Our bi-weekly news updates are designed to keep you up to date with current developments relating to the Acute Care Continuum. Feel free to share your perspective on these stories or link to articles that you have found relevant to today’s healthcare environment.

Today we look at some of the current events happening in emergency medicine — from dealing with mass-casualty events to efforts to diverting patients away from the ED (in one way or another).

Our bi-weekly news updates are designed to keep you up to date with current developments relating to the Acute Care Continuum. Feel free to share your perspective on these stories or link to articles that you have found relevant to today’s healthcare environment.

This week, we examine reports and studies highlighting potential barriers to patient care, including throughput issues, understaffing, and cost-cutting policies.

Our bi-weekly news updates are designed to keep you up to date with current developments relating to the Acute Care Continuum. Feel free to share your perspective on these stories or link to articles that you have found relevant to today’s healthcare environment.

This week, we focus on what has been happening in Washington, DC, including what will be affected by the budget sequestration and CMS’ purported victory over readmission rates.

By Thomas Sugarman, MD, FACEP, FAAEM

As physicians in the Acute Care Continuum, we want to treat our patients' problems quickly, especially their pain.  While I would prefer to give pain medications to many people who do not need to be treated rather than to deny one person in pain, it would be ideal to know who really needs these drugs.  Fortunately for physicians in California, a database reporting application called the Controlled Substance Utilization Review and Evaluation System (CURES)  provides timely information aiding in the process of making this determination.  

Just as the vast majority of physicians prescribe drugs appropriately, the vast majority of patients also use them appropriately.  Nevertheless, when prescribing to an unknown patient, physicians face uncertainty about that patient’s history of controlled substance use.   Physicians in the Acute Care Continuum frequently find themselves in this difficult position. As CURES catches on and becomes more generally adopted, it is much more likely that we can choose appropriate treatment for our patients.

This feature, called “News Updates” is designed to keep you up to date with current developments relating to the Acute Care Continuum.

We take a look at 'post-hospital syndrome' discussed in The New England Journal of Medicine (January 2013). In addition, Health Affairs reports how a team approach could help with the physician shortage and The Hospitalist takes a look at CMS's Value-Based Payment Modifier (VBPM). Finally, we present 40 ED Performance benchmarks from Becker's Hospital Review.

We invite you to post your perspective on these stories and to share articles that you have found relevant.

By Prentice Tom, MD, FACEP

As many primary care and emergency physicians across the country are already aware, this year’s flu season promises to be not only earlier than usual but also unusually aggressive.  In addition, we are seeing regional outbreaks of norovirus and the worst whooping cough outbreak in the last 60 years.  During my last shift, the emergency department was filled with patients with severe diarrhea and dehydration or influenza and/or influenza-like symptoms.  As expected, the winter months also bring an increase in emergency patients with significant pulmonary and cardiovascular diseases.  This combination of multiple viral “epidemics” with an increase in patients with two of the most common system illnesses creates a patient volume surge situation for many emergency departments.

Perspectives on The Acute Care Continuum gives a tip of the cap to Myles Riner, MD for his prodigious year of blogging, including our number 2 most popular blog from 2012:

One of the topics that attracts a lot of attention when emergency physicians and those interested in ED practice management get together to discuss how emergency medicine can remain relevant in, and become integrated into, the new health care reform and value based purchasing paradigms, is the concept of care coordination.  In theory, since the ED is linked to such a wide range of diagnostic testing resources, care facilities, and providers, and sits at the intersection of outpatient and inpatient care for many of the patients who are hospitalized:  emergency physicians ought to be able to play an important role in the coordination of care, both for the acutely and for the chronically ill.  In practice, many of the systems support structures that need to be in place to facilitate this role have often been ignored or neglected, or deferred on the assumption that they will be addressed with the adoption of the electronic medical record.  

If emergency physicians and EDs are going to assume the role of master care coordinators (something that family physicians staffing the medical home might consider within THEIR scope), they are going to have to define this role carefully, invest in the systems and staffing to support it, and integrate the concept into everyday practice.  Until now, few payers have been willing to pay for this service, and few hospitals and ED groups have been willing to invest significantly in the systems and staff to support it.  Suddenly, care coordination is the latest buzzword, and the presumptive salvation for what is often perceived as a frequently too expensive and often inappropriately utilized drain on the health care system:  the ED as poster-child for ‘the ‘failure of health care’.