PA programs (and not just the doctoral programs, all of them).

We live in interesting times.

Nadeem Esmail Says Nationalized Health Care Will Cost Us Pain and Suffering –

Nadeem Esmail Says Nationalized Health Care Will Cost Us Pain and Suffering –
‘Too Old’ for Hip Surgery
As we inch towards nationalized health care, important lessons from north of the border.


President Obama and Congressional Democrats are inching the U.S. toward government-run health insurance. Last week’s expansion of Schip — the State Children’s Health Insurance Program — is a first step. Before proceeding further, here’s a suggestion: Look at Canada’s experience.
[The Americas] Martin Kozlowski

Health-care resources are not unlimited in any country, even rich ones like Canada and the U.S., and must be rationed either by price or time. When individuals bear no direct responsibility for paying for their care, as in Canada, that care is rationed by waiting.

You don’t say.

New Style for GruntDoc

I’m trying to appeal to more readers.  Click here for a preview.


via InstaPundit.

iPhone medical app review: Medical Terminology and Abbreviations Quick Reference

I’ve been using the above iPhone program for the last month or so, and here’s a short review and interview of the programmer.  Disclosures: they gave me a free $1.99 copy to use.

My review: a very useful reference for those new to medical terminology, or who teach the same group.  Could use a search function, but otherwise it’s worth the price.

My review after the fold:

[Read more…]

The Actual Obama Economic Stimulus Plan

Apologies for a political post, but this was told to me by another blogger, and it’s too good to pass up.

The actual Obama Economic Stimulus Plan:

  1. Identify and nominate a politician for the administration
  2. Vet said politician
  3. Find their unpaid tax liabilities
  4. Collect unpaid taxes
  5. Accept their withdrawal
  6. Repeat until national debt paid off.

That might just work.

Police: Doctor injured when bomb erupts in Lexus –

Police: Doctor injured when bomb erupts in Lexus –
(CNN) — An explosion that critically injured the chairman of the Arkansas Medical Board on Wednesday was caused by a bomb, police said.

Hopes and prayers for the doctor.  Awful.

Doctor Finders – not just trackback spammers, but bad spellers as well

Following another pingback that turned out to be spam, I found this.  It fills me with laughter; it’s not like LA s a big market or anything.


You’re welcome.

How Docs can continue to have illegible records in an EMR

Make our own font based on your handwriting:

DIY: YourFonts Turns Your Handwriting Into a Personlized Font
YourFonts is a web-based service that turns your handwriting into a TrueType font for free. If you have a printer and scanner, nothing can stand between you and the awesomeness of your own script.

What could go wrong?

Compassion in MedBlogging

Explained more eloquently in the full post, but:

Head Nurse: Let’s talk about compassion.
This is an important point for those of us who blog, and those of us who nurse: People will criticize you for not being the constant comforting angel that they think you ought to be. To hell with them. The important thing is that you do what you are meant to do for those people who find themselves in your care.

I’m occasionally accused of not blogging in a warm-and-fuzzy fashion suitable to whatever aggrieved person comments, and I don’t generally respond; they don’t know me, they are’t my patients, heck with them.

Emergency Department Admissions Are More Profitable Than Non–Emergency Department Admissions

Well, now…

From the “I wouldn’t have believed it, either” files comes this paper from the Annals of Emergency Medicine:

Study objectiveJournal Home

We compare the contribution margin per case per hospital day of emergency department (ED) admissions with non-ED admissions in a single hospital, a 600-bed, academic, tertiary referral, Level I trauma center with an annual ED census of 100,000.


In summary, ED admissions in our institution generate a higher contribution margin per day than non-ED admissions.

Should make for friendlier conversations with your administrators.