Do We Still Need Annual TB Skin Testing?

Do We Still Need Annual TB Skin Testing?

The CDC no longer recommends* annual TB screening of health care providers in the absence of a known exposure or ongoing transmission.

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.

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