Is this right answer for the workforce shortage in EM? Keep your eyes open as new developments unfold. This may be the solution that face rural ED’s and difficult to staff locations where malpractice is still an issue. It is unlikely to think that resident education will be effected but as usual instead of focusing on our issues we will waste endless energy in discussions about purity. Is purity the issue or is treating the masses that flock to our door our mission? As a specialty we will debate and never decide, post in our camps but I welcome all with open arms who want treat the growing number of patients with narcopenia, the febrile Tylenol deficient babies, and the non-ambulatory elders who have lived too long because of science.
Please note new classification for emergency med and orthop PAs.
An article posted in Advance for Physicians says: There's a new PA degree in town, and its name is "Doctor."
The U.S. Army and Baylor University have created the first clinical doctorate degree for PAs. Army PAs will receive a doctor of science physician assistant (DScPA) degree after successfully completing an 18-month residency in emergency medicine at Brooke Army Medical Center at Fort Sam Houston in San Antonio.
The first four DScPAs will graduate in a few weeks, followed by a fifth in early 2008. Eight more Army PAs began the 18-month program in July 2007, and 10 are scheduled to start in July 2008.
"The Army needs more emergency-medicine-trained, trauma-trained PAs for the battlefield," says Maj. Leonard Gruppo, MPAS, PA-C, who is the director of postgraduate education for the U.S. Army. "It was difficult for us to ask PAs to go through 18 months of incredibly rigorous, demanding training and then give them a certificate, as was done with our previous 12-month residency upon which this is based, and is done with almost all postgraduate (PA) residencies.
"We wanted to recognize their training and expertise, and there is no other way to do it right now. There is no board certification for advanced (PA) training or specialty certification (for PAs). There's no way to recognize advanced training in a way other people (outside the PA profession) would understand. We feel that the training is doctorate-level. When we compared (the PA doctorate program) to (doctorate programs for) other professions such as pharmacy or physical therapy, it compared favorably. This (PA doctorate training) is even more robust than many other (doctorate) programs."
The Army conceived of a PA clinical doctorate program in 1999 and began development of the initial program in earnest in 2003. The Army plans to convert all of its PA residencies in emergency medicine and orthopedics to doctorate programs, Gruppo says.
In addition to being the appropriate degree for advanced clinical training, these PA clinical doctorate degrees should also be a strong incentive for PAs to remain in the military and possibly for civilian PAs to consider military service, Gruppo says. The Army needs a large number of well-trained and experienced PAs to care for soldiers injured in combat.
"We did a study of Army PAs and two-thirds of the respondents said that the availability of these (doctorate-level PA) programs would significantly affect their decisions to stay on active duty," Gruppo says. "That's a pretty enthusiastic response."
Wednesday, February 20, 2008
Sunday, February 17, 2008
ED Management- Interesting recent article...
I am always searching for recent information on patient claims, statistics, etc. and stumbled upon this article. The numbers were a bit surprising- 22,000 preventable deaths directly related to pneumonia and heart attacks??? As it turns out, seems that documentation may be the real issue. I understand RVU and I understand the need to move patients through the ED as quickly as possible, but isn't there a better way? The numbers are frightening- screaming patient claims!! Who is managing your documentation? With the shortage of emergency physicians, the pressure to move patients up or out (see Movin' Meat) combined with paperwork, documentation WHY do so many people who are clearly NOT ill visit the ED?! Don't they know?? They are putting themselves at greater risk visiting the ED vs. ignoring their ear aches, stuffy noses and headaches!! Maybe we should send out e-mail blasts to everyone with some statistics, urging them to eat chicken soup and visit their family doc.
Study Claims EDs Fall Short on Pneumonia and Heart Care
ED Management
January 18, 2008
According to a new study by Johns Hopkins researchers, Emergency Department (ED) managers and their staffs are doing a poor job of treating pneumonia and heart attack patients.
In fact, the authors of the Academic Emergency Medicine article say that as many as 22,000 preventable deaths occur each year in the United States because EDs across the country aren’t meeting national goals.The researchers looked at the records of 1,492 heart attack and 3,955 pneumonia patients treated at 544 EDs between 1998 and 2004.
They found that only 40% of eligible heart attack patients received recommended aspirin therapy, and only 17% received recommended beta-blocker treatment; and among pneumonia patients, only 69% received recommended antibiotics, and 46% had blood oxygen levels assessed, as recommended by the American Thoracic Society.
However, ED observers assert that these numbers paint an inaccurate picture of care given in EDs, and that by and large it is poor documentation—not poor care—that caused the statistics to appear so disappointing.
“Once core measures started to be introduced, CMS (Centers for Medicare & Medicaid Services) would come to us an ask why we were not giving aspirin (to heart attack victims),” said Kevin Klauer, DO, FACEP, director of quality and clinical education and the Center for Emergency Medical Education with Emergency Medicine Physicians (EMP), a Canton, OH-based provider of emergency medical services.
“We discovered that in every hospital, there was some component of sampling that was to blame,” he added. “For example, EMS might have already given the patient aspirin, or they had taken it before arrival and the chart abstractor either didn’t know to check that or just didn’t do it.”
Certainly, some areas are documented better than others, says the study’s principal investigator, Julius Cuong Pham, MD, an assistant professor in the Department of Emergency Medicine at Johns Hopkins University School of Medicine, Baltimore, and a practicing emergency physician.
“But if a patient gets an aspirin, the medical record is a legal document,” Pham said, “so if you give someone aspirin you had better be sure you document it—the same thing with beta-blockers.”
For other variables, such as pulse oximetry, Pham concedes that the physician could just measure it, determine it is normal and not write that down. “What percentage (of reported errors) is due to documentation? We don’t know,” he said.
Klauer’s own documentation, he said, shows good compliance when it comes to aspirin. “Two years ago, we went to physicians checking charts and came up with different numbers than the hospital (was reporting),” he said. “We have physician reviewers review their peers’ charts. They know to look in a specific part of the chart.”
The numbers for all of his practice have been about 99%, with beta-blockers at 96% to 97%, Klauer said. “We have a quality director at every site. These statistics are measured quarterly and annually and compared to the other facilities, and the doctors are partially compensated on that basis,” he said.
This incentive-based compensation plan puts a certain portion of the physician pay at risk, and of that portion, 5% to10% is assigned to quality, Klauer said. Pham and Klauer agree the most controversial measure involves antibiotics. Pham said, “There’s a lot of controversy in the ED as the whether four hours (from admission) is appropriate, versus six or eight hours.”
There isn’t a single piece of controlled literature that assigns a specific time, Klauer said. “So, we may appear to not be in compliance because of flawed parameters, but we certainly won’t let our doctors practice bad medicine.”
Pham and his colleagues recommend the creation of systems in the ED to minimize whatever lapses in care are occurring. “Standardized protocols are shown in the literature to be effective,” he said. “For example, every patient with acute MI or chest pain gets aspirin and beta-blockers as part of their care unless it is contraindicated.” The nurse should serve as a check and balance by ensuring the doctors are following the protocol.
There may even be a role for IT, Pham said. “If you have a diagnosis of heart attack and you are about to log off without giving aspirin, a red flag may pop up. This takes the individual caregiver out of the equation,” he said. “The ED is very hectic, and it is not unreasonable to forget something. We need some warning feedback.”
Any performance feedback should be easily visualized, Pham added. “It could be a blinking light on the computer screen, a red flag on a chart. The bottom line is, these errors are likely lead to patient harm and death, and whatever we can do to improve on that will affect the health of patients.”
Klauer said, “If patients are getting aspirin 44% of the time, we are doing them a huge disservice, but I don’t believe that is happening.”
Study Claims EDs Fall Short on Pneumonia and Heart Care
ED Management
January 18, 2008
According to a new study by Johns Hopkins researchers, Emergency Department (ED) managers and their staffs are doing a poor job of treating pneumonia and heart attack patients.
In fact, the authors of the Academic Emergency Medicine article say that as many as 22,000 preventable deaths occur each year in the United States because EDs across the country aren’t meeting national goals.The researchers looked at the records of 1,492 heart attack and 3,955 pneumonia patients treated at 544 EDs between 1998 and 2004.
They found that only 40% of eligible heart attack patients received recommended aspirin therapy, and only 17% received recommended beta-blocker treatment; and among pneumonia patients, only 69% received recommended antibiotics, and 46% had blood oxygen levels assessed, as recommended by the American Thoracic Society.
However, ED observers assert that these numbers paint an inaccurate picture of care given in EDs, and that by and large it is poor documentation—not poor care—that caused the statistics to appear so disappointing.
“Once core measures started to be introduced, CMS (Centers for Medicare & Medicaid Services) would come to us an ask why we were not giving aspirin (to heart attack victims),” said Kevin Klauer, DO, FACEP, director of quality and clinical education and the Center for Emergency Medical Education with Emergency Medicine Physicians (EMP), a Canton, OH-based provider of emergency medical services.
“We discovered that in every hospital, there was some component of sampling that was to blame,” he added. “For example, EMS might have already given the patient aspirin, or they had taken it before arrival and the chart abstractor either didn’t know to check that or just didn’t do it.”
Certainly, some areas are documented better than others, says the study’s principal investigator, Julius Cuong Pham, MD, an assistant professor in the Department of Emergency Medicine at Johns Hopkins University School of Medicine, Baltimore, and a practicing emergency physician.
“But if a patient gets an aspirin, the medical record is a legal document,” Pham said, “so if you give someone aspirin you had better be sure you document it—the same thing with beta-blockers.”
For other variables, such as pulse oximetry, Pham concedes that the physician could just measure it, determine it is normal and not write that down. “What percentage (of reported errors) is due to documentation? We don’t know,” he said.
Klauer’s own documentation, he said, shows good compliance when it comes to aspirin. “Two years ago, we went to physicians checking charts and came up with different numbers than the hospital (was reporting),” he said. “We have physician reviewers review their peers’ charts. They know to look in a specific part of the chart.”
The numbers for all of his practice have been about 99%, with beta-blockers at 96% to 97%, Klauer said. “We have a quality director at every site. These statistics are measured quarterly and annually and compared to the other facilities, and the doctors are partially compensated on that basis,” he said.
This incentive-based compensation plan puts a certain portion of the physician pay at risk, and of that portion, 5% to10% is assigned to quality, Klauer said. Pham and Klauer agree the most controversial measure involves antibiotics. Pham said, “There’s a lot of controversy in the ED as the whether four hours (from admission) is appropriate, versus six or eight hours.”
There isn’t a single piece of controlled literature that assigns a specific time, Klauer said. “So, we may appear to not be in compliance because of flawed parameters, but we certainly won’t let our doctors practice bad medicine.”
Pham and his colleagues recommend the creation of systems in the ED to minimize whatever lapses in care are occurring. “Standardized protocols are shown in the literature to be effective,” he said. “For example, every patient with acute MI or chest pain gets aspirin and beta-blockers as part of their care unless it is contraindicated.” The nurse should serve as a check and balance by ensuring the doctors are following the protocol.
There may even be a role for IT, Pham said. “If you have a diagnosis of heart attack and you are about to log off without giving aspirin, a red flag may pop up. This takes the individual caregiver out of the equation,” he said. “The ED is very hectic, and it is not unreasonable to forget something. We need some warning feedback.”
Any performance feedback should be easily visualized, Pham added. “It could be a blinking light on the computer screen, a red flag on a chart. The bottom line is, these errors are likely lead to patient harm and death, and whatever we can do to improve on that will affect the health of patients.”
Klauer said, “If patients are getting aspirin 44% of the time, we are doing them a huge disservice, but I don’t believe that is happening.”
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