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Race and ethnicity may affect whether and where hospitals transfer patients – Pennsylvania State University

Race and ethnicity may affect whether and where hospitals transfer patients - Pennsylvania State University

The researchers analyzed six models, each of which explored specific aspects of how hospital transfers relate to a variety of factors, including patient race and ethnicity, patient insurance status, patient medical conditions, referring hospital urbanicity or rurality, and the market of hospitals around the referring hospital.

According to Hsuan, every model was important because each of these factors can affect whether and where a hospital transfers a patient. A rural hospital may be more likely to transfer a patient to a better-equipped regional hub hospital, public or not. A patient with Medicaid may be transferred differently than a patient with private insurance, and both may be transferred differently than a patient with no insurance.

The researchers compared the hospital transfer rates of non-Hispanic Black patients, Hispanic patients and non-Hispanic white patients. Results for Hispanic patients varied based on the specific conditions of the transfer, but Black patients were consistently transferred to public hospitals more often than white patients across all six models. The only times Black patients were not transferred more than white patients were a few specific medical conditions like strokes and heart attacks for which rigorous transfer protocols exist.

The disparity in the transfer rates varied based on which factors were being considered. Overall, 16.6% of Black patients were transferred to a public hospital while only 11.5% of white patients were. Health care system factors like hospital market and urbanicity accounted for most of the disparity. However, when comparing Black and white patients from the same hospital with similar health conditions and the same insurance, there was still an 0.8 percentage point difference in the rate of transfers to public hospitals resulting in more Black patients being transferred than white patients.

No matter how similar the hospitals or patients were that we compared, a difference between transfer rates to public hospitals for Black and white patients persisted, Hsuan said. Even a small percentage difference affects many, many people when your system has millions of transfers.

The researchers described the racial disparity as concerning in their publication. Hsuan said the reason for the disparity needs to be investigated, but addressing the problem is more important than immediately understanding the root cause.

Our data do not allow us to identify why Black people are transferred to public hospitals more often, but whatever the cause, there is inequality in the system that should be examined and corrected, Hsuan said. We need to address this inequality so that a person of any background can enter any emergency department and receive the best possible care to treat their condition and if needed potentially save their life.

Co-authors of this research include David Vanness, Department of Health Policy and Administration at Penn State; Yinan Wang, Department of Health Policy and Administration at Penn State; Douglas Leslie, Department of Public Health Sciences at Penn State; Eleanor Dunham, Department of Emergency Medicine at Penn State; Jeannette Rogowski, Department of Health Policy and Administration at Penn State; Alexis Zebrowski, Department of Emergency Medicine and Department of Population Health Science and Policy at Icahn School of Medicine at Mount Sinai; Brendan Carr, Department of Emergency Medicine and Department of Population Health Science and Policy at Icahn School of Medicine at Mount Sinai; David Buckler, Department of Emergency Medicine at Icahn School of Medicine at Mount Sinai; and Edward Norton, Department of Health Management and Policy and Department of Economics at University of Michigan.

The National Institute on Minority Health and Health Disparities, the Penn State Clinical and Translational Science Institute and the Penn State Social Science Research Institute supported this research.

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Opinion: To reduce ER wait times, hospitals must stop using them as in-patient warehouses – The Globe and Mail

Opinion: To reduce ER wait times, hospitals must stop using them as in-patient warehouses - The Globe and Mail

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Ambulances sit at the emergency room entrance at the Michael Garron Hospital, in Toronto, on April 29, 2021.Frank Gunn/The Canadian Press

James Worrall and Paul Pageau are emergency physicians at the Ottawa Hospital. Dr. Pageau is also a former president of the Canadian Association of Emergency Physicians.

Wait times for emergency department (ED) care have ballooned across Canada. At the ED where we work, patients who arrive in the evening are routinely not seen by a doctor until after 8 oclock the following morning. As we move through the winter, with continued high levels of respiratory illness, we will likely see the situation worsen.

But the standard explanations for long wait times are wrong. We repeatedly hear that there is nowhere else for patients to go because they do not have a family doctor. Patients are also often criticized for inappropriately using EDs. The scientific research, however, shows that we can blame neither the breakdown in Canadas primary care system, nor our patients, for overcrowding. It is ineffective patient-flow practices that unnecessarily increase wait times.

Research by the Canadian Institute for Health Information has shown that only 20 per cent of emergency patients who are ultimately discharged have a condition that could be managed in a family doctors office. Research also shows that these patients are the least complex and least time-consuming of all those we see in the ED. Patients with minor issues only modestly affect wait times for patients with more serious problems. So, even if they could be diverted to other clinics, overall waits and volumes are unlikely to improve.

Even patients who do have a family doctor often choose to come to the ED. Why? Studies show there are several reasons. Often, patients perceive their problem may be serious or dangerous, i.e., an emergency. Or they believe they require a test or treatment that can only happen in the ED.

Since the early days of emergency medicine, the medical establishment and politicians have derided patients for using the health care system inappropriately. This is nonsense. The great majority of ED patients are rational people who put up with terrible waits because they have real concerns that need to be addressed. Sometimes, patients think they are having a health emergency, such as a heart attack or appendicitis, but they are not. To sort that out, of course, requires a medical assessment and testing. How can we expect patients to be able to determine what is a health emergency on their own?

Demand for unscheduled care is normal. Emergencies, both major and minor, will not stop happening. Trying to solve ED wait times by diverting patients elsewhere will never make a meaningful impact. It is time to stop blaming patients and a lack of family doctors. Instead, we need to tackle the real cause of overcrowding: ED beds are filled with admitted patients.

The majority of stretchers and resources in most Canadian EDs are used to care for patients who have already been seen and treated in the ED, but who require admission to the hospital and are simply waiting for an in-patient bed. Despite regional variations in funding and patient demographics, every large hospital in Canada suffers from this malaise. It is the natural byproduct of ineffective patient-flow procedures.

All hospitals experience fluctuations in their in-patient census. The problem is that we use the ED as a buffer zone to handle this variation. In effect, it has become the waiting room for in-patient care. In-patient units also struggle to discharge patients, particularly the elderly, who need posthospitalization services such as long-term care, rehabilitation or community care. We clearly need to improve access to these services.

Leaving admitted patients in the ED in the meantime is not, however, a safe or logical solution, as it has unintended consequences. When ED stretchers are being used by patients better cared for in an in-patient unit, they are not available for new patients waiting to be seen. Holding admitted patients in the ED has been shown to increase in-hospital mortality, lengthen stays and increase costs. This evidence is ignored, because change is perceived to be too difficult. It would require hospitals to adopt dynamic staffing and operations models.

But this is possible. Britain, Australia and New Zealand have all implemented rules that ensure admitted patients are moved to in-patient units within hours. While not perfect, such rules do free up critical space in the ED, reduce wait times and may reduce mortality. ED wait times will not improve in Canada until governments have the courage to make similar rules. This will require political mettle, and hospitals will have to make difficult modernizations to their age-old patient-flow strategies.

So let us dispense with the fiction that long waits in the ED are due to patients presenting with minor problems, and that fixing primary care will solve things. People will always need emergency care, and they cannot get it if hospitals continue warehousing admitted patients in the ED.

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Physician Summits World’s Seven Highest Mountains — And You Can Join Him – Medpage Today

Physician Summits World's Seven Highest Mountains -- And You Can Join Him - Medpage Today

After a decade of expeditions around the world, Kentucky-based emergency medicine physician Ben Mattingly, MD, has finally summited the highest mountain on each continent -- a feat known as the seven summits.

While chipping away at the seven peaks, Mattingly has been simultaneously growing his business, Wild Med Adventures, which runs "adventure CME" trips around the world to train healthcare professionals on real-world situations that could happen while mountaineering, white water rafting, hunting, biking, and more.

MedPage Today caught up with Mattingly, who we last spoke with nearly a decade ago when Wild Med Adventures was just getting off the ground. Since then, thousands of physicians and other healthcare workers have gone on adventure CME trips with him, and the company's offerings have expanded; in addition to mountain-based trips, they now offer diving, off-roading, and wellness retreats -- and yes, there's still a duck hunting trip.

Mattingly's career combines medicine and adventure, yet he didn't travel much growing up in Kentucky. A year-long trip to New Zealand with his wife and kids further ignited his love for travel and adventure.

"I think I've always had sort of an adventurous spirit. And I think what you'll find is a lot of people who go into emergency medicine already have a little bit of a love for adrenaline," he said.

The Seven Summits

Mattingly also founded a Wilderness Medicine Fellowship at UMass Chan Medical School-Baystate in Massachusetts, and together with the first fellow, Joseph Schneider, MD, he ascended Mount Aconcagua in Argentina, the tallest mountain in the Americas, in 2013. That experience introduced him to an opportunity to climb Carstensz Pyramid (also called Puncak Jaya) in Indonesia, which he summited 2 years later.

After that, he and his wife, Jennifer Mattingly, PA-C, who also helps run Wild Med Adventures, led an adventure CME trip to Mount Kilimanjaro in Tanzania in 2016. Later that year, he also climbed Mount Elbrus in Russia.

Then, in 2019, Mattingly, his father, and frostbite expert Chris Imray, PhD, summited Mount Vinson in Antarctica. Mattingly had grown more confident and experienced at this point, and decided to summit Mount Denali in Alaska without a professional guide like he had on the other trips. His first attempt in 2017 had bad weather and was unsuccessful. But in 2021, alongside his father and eldest son, he reached the top of Denali.

Finally, last year, Mattingly's ascent of Mount Everest -- the tallest mountain in the world -- sealed the deal, though the experience was not without challenges. He first led a Wild Med Adventures trip to Everest's base camp and stayed to tackle his last peak. His dad was supposed to join, but got sick and had to turn back for medical care in Kathmandu. Mattingly and a Sherpa forged on through Everest's notorious foot traffic, waiting their turn and for a weather window to finally make the ascent. Making the way back down was treacherous, too; another party fell down, knocking down Mattingly and injuring his leg, which he later found out was a torn meniscus.

"If I'd had broke my leg there, it's probably game over," he thought. Luckily, he pushed through the excruciating knee pain and made it to the bottom safely, for which he said he's fortunate.

Going on Wild Med Adventures

Mattingly leads most Wild Med Adventures trips himself and said he gets a lot of repeat customers who come back from one adventure ready to embark on another. It's also fairly common for spouses to come along. Plus, he noted that many people come back from trips inspired to make changes in their life. For instance, one attendee who was actually a banker found a passion for wilderness medicine and went back to PA school.

It makes sense that someone with an emergency medicine background like Mattingly is drawn to this work, but he said the trips make all physicians more well rounded, even if the topics don't play heavily in their day-to-day practice.

For example, going on a hunting-based CME trip gives insight on patients who hunt, and how they may have increased risk for heart disease. Even for cases where a stranger needs help from a doctor, having refreshers on tourniquets or frostbite could come in handy and save someone's life.

One of the company's most popular trips is the annual trek to Kilimanjaro, where participants experience altitude sickness together and have conversations about relevant health issues along the way.

"So you're going over all of the pathophysiology of altitude -- what is high-altitude pulmonary edema? What is frostbite? How do you take care of it? How do you treat hypothermia?" Mattingly explained.

Meanwhile, diving trips focus more on topics such as decompression control, hemorrhage control, and jellyfish stings. He hopes to add trips for rock climbing and skiing to the roster in the coming years.

A more recent addition were wellness retreats at serene destinations, like a lodge in New York's Adirondack Mountains.

"Those have been really popular because I think the medical community is falling apart, to be honest," Mattingly said. "I'm seeing young guys finish residency and then only 2 years out, they look depressed and tired."

He sees small-group adventure CME trips as an invigorating alternative to the traditional CME acquisition.

Trip prices range from $1,500 for shorter trips and wellness retreats, to upwards of $10,000 for the longer trips, and the cost doesn't cover airfare. CME credits vary as well, ranging from around 10 to 20 per trip. More information is available on the Wild Med Adventures website.

Rachael Robertson is a writer on the MedPage Today enterprise and investigative team, also covering OB/GYN news. Her print, data, and audio stories have appeared in Everyday Health, Gizmodo, the Bronx Times, and multiple podcasts. Follow

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UH opening new urgent care facility, relocating another – Bay News 9

CLEVELAND University Hospitals is opening a new urgent care facility and relocating another at the end of January, according to a press release.

The urgent cares will be a welcome addition to both communities and reduce their travel time when seeking medical attention, the release states. The new locations are part of the larger plan to deliver health care closer to where patients live, shop and work.

The facility being relocated is UH Urgent Care Streetsboro, previously located at the UH Streetsboro Health Center. It will move to 9449 State Route 14, Streetsboro, Ohio 44241 and will open on Jan. 29.

The new facility, UH Urgent Care Shaker Heights, will be located at 16601 Chagrin Blvd., Shaker Heights, Ohio 44120 and will open on Feb. 1.

These locations will be open from 8 a.m. to 8 p.m. every day, with some exceptions for holidays.

Our UH Urgent Care delivery model aims to provide the most convenient and valuable care for our patients, said Dr. Paul Hinchey, UH chief operating officer, in the release. Having easy access to urgent care locations provide a more affordable option than emergency departments for patients who dont have a primary care physician but need immediate, non-life-threating medical attention. By offering more urgent care locations, we can relieve the burden on emergency departments and reduce wait times so our emergency medicine teams can focus on critical cases.

The release notes that this expansion will add hundreds more health care jobs to the local market and that the hospital network is currently looking for medical professionals, who can click this link for more information.

Dr. Lee Resnick, UH Urgent Care president, said in the release that their goal is to remove obstacles and ease access to health care while still providing patients with good experiences.

The expansion of UH Urgent Care in Northeast Ohio is a significant step towards fulfilling this commitment, Resnick said in the release. By increasing access to urgent care services, we aim to make a positive impact on the lives of individuals and families throughout the region, providing them with the prompt and effective care they deserve in retail locations where they live, shop and work.

Decision Fatigue in Emergency Medicine: An Exploration of Its Validity – Cureus

Decision Fatigue in Emergency Medicine: An Exploration of Its Validity - Cureus

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New Year’s Eve safety tips, straight from emergency department doctors – Newsday

New Year's Eve safety tips, straight from emergency department doctors - Newsday

New Years Eve,thatbusy night of revelry,food and drink with friends and loved ones,also canbe a hectic time at hospital emergency departments when the fun goesawry.

Doctors say this is the time of year they see an increase in car crashes, intoxication cases and even accidents in the kitchen.

Newsday spoke with several emergency department doctors on Long Island about common holiday hazardsandhow people can celebrate and stay safe.

Injuries due to vehicle accidents increase every year around New Years Eve, said Dr. Neil K. Dasgupta, director of Emergency Critical Careat Nassau University Medical Center.

Its the holidays everyones stressed, everyone's busy, things are crowded, Dasgupta said. There are a lot of traffic accidents, whether they are related to alcohol or not. People are out trying to get places and they are not paying attention. There is a lot more traffic on the road.

The National Safety Council estimates that 375 people may die on U.S. roads during the New Years Day holiday period, which lasts from Friday through Monday. Alcohol consumption is a major contributing factor.

Doctors suggest designating a driver who will abstain from alcohol for the night, or using a ride share service. If possible, stay off the roads to avoid dangerous drivers.

Really, there is no safe amount [of alcohol]if you are driving, said Dr. Matthew Projansky, associate chair of emergency medicine for Plainview Hospital and Syosset Hospital.

There are a lot of alcohol-related cases that come into the emergency room every New Years Eve, Projansky said. A lot of teenand underage drinking takes place,he said. [Teens]are usually more susceptible to the effects of alcohol because they dont drink regularly.

Some patients require IV fluids to hydrate,and time, but others who are vomiting and aspirating may need more serious medical intervention, doctors said.

Excessive alcohol consumption also could lead to a condition known as holiday heart, said Dr. Robert Schwaner, medical director of the department of emergency medicine and chief of the division of toxicology at Stony Brook University Hospital.

Alcohol is a direct irritant to the heart, he said. If someone binges on alcohol over a week or two, its not uncommon to get atrial fibrillation," an irregular heart rate that impacts blood flow.

Projansky said he also sees more trips and falls, and twisted ankles, sometimes due to people wearing high-heeled shoes.

"Even if you aren't drunk, your balance might be a little off," he said.

Using knives and other sharp utensils to prepare meals;washing glasses;falling down stairs and even popping the cork can lead to injuries that land people in emergency rooms every New Years Eve.

A big one we see all the time is people trying to clean glasses who are intoxicated, Schwaner said. Then they break the wine glass and cut their hand.

And when you have 50 champagne corks going off in a room, it can definitely cause some injuries, Dasgupta said.

He said some people choose dangerous ways fireworks and even firearms to celebrate the holidays.

Make sure you are around people who you trust, Dasgupta said. Keep your phone charged and stay in touch with your friends and family.

Schwaner suggests everyone have a plan to keep an eye on each other, travel safely and dress appropriately for the weather. No one wants to be stranded, he said, especially since temperatures are expected to dip into the 30s on Sunday night.

Hypothermia is a real issue, he said.

Projansky pointed out that people who are drunk may not even realize they are hypothermic.

Whiskey going down feels warm, but alcohol doesnt raise your body temperature, he said. It actually lowers it.

Lisa joined Newsday as a staff writer in 2019. She previously worked at amNewYork, the New York Daily News and the Asbury Park Press covering politics, government and general assignment.

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Emergency physician jobs: Navigating tech’s impact on healthcare – Arizona Big Media

Emergency physician jobs: Navigating tech's impact on healthcare - Arizona Big Media

Step into the next future of healthcare transformation. A revolution that is reshaping emergency physician jobs and patient care.

Prepare to embark on a journey as we navigate the thrilling evolution. Uncovering the impacts of cutting-edge advancements.

Join us as we delve into this progressive landscape. Where healthcare tech revolutionizes the healthcare sector. It also redefines the scope and practice of emergency medicine. Brace yourself for an exploration of how innovation is shaping healthcare.

Lets dive in!

EHRs have transformed healthcare by replacing paper records. It can now be accessed with efficient and secure digital systems. It allows for quick access to medical information.

It will enable healthcare providers to make timely and accurate diagnoses. This further reduces errors and improves patient outcomes.

These apps have revolutionized emergency physician jobs. It offers advanced that include the following.

These apps empower individuals to enhance their health and well-being.

Telemedicine has sparked a radical transformation in the role of emergency healthcare. It uses video conferencing, remote monitoring, and secure messaging.

Doctors can now deliver consultations to patients from a distance. This improves access to healthcare services.

Telemedicine provides immediate support to paramedics. It also aids in triage operations during times of disaster. Websites like https://www.abstaffing.com/ offer the availability of travel nurses.

They also offer physician assistants and nurse practitioners to assist in emergencies. This tech influence expands the scope and reduces response times in critical situations.

Growth in diagnostic tools and imaging has improved emergency medicine. It provides real-time data at the bedside. These aid in quick diagnosis and decision-making, leading to better patient care.

These could include:

A technology impact is revolutionizing emergency medicine. It provides heart rate monitoring, fall detection, and even ECG capabilities. Devices like fitness trackers and smartwatches offer valuable data for emergency physicians.

This enables remote monitoring of high-risk individuals. This also gives valuable insights into patients health.

The future of healthcare lies in the USE of AI. This technology has already made significant strides in analyzing medical data. It also includes identifying patterns and predicting diagnoses.

In emergency medicine, AI is being utilized to assist in decision-making. This aids physicians in providing faster and more accurate care.

Growth in robotics has transformed emergency physician jobs. It helps aid in surgeries and provides remote support for patients.

Robots can also be utilized to transport medical supplies and perform tasks. This frees up physicians to focus on critical patient care.

VR technology is revolutionizing medical training and education for emergency physicians. Immersive simulations allow for hands-on learning. It also allows practicing high-risk procedures without putting patients at risk.

VR is also being used to manage pain and anxiety in patients. This further reduces the need for sedation and medication.

Groundbreaking advancements are transforming emergency physician jobs. This includes the likes of AI, telemedicine, and robotics. These innovations enhance diagnostics and patient engagement.

It also helps redefine the role of emergency physicians. The future of emergency medicine holds limitless potential driven by innovation.

Stay informed and explore the fascinating impact of technology on healthcare.

Browse our blog for more interesting reads.

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Emergency room doctor unveils the most dangerous toys this season – WTOP

Emergency room doctor unveils the most dangerous toys this season - WTOP

Children's National Hospital emergency medicine physician and director of outreach Sarah Ash Combs shares what gifts parents should avoid this Christmas.

In less than 24 hours kids everywhere will begin tearing into toys from their wish list. But before that happens, one D.C.-area doctor suggested some ways to play it safe and avoid a Christmas trip to the emergency room.

Dr. Sarah Ash Combs, an emergency medicine physician and director of outreach for Childrens National Hospital, said there is an easy way for parents to make sure toys are safe. It begins with carefully checking the toys packaging and wrapping especially if you have children younger than three years old.

Is it wrapped in shrink-wrap packaging? she said. Is it something that a young child can get their hands on and ingest and use to cover their mouths? Bear in mind what the toy is coming in.

Combs also suggested keeping toys with tiny magnets, loose buttons or coin batteries away from children. If those parts are swallowed, they could be deadly for kids.

Look at a toy critically, Combs said. Ask yourself, If this went into my childs mouth, could be sucked down into the back of their throat? If you are saying yes, I would just put those toys to one side.

Another toy that strikes fear in the hearts of emergency room physicians, especially with New Years Eve on the horizon, is balloons.

If ingested, Combs said, balloons can cut off a childs airway and cause suffocation.

We really like to veer away from too many balloons lying around, especially in a young childs house, she said.

For larger kids, Combs advised parents to avoid gifting trampolines and rocket launchers this holiday.

The risk with trampolines is that children can land wrong on their heads or necks, or fall and break a bone. And toys that propel objects can cause severe close-range injuries, Combs told WTOP.

She said strict parental supervision is key.

Bear in mind, were talking about a minority of toys to stay away from, with the idea that this will give you a joyful holiday, she said. So that youre not coming to visit me in the emergency department.

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