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 May/June 2007 Volume 5, Issue 3
 Consultant's Corner
Feature Article
Quote of the Month
New Articles / Abstracts
In the News
Upcoming Meetings
Upcoming Conference: Dr. Petrack will be speaking at the Urgent Care Association of America annual conference, to be held May 9-12 in Daytona Beach, FL (see the Upcoming Meetings section for details). His topics will be "Common Presenting Complaints and Clinical Pearls in Pediatric Urgent Care" and "Approach to the Pediatric Rash."
For free articles, abstracts, Emergency Care Briefs, and more, visit our Resource Center at PetrackConsulting.com...
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Consultant's Corner Emory Petrack, MD, FAAP, FACEP I'd like to welcome new Spotlight on Emergency Care subscribers from the Urgent Care Association of America (UCAOA); I'll be speaking to members of your organization next week. Urgent care medicine appears to be on an upswing, as evidenced by the 12,000 subscribers to the Journal of Urgent Care Medicine. It also seems to me that, compared to emergency departments, urgent care centers have a greater potential to focus more on customer service challenges. Since they are frequently "self-contained" and operated by a leadership whose focus is undivided, urgent care centers tend to be less enmeshed in the larger bureaucracies that hinder change and service enhancements in emergency departments. This relative agility offers a significant competitive advantage for urgent care centers. With strong leadership and committed staff, urgent care centers have a great opportunity to create an exceptional service for the community, as well as to potentially relieve emergency department overcrowding by providing non-emergent care at a lower cost. Such centers, with outstanding service and the right business model, will thrive. This month's feature article offers one example of an important urgent care service that, if provided consistently, will lead to increased growth as word gets out into the community. The service? Pain management.
Feature Article The Painful Truth
Providing relief from pain is a core concern and expectation of patients seeking emergency or urgent care. As we enter "trauma season," we'll be seeing more and more patients presenting with painful injuries. How well, and how consistently, is your department or center meeting this particular patient expectation of pain relief?
In the News
Quote of the Month
New Articles/Abstracts
Brief summary of recent new articles and abstracts from http://www.PetrackConsulting.com/articles.html
Bourgeois, F. T.Shannon, M. W.
Using the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 1995-2002, these authors reviewed differences in pediatric care between pediatric and general emergency departments. They found that pediatric EDs saw more medical problems, while general EDs saw more injuries. Visits to pediatric EDs were associated with longer wait times to see a physician, and longer stays in the ED. There were no differences in the ordering frequency of common diagnostic studies, such as CBC, urinalysis, and chest radiograph. Not surprisingly, children in pediatric EDs seemed to be sicker. The authors note that these data provide the first glimpse of pediatric health care in EDs nationally.
It is well known that patients frequently present to the ED with minor illnesses and injuries. As managers work to reduce throughput times, the impact of this population has come under scrutiny. This study looked at the impact of low acuity patients on waiting times at Ontario hospitals during a one year period. There were 4.1 million patient visits at 110 EDs during the study period. Low, medium and high complexity patients represented 50.9%, 37.1% and 12% of all patients, respectively. In adjusted analyses, every 10 low complexity patients arriving per 8 hours was associated with a 5.4 minute increase in mean length of stay and a 2.1 minute increase in mean time to physician contact for medium and high complexity patients. The authors conclude that low complexity patients are associated with a negligible increase in ED length of stay and time to first physician contact. Diverting this population of patients away from the ED are unlikely to improve these parameters.
It is well known that boarding admitted patients in the ED is a major cause of crowding and ambulance diversions. This study examined retrospectively 62,588 patients to a 450 bed community teaching hospital during a one year period. They found that transferring admitted patients from the ED to an impatient unity within 120 minutes would have increased the functional treatment capacity of the ED by 10,397 hours during this period. By reducing other delays related to the admission process, providing services to new patients in ED beds formerly used to board inpatients could have generated nearly $4 million in additional net revenue.
This was a prospective, randomized, double-blind, placebo-controlled trial comparing atomized intranasal fentanyl (mean 1.7 ug/kg) with intravenous morphine (mean 0.11 mg/kg) for pain associated with long bone fractures. 67 children were enrolled. There were no differences in pain visual analog scales at 5, 10, 20 or 30 minutes postanalgesia. It appears that intranasal fentanyl is as effective as intravenous morphine for acute fracture pain, and can be delivered more quickly and painlessly.
Upcoming Meetings
May 9-12, 2007, Urgent Care Association of America, National Conference, Daytona Beach, FL
May 16-19, 2007, Society for Academic Emergency Medicine, Annual Meeting, Chicago, IL
Sept 26-29, 2007, Emergency Nurses Association, Annual Meeting, Salt Lake City, UT
About Our Organization
Created in 2003, Petrack Consulting is dedicated to helping physician and hospital
leadership bring excellence to emergency services. We work collaboratively to
fully understand our client's needs, and then address programmatic initiatives
with measurable outcomes. Our unique background in emergency medicine, administrative
medicine, and organization development allows us to create uniquely effective solutions
for enhancing emergency services.
Website: http://www.PetrackConsulting.com |
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