Wow. Short, and sweet, and painful.

…peddling the same tired phenomenon of magical thinking regarding the diagnostic miracle of highly sensitive troponins…

via Emergency Medicine Literature of Note: Yet Another Highly Sensitive Troponin – In JAMA.

Nice! Go and read.

via @nickgenes on that Twitter thing…

Let’s say, hypothetically, you could design the ED of the Future. I say hypothetically as there may be a new (like New) ED in my future. Maybe; it sounds like a heck of a challenge. Considering we’re a Trauma Center and currently see nearly 100K/year in volume, and have an admission rate that’s between 18-35%,

What would that new ED look like, from the following viewpoints :

• the patient
• the triage nurse (is there one?)
• the treating nurse
• the ED doc
• the consultant
• the hospital admissions team (billing)
• the OR
• the Tele units
• the Floor units
• ED discharge areas
• physical plant

I have a few ideas, but am frankly hamstrung by a lack of ‘out there’ imagination. Let’s hope you’re not similarly limited. Don’t feel like you need to answer all of these, but I’m interested in your ‘out of the box’ ideas…which you’ll get full (if ephemeral) credit for.

The irony here is that Eli Lilly has advanced sepsis care (as a prelude to using their drug), and while Xigris hasn’t panned out, aggressive sepsis resuscitation has.

Eli Lilly is withdrawing drotrecogin alfa (Xigris) from all markets worldwide after a major study failed to show a survival benefit for patients taking the drug.

…

Xigris should be discontinued immediately in patients currently receiving it and should not be started in new patients, the company said.

The trial with the bad news on Xigris was called PROWESS-SHOCK, a placebo-controlled study with 28-day mortality as the primary outcome and planned enrollment of nearly 1,700 patients.

via Medical News: Sepsis Drug Pulled from Market – in Product Alert, Prescriptions from MedPage Today.

At ACEP the reviewers of this study said it favored placebo over Xigris. Tough to market a very very expensive drug when not using it is better…

If you don’t follow me on twitter, you missed my play by play of the recent ACEP 2011 Scientific Assembly from San Francisco. Several of us attending twittered (and it was terrifically entertaining to meet them and socialize)!

These are trimmed from my tweets ( http://twitter.com/#!/gruntdoc ) and should you be interested, all the Scientific Assembly tweeters were using the hashtag #sa11.

My rough count for the ones I included here is 95. Some are more interesting than others. Enjoy.

Asplin says its harder to collect from high deductible/HSA pts than from self pay. Seems odd. Asplin

1% of population accounts for 30% of all spending in a given year, 5% account for HALF. 20% spend nothing. There’s your problem.Asplin

Understatement: there’s a gap between the vision and the reality of the Medical Home. Asplin

ER docs make the most expensive routine decision in healthcare: admit or home? We have little to no control over readmissions. Asplin

Read the rest of this entry »

It’s in San Francisco this year, and starts in the morning. While I’m NOT a morning person I’m going to make as much of it as I can, as the lectures are good, and worth the time.

I plan to live-tweet my conferences tomorrow, so if you’re interested follow along on Twitter @gruntdoc. Last year I had more than 200, and some people liked them. We shall see, some lectures, and lecturers, are more quotable than others.

Yes, people watching here.

Via hqdmeded.com:

Gastroenterologist Michael Kirsch put up a post on his blog that was then reposted over at ACP Hospitalist asking where the threshold for admitting a patient to the hospital should be.

He asserts that there should be more collaboration between medical colleagues to determine whether or not a patient needs to be hospitalized…

via To Admit or Not to Admit? That is the Question. | WhiteCoat’s Call Room.

Another WhiteCoat tour de force.

“Would any EMS unit that can leave, leave now? We’re out of bays.”

When you run out of EMS bays (and we have several), you’re having a bad day.

Kudos to MedStar (our Fort Worth EMS provider) for their excellent work on this project:

The Community Health Program was started in 2008 after MedStar officials discovered that 21 patients were using a big chunk of ambulance and emergency department resources. Those patients triggered more than 800 ambulance calls and cost the system more than $962,000 in charges, most of which were never collected because the patients lacked health insurance.

Nine of the 21 were selected for the program. They experienced a 77 percent reduction in their need for services during a 30-day test.

via In Fort Worth, MedStar’s Community Health Program cutting costs, improving patients’ well-being ….

I walked into one of my first patients’ rooms last the other night, and saw this 3 Lead strip sitting on the counter:

It was for a different patient.

Took me a minute to recover, though…

Okay, it’s kind of amusing, and I hope it induces someone to learn compression only CPR. Which is WAY easier to do, and teach, than what I started with back in the day (15 compressions, 2 breaths, rinse/repeat).

But if this makes Disco come back, is it worth it?

via Ace.

Read the rest, and wonder. Others practice risk-avoidance to the ED, and then we wonder why our patients are unhappy and give us poor scores.

Man and squirrel fight it out in man’s driveway. Squirrel scratches him twice, man runs inside grabs BB gun and plugs squirrel ala Elmer J Fudd. Man then calls health department for advice about what to do. Health department tells him to go to ED for rabies shots.

via The Case of the Crazy Rabid Squirrel | WhiteCoat’s Call Room.

…Actually, statements like that do serve one purpose. They make it a pretty good bet that none of the doctors in our department will ever refer another patient to you or your your hospital…

via Dr. Perfect | WhiteCoat’s Call Room.

Sing it, brother.

Laugh if you want, this helps my life, at least at work.

For months after starting my current gig, I would sometimes get to work with everything in all my pockets, and sometimes not.

I’d forget my ID, or my pen, or my phone, or my…well, there you go.

Then my OCD started to kick in, and, a Mental Checklist was born.
I now have to get 6 things, and set them on the table or I screw it up every time.

• ID
• stethoscope
• my phone
• work phone
• pen
• sharp stick (I’ve written about this before, but cannot find it. You should search an ER blog for the word ‘knife’ and then wonder why you bothered).

Last week I apparently went against the checklist, and halfway through the shift realized I’d lost my ID. Of course, after about a combined half-hour of fruitless search I gave up, and found it in my bag on the way out. Geez.

Yeah, it sounds stupid. But if it’s stupid and it works, it’s not stupid.

When emergency physician Harvey Castro asked a nurse to start a dopamine dose for a hypotensive patient one day, he watched the nurse leave the room, find the book that could guide her to the titratable dose, look in the index and then flip through until she found what she needed. Castro wondered, Isn’t there a more efficient way?

via Medical Apps? There’s a Doc for That.

A fellow DFW doc who’s done well in the Medical App world ( Deep Pocket Series ).

Dr. Castro was nice enough to let me play with some of his apps about a year ago, and while I never found a big use for them (my practice style, no knock on him) they were well done and approachable for me.

Kudos to Dr. Castro!