Urgent Care Siphons Off Emergency Patients

Urgent Care Siphons Off Emergency Patients

From 2008 to 2015, low acuity care in commercially insured patients has dropped 36% in EDs and increased 140% in non-ED settings, dominated by an increase in urgent care but also, less so, by increases in retail clinic and telemedicine utilization.

Why SEP-1 CMS "Quality" Metrics Are Dumb

Why SEP-1 CMS "Quality" Metrics Are Dumb

Sepsis bundles like the CMS SEP-1 guidelines are too restrictive, requiring an all-or-nothing approach to achieve compliance. These bundles fail to prioritize the most important bundle components while penalizing providers for meaningless omissions that have no impact on mortality.

Sign-Out Bombs and Resident Productivity

Sign-Out Bombs and Resident Productivity

With ED boarding, the burden of sign-out patients is greater than ever. This study shows just what I expected.  All of these sign-out patients negatively affects how many new cases each resident is able to see on each shift.

Door to tPA Under 20 Minutes - Impressive or Dangerous?

Door to tPA Under 20 Minutes - Impressive or Dangerous?

A door-to-tPA in under 20 minute protocol at this center with 1015 stroke alerts resulted in a misdiagnosis rate of 14.8% and 8 people being harmed.  The authors concluded this was safe.  I'm not so sure about that.

Start Strong, Finish Weak - Attending Shift Productivity

Start Strong, Finish Weak - Attending Shift Productivity

Attending physician productivity peaks at the beginning of the shift, starting with about 3 new patients in the first hour and decreases as the shift progresses.  This has important implications for staffing models.  Assuming a simple, uniform average over the shift won't work.

Private to Public ED Dumps Hurt Patients

Private to Public ED Dumps Hurt Patients

Failure of private hospitals to care for the uninsured resulted in informal ED to ED referrals, which meant up to 20% increased volume in public EDs for certain diagnoses, particularly orthopedic issues.  This led to duplicate testing, increased cost, complications, delays in care, and poor treatment of the most vulnerable patients.

Is There Such Thing as a Black Cloud?

Is There Such Thing as a Black Cloud?

There is no such thing as a "black cloud."  Those who self-identified as a black-cloud were also identified as such by their peers, but a look at the actual PED metrics showed no statistical difference except higher admission rate.  I'm not sure I believe this, but there you go...

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