Emergency physicians, nurses, and residents writing on KevinMD from the emergency department: acute care, the realities of the ER, boarding and overcrowding, violence against staff, and medicine practiced under pressure. Most contributors work in emergency departments. For what emergency physicians and nurses have said about being assaulted at work and told it was part of the job, see Violence against health care workers: what physicians and nurses say, in their own words. For what emergency physicians wrote in the first weeks and months of the pandemic, see COVID-19: what physicians wrote as it happened. For what emergency physicians and pain patients have said about opioid prescribing, see Opioids: what physicians and pain patients say, in their own words. For what physicians in the highest-burnout specialty have said about burnout since 2009, see Physician burnout: what physicians say, in their own words.

Children with fever may not receive antibiotics in the ER

Physician
May 10, 2010

by John Gever

Up to one-third of children with febrile bacterial infections failed to receive antibiotics in a large emergency department, while 20% of youngsters without such infections received antibiotics unnecessarily, Australian researchers said.

A computer algorithm based on standard test results could do a better job of assigning feverish children to the correct treatment sooner, Jonathan C. Craig, MBChB, PhD, of the University of Sydney, and colleagues reported online in BMJ.

Although …

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Children with fever may not receive antibiotics in the ER

False patient contact information worsens emergency care

Physician
May 10, 2010

One of the biggest emergency room problems is contacting patients after they leave.

Patients sometimes leave false contact information — which makes it difficult for the emergency room staff should problems arise after the visit.

The issue was illustrated in a piece from msnbc.com. Many times, results like blood cultures or x-ray findings take time to return. And if there’s something that needs to be acted upon, contacting the …

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False patient contact information worsens emergency care

Money prevents patients from seeking timely heart care

Physician
May 3, 2010

by Crystal Phend

Lack of insurance and financial concerns keep patients from treating a heart attack like the emergency it is, researchers affirmed.

A delay in getting to the hospital for treatment of acute MI was 38% more likely among the uninsured and 21% more likely among insured patients with financial concerns, reported Paul S. Chan, MD, MSc, Mid America Heart Institute in Kansas City, Mo., and colleagues.

More than two in every …

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Money prevents patients from seeking timely heart care

Cardiac arrest resuscitation, with wife as witness

Physician
April 29, 2010

The patient arrived in cardiac arrest. He had been brought to our emergency department in the middle of the night. Although he had a significant cardiac history, he was only in his late-forties. His transport from his house to our department had been less than ten minutes and, along the way, the pre-hospital team had done an excellent job of intubating this patient and establishing an IV.

His wife was with …

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Cardiac arrest resuscitation, with wife as witness

Health reform won’t help the ER

Health Policy
April 26, 2010

Contrary to popular belief, those without health insurance are not flooding emergency rooms as a consequence of being cut off from routine and preventive care. Actually, frequent visitors to the local ER are far more likely to have insurance according to a new review of 25 studies on ER use published since 1990.

Frequent users account for about 8% of ED patients but 28% of visits. Although frequent …

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Health reform won’t help the ER

Psychiatric patients detained in the ER

Physician
April 22, 2010

Our state of South Carolina is a delight. From wonderful people to beautiful landscapes, from a vibrant Southern culture to excellent food like shrimp and grits, it’s a place I’m thrilled to live. But we do lack a few things. And one of the most striking is adequate mental health care.

The state budget, like so many state budgets, has been trimming anything and everything. And of course, mental health coverage …

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Psychiatric patients detained in the ER

Patients who visit the emergency department have insurance

Health Policy
April 14, 2010

by Joyce Frieden

Most patients who visit the emergency department (ED) four or more times a year have health insurance and a primary care physician, a review of the literature found.

“The uninsured represent only 15% of frequent users and are no more likely to be frequent users than they are to be occasional ED users (<4 visits/year),” Eduardo LaCalle, MD, MPH and Elaine Rabin, MD, of the Mount Sinai School of …

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Patients who visit the emergency department have insurance

Healthcare workers in the ER hit hard by H1N1

Physician
April 13, 2010

by Michael Smith

Healthcare workers in a New York City emergency department had the highest rate of infection among employees of an urban hospital system during the first wave of the H1N1 pandemic flu, researchers said.

In a single-institution study using medical and administrative records, the adult emergency department had an H1N1 infection rate of 28.8% during April, May, and June of 2009, according to Robert Bristow, MD, and colleagues at New …

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Healthcare workers in the ER hit hard by H1N1

Emergency departments are frequently used by young adults

Physician
April 12, 2010

by Kristina Fiore

Twenty-somethings rely on emergency departments (EDs) for care far more than do other age groups, researchers have found.

In 2006, nearly a quarter of all young adult healthcare visits — 22.1% — took place at an ED, compared with 12.6% for children and adolescents and 8.3% for patients over 30.

That rate has significantly increased over a 10-year period, Robert J. Fortuna, MD, MPH, of the University of Rochester Medical …

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Emergency departments are frequently used by young adults

Hospital admissions may require watching and waiting

Physician
April 6, 2010

A sweet little lady came to the emergency department recently. She said she felt short of breath and sweaty at home. In the department, she looked like a rose! Normal oxygen levels, normal labs. Her chest x-ray had a faint area that ‘one might possibly imagine could perhaps be’ a pneumonia. It looked remarkably like her previous film.

But her history was concerning to me, and it was concerning to …

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Hospital admissions may require watching and waiting

iPad in the ER, a hands on physician review

Health Technology
April 6, 2010

I had been anxiously awaiting the arrival of my iPad. This is the form factor I have been asking (begging) of all the vendors for years. I’m very happy to say that it appears to be living up to my high expectations.

The screen is gorgeous. It’s very clear and bright, I had no trouble seeing the screen in bright outdoor light. The machine seems extremely responsive — it …

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iPad in the ER, a hands on physician review

Use iPhone apps for emergency room wait times with caution

Health Technology
March 15, 2010

Emergency rooms are notorious for their long waiting times – that’s pretty common knowledge. But now the Hospitals of Central Connecticut are looking to a new medical app for the iPhone to help improve their emergency room wait times.

Having spent a fair amount of time recently working in an emergency room, I (and probably everyone with similar experiences) can assure you that no one – physicians, nurses, administrators – want …

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Use iPhone apps for emergency room wait times with caution

Using CT scans to diagnose chest pain in the ER

Physician
March 6, 2010

During residency, there was always a case of misdiagnosed chest pain to discuss in conference.  Incorrectly sending a patient home and missing the diagnosis of cardiac chest pain was an infrequent, but repetitively observed, phenomenon.

So as to tread carefully with words, it is sufficient to say that even now, chest pain triage remains a vexing problem.

Chest pain diagnosis is like appendicitis; there are always small numbers of unusual cases in …

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Using CT scans to diagnose chest pain in the ER

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The Haiti earthquake and its broken health infrastructure

Physician
February 27, 2010

Dr. Barth Green co-founded Project Medishare, which has worked in Haiti for two decades. He led the first team of U.S. physicians to Port-au-Prince after the earthquake and, together with the University of Miami’s Global Institute, spearheaded the development of a 240-bed tent hospital that is now the country’s largest functioning urgent care hospital. His group is working with the U.S. government to establish Haiti’s first rehabilitation hospital. Green …

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The Haiti earthquake and its broken health infrastructure

How patient satisfaction scores can affect physicians

Physician
February 26, 2010

I am very blessed. The hospital where I practice, while concerned with patient satisfaction, does not worship at its altar.

That is, so far our administrators seem to understand that people will occasionally be angry or unsatisfied, and that such dissatisfaction is within the realm of real life. We still have people storm out of the emergency department, prattling on about lawyers and lawsuits, promising to go to another hospital in …

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How patient satisfaction scores can affect physicians

How the ER is now used to triage every patient

Physician
February 22, 2010

The ER is the portal of entry to our hospitals now, for better and for worse.

On the plus side, this means that most patients being admitted to general medical and surgical services have a workup at least started and are triaged appropriately to their destination.

A good ER evaluation should answer the following questions:

1. What’s the nature of the illness?

Are we dealing with the heart, the brain, or an abdominal organ? …

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How the ER is now used to triage every patient

Texting and cell phone use are becoming more common in hospitals

Physician
February 18, 2010

The cell-phone is a wonderful device. Even I, somewhat Luddite about certain technologies, find it delightfully useful for things like calling my wife when I lose the grocery list, calling my wife for directions and calling my wife to remind me of what I was supposed to be doing. I’m not really a fan of texting, though my wife and oldest son seem to communicate that way quite effectively. It’s …

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Texting and cell phone use are becoming more common in hospitals

Why Haiti disaster relief efforts cannot be applied domestically

Social Media in Medicine
February 11, 2010

Like most people, I’ve found the news and images coming from Haiti in the aftermath of the January’s earthquake appalling and upsetting.

The sheer amount of devastation and orders of magnitude loss of life make the story compelling by itself. Coupled on top of Haiti’s ignominious history, the situation touches us for its Job-like quality: ”How much misery can one people withstand?”

I’ve been pleased at the outpouring of support for Haiti. …

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Why Haiti disaster relief efforts cannot be applied domestically

How will the earthquake affect the future of the Haitian American community?

Physician
February 10, 2010

Marleine Bastien is the founder and executive director of Fanm Ayisyen Nan Miyami–Haitian Women of Miami–www.fanm.org, which advocates for the rights of Haitian women. She is also a congressional candidate for U.S. House District 17, representing Little Haiti and other neighborhoods in Miami. Erin N. Marcus spoke with Bastien on Jan. 22 about the Haiti earthquake.

What has FANM been doing since the earthquake?

As soon as we heard about it, …

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How will the earthquake affect the future of the Haitian American community?

What is the biggest risk for soldiers fighting overseas?

Conditions and Diseases
February 6, 2010

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

More than 85% of American military medical evacuations from the Middle East were not the direct result of enemy action, but the result of non-battle injuries and disease, researchers said.

Of some 34,000 military personnel in Iraq and Afghanistan who shipped out for medical reasons from 2004 to 2007, only …

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What is the biggest risk for soldiers fighting overseas?

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