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Human rights breaches found in Northern Ireland. Nurs Stand 2015; 29:8. [PMID: 26036366 DOI: 10.7748/ns.29.40.8.s5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Sorrel AL. Balance-billing ban back in 2015 legislature. Tex Med 2015; 111:33-38. [PMID: 25974847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Ford S, Lintern S. NICE sets out A&E nursing ratios. NURSING TIMES 2015; 111:3. [PMID: 26016100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Ung L, Dvorkin R, Sattler S, Yens D. Descriptive study of prescriptions for opioids from a suburban academic emergency department before New York's I-STOP Act. West J Emerg Med 2015; 16:62-6. [PMID: 25671010 PMCID: PMC4307728 DOI: 10.5811/westjem.2014.12.22669] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 12/04/2014] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Controlled prescription opioid use is perceived as a national problem attributed to all specialties. Our objective was to provide a descriptive analysis of prescriptions written for controlled opioids from a database of emergency department (ED) visits prior to the enactment of the I-STOP law, which requires New York prescribers to consult the Prescription Monitoring Program (PMP) prior to prescribing Schedule II, III, and IV controlled substances for prescriptions of greater than five days duration. METHODS We conducted a retrospective medical record review of patients 21 years of age and older, who presented to the ED between July 1, 2011 - June 30, 2012 and were given a prescription for a controlled opioid. Our primary purpose was to characterize each prescription as to the type of controlled substance, the quantity dispensed, and the duration of the prescription. We also looked at outliers, those patients who received prescriptions for longer than five days. RESULTS A total of 9,502 prescriptions were written for opioids out of a total 63,143 prescriptions for 69,500 adult patients. Twenty-six (0.27%) of the prescriptions for controlled opioids were written for greater than five days. Most prescriptions were for five days or less (99.7%, 95% CI [99.6 to 99.8%]). CONCLUSION The vast majority of opioid prescriptions in our ED prior to the I-STOP legislature were limited to a five-day or less supply. These new regulations were meant to reduce the ED's contribution to the rise of opioid related morbidity. This study suggests that the emergency physicians' usual prescribing practices were negligibly limited by the new restrictive regulations. The ED may not be primarily contributing to the increase in opioid-related overdoses and death. The effect of the I-STOP regulation on future prescribing patterns in the ED remains to be determined.
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Huff DJ. Lawsuits arising out of care in the ER--10 years after tort reform in Georgia. JOURNAL OF THE MEDICAL ASSOCIATION OF GEORGIA 2015; 104:38-45. [PMID: 27451583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Bagley N. Medicine as a Public Calling. MICHIGAN LAW REVIEW 2015; 114:57-106. [PMID: 26394459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The debate over how to tame private medical spending tends to pit advocates of government-provided insurance--a single-payer scheme--against those who would prefer to harness market forces to hold down costs. When it is mentioned at all, the possibility of regulating the medical industry as a public utility is brusquely dismissed as anathema to the American regulatory tradition. This dismissiveness, however, rests on a failure to appreciate just how deeply the public utility model shaped health law in the twentieth century-- and how it continues to shape health law today. Closer economic regulation of the medical industry may or may not be prudent, but it is by no means incompatible with our governing institutions and political culture. Indeed, the durability of such regulation suggests that the modern embrace of market-based approaches in the medical industry may be more ephemeral than it seems.
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West JC. Emergency medicine. Lee v. Hennepin County, Civil No. 13-1328 PJS/AJB (D. Minn. November 20, 2013). J Healthc Risk Manag 2015; 34:43-44. [PMID: 25796634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Kajitani A, Asada M, Iwai H, Kuwabara H, Kawasaki S, Kobayashi H. [What we can learn from a case of medical malpractice--physician at the secondary emergency facility held liable for medical negligence for the death of a patient transported to the facility for an automobile accident]. NIHON GEKA GAKKAI ZASSHI 2015; 116:60-61. [PMID: 25842817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Waxman DA, Greenberg MD, Ridgely MS, Kellermann AL, Heaton P. The effect of malpractice reform on emergency department care. N Engl J Med 2014; 371:1518-25. [PMID: 25317871 DOI: 10.1056/nejmsa1313308] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Many believe that fear of malpractice lawsuits drives physicians to order otherwise unnecessary care and that legal reforms could reduce such wasteful spending. Emergency physicians practice in an information-poor, resource-rich environment that may lend itself to costly defensive practice. Three states, Texas (in 2003), Georgia (in 2005), and South Carolina (in 2005), enacted legislation that changed the malpractice standard for emergency care to gross negligence. We investigated whether these substantial reforms changed practice. METHODS Using a 5% random sample of Medicare fee-for-service beneficiaries, we identified all emergency department visits to hospitals in the three reform states and in neighboring (control) states from 1997 through 2011. Using a quasi-experimental design, we compared patient-level outcomes, before and after legislation, in reform states and control states. We controlled for characteristics of the patients, time-invariant hospital characteristics, and temporal trends. Outcomes were policy-attributable changes in the use of computed tomography (CT) or magnetic resonance imaging (MRI), per-visit emergency department charges, and the rate of hospital admissions. RESULTS For eight of the nine state-outcome combinations tested, no policy-attributable reduction in the intensity of care was detected. We found no reduction in the rates of CT or MRI utilization or hospital admission in any of the three reform states and no reduction in charges in Texas or South Carolina. In Georgia, reform was associated with a 3.6% reduction (95% confidence interval, 0.9 to 6.2) in per-visit emergency department charges. CONCLUSIONS Legislation that substantially changed the malpractice standard for emergency physicians in three states had little effect on the intensity of practice, as measured by imaging rates, average charges, or hospital admission rates. (Funded by the Veterans Affairs Office of Academic Affiliations and others.).
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Zimmermann GW. [BSG sets limits for clinics in EBM accounting]. MMW Fortschr Med 2014; 156:12. [PMID: 25417453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Hearle K. Preparing for section 501(r). HEALTHCARE FINANCIAL MANAGEMENT : JOURNAL OF THE HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION 2014; 68:104-108. [PMID: 24968633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Steps hospitals should take to prepare for Section 501(r) requirements include the following: Prepare the board for its role in approving updated financial assistance, billing and collections, and emergency medical care policies. Revisit financial assistance policy eligibility requirements. Conduct a policy gap analysis. Review how the current financial assistance policy is publicized and make adjustments where necessary.
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McQuoid-Mason DJ. Prof. McQuoid-Mason responds. S Afr Med J 2014; 104:260. [PMID: 25118538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
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Merritt AK. The rise of emergency medicine in the sixties: paving a new entrance to the house of medicine. JOURNAL OF THE HISTORY OF MEDICINE AND ALLIED SCIENCES 2014; 69:251-293. [PMID: 22966181 DOI: 10.1093/jhmas/jrs054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Emergency medicine evolved into a medical specialty in the 1960s under the leadership of physicians in small communities across the country. This paper uses three case studies to investigate the political, societal, and local factors that propelled emergency medicine along this path. The case studies-Alexandria Hospital, Hartford Hospital, and Yale-New Haven Hospital-demonstrate that the changes in emergency medicine began at small community hospitals and later spread to urban teaching hospitals. These changes were primarily a response to public demand. The government, the American public, and the medical community brought emergency medical care to the forefront of national attention in the sixties. Simultaneously, patients' relationships with their general practitioners dissolved. As patients started to use the emergency room for non-urgent health problems, emergency visits increased astronomically. In response to rising patient loads and mounting criticism, hospital administrators devised strategies to improve emergency care. Drawing on hospital archives, oral histories, and statistical data, I will argue that small community hospitals' hiring of full-time emergency physicians sparked the development of a new specialty. Urban teaching hospitals, which established triage systems and ambulatory care facilities, resisted the idea of emergency medicine and ultimately delayed its development.
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Prezioso V, Mangiulli T, Bolino G, Sciacca V. About a case of missed diagnosis of a post-traumatic aneurysm in the ulnar artery. Medical-legal aspects in respect to the professional liability. Ann Ital Chir 2014; 85:171-176. [PMID: 24394807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Compartment syndrome of the left hand from a late diagnosed post-traumatic ulnar artery pseudoaneurysm. We report the case of 27 years old boy with a tipping and cutting wound on his left wrist, generating an ulnar artery pseudoaneurysm, that was late diagnosed, and therefore complicated by a compartment syndrome in the wrist. Immediately after the trauma the subject went to the emergency room where the severity of the injury was undestimated; in fact, it was sutured and medicated, without further investigation. When he went to the same hospital for the second time, symptoms (pulsatile mass, redness and irritation of the skin) were interpreted as an infectious process and treated in an incongruous way. Then, when he went to another hospital in which imaging studies (ultrasound) were performed, the pseudo- aneurysm of the ulnar artery was diagnosed and surgically treated. The delay in diagnosis led to a compartment syndrome that is still appreciable as a sensory-motor deficit of the hand, especially of the fourth and fifth finger. This pseudo- aneurysm complication and its debilitating outcomes are known in literature, so the diagnostic delay makes the sanitary staff guilty of the suffered damage.
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McLean SA, Ulirsch JC, Slade GD, Soward AC, Swor RA, Peak DA, Jones JS, Rathlev NK, Lee DC, Domeier RM, Hendry PL, Bortsov AV, Bair E. Incidence and predictors of neck and widespread pain after motor vehicle collision among US litigants and nonlitigants. Pain 2014; 155:309-321. [PMID: 24145211 PMCID: PMC3902045 DOI: 10.1016/j.pain.2013.10.016] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 09/11/2013] [Accepted: 10/15/2013] [Indexed: 11/22/2022]
Abstract
Debate continues regarding the influence of litigation on pain outcomes after motor vehicle collision (MVC). In this study we enrolled European Americans presenting to the emergency department (ED) in the hours after MVC (n=948). Six weeks later, participants were interviewed regarding pain symptoms and asked about their participation in MVC-related litigation. The incidence and predictors of neck pain and widespread pain 6weeks after MVC were compared among those engaged in litigation (litigants) and those not engaged in litigation (nonlitigants). Among the 859 of 948 (91%) participants completing 6-week follow-up, 711 of 849 (83%) were nonlitigants. Compared to nonlitigants, litigants were less educated and had more severe neck pain and overall pain, and a greater extent of pain at the time of ED evaluation. Among individuals not engaged in litigation, persistent pain 6weeks after MVC was common: 199 of 711 (28%) had moderate or severe neck pain, 92 of 711 (13%) had widespread pain, and 29 of 711 (4%) had fibromyalgia-like symptoms. Incidence of all 3 outcomes was significantly higher among litigants. Initial pain severity in the ED predicted pain outcomes among both litigants and nonlitigants. Markers of socioeconomic disadvantage predicted worse pain outcomes in litigants but not nonlitigants, and individual pain and psychological symptoms were less predictive of pain outcomes among those engaged in litigation. These data demonstrate that persistent pain after MVC is common among those not engaged in litigation, and provide evidence for bidirectional influences between pain outcomes and litigation after MVC.
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West JC. Case law update. J Healthc Risk Manag 2014; 34:43-52. [PMID: 25319467 DOI: 10.1002/jhrm.21157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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West JC. Case law update. Torres v Santa Rosa Memorial Hospital , No. C 12–6364 PJH (ND Calif August 20, 2013). J Healthc Risk Manag 2014; 33:49-51. [PMID: 24868627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Steckl PD, Samaritan G, Martinez L, Gregg MG. VAD: an under-recognized cause of stroke in the young. JOURNAL OF THE MEDICAL ASSOCIATION OF GEORGIA 2014; 103:16-17. [PMID: 24851485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Falcone N. Wisconsin District Court extends EMTALA whistleblower protections to non-employee physicians--Muzaffar v. Aurora Health Care Southern Lakes, Inc. AMERICAN JOURNAL OF LAW & MEDICINE 2014; 40:164-166. [PMID: 24844046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Becker NV, Friedman AB. ED, heal thyself. Am J Emerg Med 2013; 32:175-7. [PMID: 24332901 DOI: 10.1016/j.ajem.2013.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 11/01/2013] [Accepted: 11/01/2013] [Indexed: 11/18/2022] Open
Abstract
Emergency department (ED) wait times have continued to worsen despite receiving considerable attention for more than 2 decades and despite the availability of a variety of methods to restructure care in a more streamlined fashion. This article offers an economic framework that abstracts away from the details of operations research to understand the fundamental disincentives to improving wait times. Hospitals that reduce wait times are financially penalized if they must provide more uncompensated care as a result. Pending changes under the Patient Protection and Affordable Care Act are considered. We find that the likely effect of the Patient Protection and Affordable Care Act's insurance expansion is to reduce this penalty for improving ED wait times. Consequently, mandating adoption of solutions to ED crowding may be unnecessary and counterproductive. If the insurance expansion is insufficient to fully solve the problem, the hospital value-based purchasing initiative should adopt wait times as a goal in its next iteration.
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Dyer C. Hunt appeals against ruling he exceeded his powers in action on Lewisham Hospital. BMJ 2013; 347:f6540. [PMID: 24169491 DOI: 10.1136/bmj.f6540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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West JC. Emergency Medicine: hospital may be liable for failure to stabilize an inpatient. Liles v. TH Healthcare, LTD., No. 2:11-cvf-528-JRG(E.D. Tex. September 10, 2012). J Healthc Risk Manag 2013; 32:44-5. [PMID: 23609976 DOI: 10.1002/jhrm.21109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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