Ibuprofen vs acetaminophen vs their combination in the relief of musculoskeletal pain in the ED: a

randomized, controlled trial

The American Journal of Emergency Medicine, 09/17/2013 Clinical Article
Bondarsky EE et al. Nonopioid analgesics are often administered to emergency department (ED)
patients with musculoskeletal pain but if inadequate, opioids are given with associated potential adverse
events. The authors conclude that the combination of ibuprofen and acetaminophen did not reduce pain
scores or the need for rescue analgesics compared with either agent alone in ED patients with pain
secondary to acute musculoskeletal injuries.
Methods
The authors tested the hypothesis that the reduction in pain scores with the combination of ibuprofen and
acetaminophen would be at least 15 mm greater than with either of the agents alone.
They conducted a double-blind, randomized, controlled trial of adult ED patients with acute
musculoskeletal pain.
Patients were randomized to oral ibuprofen 800 mg, acetaminophen 1 g, or their combination.
Pain scores across the groups were compared with repeated measures analysis of variance at 20, 40,
and 60 minutes.
A sample of 30 patients in each group had 80% power to detect a 15 mm difference in pain scores across
the groups (alpha = .05).
Thirty patients were randomized to each study group.
Results
Mean (SD) age was 36 (15), 54% were male, 73% were white, and 13% were Hispanic.
Groups were well balanced in baseline characteristics including initial pain scores (59, 61, and 62 for
ibuprofen, acetaminophen, and their combination).
Pain decreased over the one hour study period for all groups (P < .001) with mean (SD) scores about 20
mm lower on the Visual Analogue Scale than the mean initial score.
However, there was no significant difference among treatments (P = .59).
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How do emergency physicians make discharge decisions?
Published Online First 17 September 2013
Background One of the most important decisions that emergency department (ED) physicians make is
patient disposition (admission vs discharge).
Objectives To determine how ED physicians perceive their discharge decisions for high-acuity patients
and the impact on adverse events (adverse outcomes associated with healthcare management).
Methods We conducted a real-time survey of staff ED physicians discharging consecutive patients from
high-acuity areas of a tertiary care ED. We asked open-ended questions about rationale for discharge
decisions and use of clinical judgement versus evidence. We searched for 30-day flagged outcomes
(deaths, unscheduled admissions, ED or clinic visits). Three trained blinded ED physicians independently
reviewed these for adverse events and preventability. We resolved disagreements by consensus. We
used descriptive statistics and 95% CIs.
Results We interviewed 88.9% (32/36) of possible ED physicians for 366 discharge decisions.
Respondents were mostly male (71.9%) and experienced (53.1% >10 years). ED physicians stated they
used clinical judgement in 87.6% of decisions and evidence in 12.4%. There were 69 flagged outcomes
(18.8%) and 10 adverse events (2.7%, 95% CI 1.1 to 4.5%). All adverse events were preventable (1
death, 4 admissions, 5 return ED visits). No significant associations occurred between decision-making
rationale and adverse events.

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How do emergency physicians make discharge decisions?Experienced ED physicians most often relied on clinical
acumen rather than evidence-based guidelines when discharging patients from ED high-acuity areas. Neither
approach was associated with adverse events. In order to improve the safety of discharge decisions, further
research should focus on decision support solutions and feedback interventions.Breaking News: Insured or Not,
Lack of Access Drives Patients to EDsThe problem then becomes that low-acuity patients usually pay more than
the cost of care while high-acuity care can cost more than the charges. If you starting taking the low-acuity
patients out of the emergency department, you could have an adverse effect on hospitals. The solutions may
backfire, and you end up increasing costs. If the goal is to reduce health care costs, there are so many other ways
to do that more effectively than reduce low-acuity visits to the emergency department, he said.avoidingI dont
blame doctors in private practice for wanting to work reasonable hours and have evenings, weekends and holidays
to spend with family and friends. But the medical profession has thus far failed to adequately fill in the gap left by
doctors who no longer make house calls or answer the phone 24/7.Big ERIt sounds funny, but it's actually a REALLY
sad testimonial to how out-of-touch people are with their own bodies. I hear grownups tell me crazy stuff like they
only poop once a week or once a month and I don't know how they can stand themselves being literally fullofshit,
if I don't poop exactly eight hours after I eat I feel sick, I can't even imagine being so unhealthy that I couldn't poo,
or being so unaware of my own body that I'd have to declare a medical emergency because I was too stupid to
understand it's most basic physical functions. Oh my god people are gross. The saddest thing about this article is
that the parents are also too stupid to figure it out, my god when are we going to start requiring an intelligence
test as a prerequisite for breeding!?!?. JesusDebt collectors. Beating up the debt collectors doesn't accomplish
anything. I'm sure that most of them are just more people desperate to make a buck, probably struggling with debt
themselves. This is simply what happens when you have a system where you try to create an entitlement to health
care but there is no mechanism to pay for it. I have no idea if Obamacare will make it better, but if it is repealed
with no replacement this will get exponentially worse.for elederly This is great news. As a senior citizen, I waited 2
hours in the ER when I thought I was having a heart attack. The staff was busy with a teenage gang banger who
had two gunshot wounds. I could have died while he lived. I hope my city sets up a senior ER.Snags er jod He had
nothing better to do? Either he is seriously delusional and really believes he was on a secret mission or he is
somehow simultaneously both a good enough liar to forge the documents and get through the interview processes
AND so bad that when he gets caught he makes up a story that is so unbelievable, it makes him LOOK crazy.










Breaking News: Insured or Not, Lack of Access Drives Patients to EDs
SoRelle, Ruth MPH
Those in and outside the health care system often blame patients for their nonurgent ED visits, labeling
them medically illiterate. Some, despite all the evidence, point to this as the cause of emergency
department crowding.
As emergency departments brace themselves for the onslaught of the newly insured anticipated to come
with the Patient Protection and Affordable Care Act, new studies indicate that the answer may be easier
to define but more difficult to solve.The simple answer is that many patients lack timely access to primary
care or clinics. Faced with symptoms such as pain or fever, they go where they know the door is always
open.Sixty-five percent of the adults in one study, which was reported at the recent annual meeting of the
Society for Academic Emergency Medicine, said they came to the ED because they were suffering from
what the researchers called a high-acuity problem. And an astounding 78.9 percent reported at least one
problem in accessing care, said Adit A. Ginde, MD, MPH, an assistant professor of emergency medicine
at the University of Colorado School of Medicine and Epidemiology at the Colorado School of Public
Health.The researchers evaluated responses from 4,606 participants in the 2010 National Health
Interview Survey who had sought care in an emergency department in the past year, and 83.9 percent of
those who did not have a high-acuity issue said they sought ED care because of one or more barriers to
obtaining regular care.The investigators, after adjusting the data for covariants, found that those who
reported a high-acuity problem as the reason for the ED visit were pretty much the same whether or not
the patient had insurance. Instead, the differences lay with access to care. Patients with Medicaid only,
those with Medicare and Medicaid, and those without insurance were more likely to have at least one
problem accessing care compared with those who had private insurance.Dr. Ginde, also an associate
director of the Colorado Emergency Medicine Research Center, said he and his colleagues anticipated
that Medicaid patients would be less likely to say they thought they had a true emergency, but that proved
wrong. When we adjusted for co-morbidities, they were as likely as those with insurance to say they had
a truly emergent issue. From a patient perspective and a prudent layperson standard, they perceived that
they had a true emergency and often may have called a primary care office only to be told to go to the
emergency department, he said.Jennifer Wiler, MD, MBA, an assistant professor of emergency medicine
at the University of Colorado School of Medicine and an author of the report, said providers do not view
all types of insurance equally. Medicaid is different. Access to care is different for Medicaid, Medicare,
and private insurance, she said. One barrier for Medicaid patients in a lot of states is that the cost of
delivering care is higher than the payment. Until we fairly pay providers for caring for these patients, it's
always going to be challenging.The Affordable Care Act is a great first step to expand insurance
coverage to Americans, Dr. Ginde said, but no parity exists among the types of insurance. It's not the
silver bullet, but it's an important but small step, he said. Medicaid patients, even if they have a
designated primary care provider or a medical home, have greater difficulty in accessing those providers
for acute care needs. There is no chance of getting a same-day or next-day appointment. You could
argue that they don't need emergency department services, but they do need acute care services, and if
they cannot get them, they go to the emergency department.Dr. Ginde said just providing insurance is
not going to be enough to fix the system. With the Affordable Care Act and infusion of new patients into
an already overtaxed primary care system, we will see new surges in the emergency department, he
said. It should be accompanied by true access.He advocated for medical homes, though he noted that
maintaining that contact can be difficult. If a patient jumps around because he or she is told, You can't
come here anymore; you should go there, then there is inconsistency, and they are more likely to end up
in the emergency department.Focusing on nonurgent visits to the emergency department may be
counterproductive to solving these overarching problems, said Jesse M. Pines, MD, MBA, the director of
the Office for Clinical Practice Innovation and a professor of emergency medicine and health policy at the
George Washington University School of Medicine and Health Sciences. Studies that look at whether a
patient's visit was urgent show, of course, that what seems urgent to patients may not be to a trained
physician. A better classification is low acuity, he said.Nonurgent use is driven not just by barriers to
care and lack of insurance, Dr. Pines and colleagues found in a recent study. (Am J Manag Care
2013;19[1]:47.) A systematic analysis of 26 articles looking at nonurgent visits revealed that none used
the same criteria to define nonurgent, they noted. The percentage of visits considered nonurgent ranged
from eight percent to 62 percent. The limited evidence suggests that younger age, convenience of the
ED compared with alternatives, referral to the ED by a physician, and negative perceptions about
alternatives such as primary care providers all play a role in driving nonurgent ED use, they wrote.Dr.
Pines cautioned that the issue is vastly more complicated than whether the patient has insurance. Is the
setting available in a timely manner? In a lot of cases, it is not. Someone calls a primary care doctor, and
is told to wait two weeks for an appointment, he said. And sometimes the setting does not have the
resources to care for a particular complaint. For a lot of things, patients don't know what's an emergency,
what's urgent, and what can potentially wait, he said. Any complaint can be potentially life-
threatening.That is backed by a recent study by Maria Raven, MD, MPH, an assistant professor of
clinical emergency medicine at the University of California-San Francisco, that showed the chief
complaint and the discharge diagnosis are often different from one another. (JAMA 2013;309[11]:1145.)
Among ED visits with the same presenting complaint as those ultimately given a primary care-treatable
diagnosis based on ED discharge diagnosis, a substantial proportion required immediate emergency care
or hospital admission. The limited concordance between presenting complaints and ED discharge
diagnoses suggests that these discharge diagnoses are unable to accurately identify nonemergency ED
visits, the study's authors wrote.Dr. Pines pointed out that many studies have shown that crowding is not
an issue of low-acuity patients but a hospital-wide problem that has high-acuity patients boarded in the
ED until a bed opens up.

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Health Tip: Get Ready for Weather-Related Emergencies
(HealthDay News) -- When winter weather strikes, your home may lose power due to the effects of snow,
wind or ice.Creating an emergency kit can help your family stay safe and provide basic necessities until
the power is restored. The U.S. Centers for Disease Control and Prevention highlights the things that
should be included in your winter-weather emergency kit:
Non-perishable food items that don't need to be cooked or refrigerated, as well as a supply of clean water
in containers.
A flashlight, weather radio and some lamps.
A few extra sets of batteries.
A first-aid kit stocked with extra supplies of your medications.
Basic items for babies.
Some sand or cat litter to sprinkle on steps and walkways that are covered in ice.

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Alcohol-related diagnoses on the rise in emergency
rooms
September 10, 2013 | by Ralph Zanfardino, MPAS, BSJ, PA-C

FreeDigitalPhotos.net
From 2001 through 2010, the rate of emergency department visits in the US for alcohol-related diagnoses
for males increased 38 percent, from 68 to 94 visits per 10,000 people. Over the same period, the visit
rate for females also increased 38 percent, from 26 to 36 visits per 10,000 people. During this time, the
visit rate for males was higher than that for females.


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One In Eight of Emergency Room Visits Related to Mental Illness or Substance abuse

Of the 95 million emergency room visits estimated that occurred in 2007, 12 million of them were
attributed to a mental disorder, substance abuse condition, or both. According to a new statistical report
from Agency for Healthcare Research and Quality (AHRQ), one in eight visits by adults to hospital
emergency departments was related to the diagnosis of mental health or substance abuse condition
(MHSA), even though one in three American adults has suffered from a mental or substance abuse
disorder within the past 12 months.
The available support services nationwide may be insufficient in managing the needs of the publics
health when it comes to mental illness and substance abuse disorders, as evidenced by the disparity
between MHSA emergency room admission rates and prevalence of mental conditions. Throughout the
past decade, the rate of emergency room admissions for MHSA conditions has been steadily rising.
Emergency room visits in 2007 associated to MHSA were also two and half times more likely to result in
hospitalization than emergency department admissions attributed to non-MHSA conditionsaround 41%
of all MHSA admissions.
The majority of MHSA admissions to hospital emergency departments were caused by a mental health
condition alone, or 63.7% of all MHSA admissions. Most mental health conditions seen in the emergency
department occurred in women (65.4%), but the majority of both substance abuse disorders and
comorbid MHSA conditions occurred in men. Adults ages 1844 accounted for the majority of all MHSA
visits regardless of what type (mental health conditions alone, substance abuse conditions alone, and
comorbid MHSA disorders); the majority of admissions for this age group were related to comorbid
disorders (58.8% of these admissions). Older adults ages 65 years and older were much more likely to be
admitted for a mental health condition alone (25.9% of these admissions) than their admissions for
substance abuse conditions (9.1%) and comorbid disorders (5.2%). Overall, the majority of all MHSA
admissions were female (53.9%) and younger adults (ages 1844 years).
The most common MHSA condition seen in emergency departments were mood disorders (42.7% of all
admissions), followed by anxiety disorders (26.1%), and alcohol-caused conditions (22.9%). Other
common MHSA conditions that resulted in emergency department visits for adults were drug-related
conditions, schizophrenia/psychoses, and intentional self harm.
The majority of emergency department visits was billed to Medicare (30.1% of admissions), followed by
private insurance (25.7%), uninsured incidents (20.6%), and Medicaid (19.8%). However, those
emergency visits that were uninsured were disproportionately more likely to result in the discharge of the
patient than those conditions that were billed to any insurance plan. Uninsured patients admitted to
emergency departments accounted for the majority of substance abuse conditions treated (35.6% of
these admissions), but they were least likely to remain hospitalized after admission. This may indicate
that those individuals suffering from a MHSA condition and have no insurance coverage are the least
likely to get the necessary treatment they require.
The rise of emergency department admissions for MHSA conditions has caused much alarm within the
healthcare community and public at large. Mental health professionals are concerned that the people who
are most in need of long-term treatment are not receiving treatment. Also, large surges in MHSA cases,
such as prescription drug intoxication, have become a national health epidemic and create the need of
more intervention and prevention policies. Secondly, medical professionals in emergency healthcare are
becoming inundated by overcrowding along with a lack of manpower to meet this demand. Without proper
admission of patients to emergency care, these medical professionals are more vulnerable to commit
medical errors and thin out the amount of medical resourcesall of which result in a reduced quality of
care for MHSA patients and all other emergency department patients.
The report, Mental Health and Substance Abuse-Related Emergency Department Visits among Adults,
2007, is based off data gathered on 26 million emergency department records from across the nation,
and is available online in AHRQs database at www.ahrq.gov.

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Avoiding Emergency Rooms
By JANE E. BRODY

On a recent Sunday afternoon, a 75-year-old Philadelphia man with a fever of over 102 degrees
was unable to reach his doctor. So his daughter took him to an emergency room, where the two
sat for hours until he was examined by a physician who found no reason for the fever and
decided to admit him overnight.

The man was given oxygen, a chest X-ray, a blood test and, finally, a urine test, which revealed
a urinary tract infection. The problem was solved with a prescription for an antibiotic, but at a
cost of thousands of dollars to Medicare.

Like so many other health issues seen in American emergency rooms, the mans infection was
a common problem easily diagnosed and treated at a fraction of the cost by a primary care
physician if patients could reach their doctors when needed.

Experts report that more than half the problems patients bring to emergency rooms either do not
or would not require hospital-based care if an alternative source were readily available.

As the Philadelphia patient, who is a friend of mine, found, care in an emergency department for
a routine medical problem can result in unnecessary hospitalization, tests and procedures that
may even complicate a patients medical problem.

The Leonard Davis Institute of Health Economics reported in 2005 that one quarter of primary
care practices had no weekday hours after 5 p.m.; more than half lacked weekend hours, and
nearly one quarter were unable to see patients for an urgent problem. The problem has grown
even worse today.

Many doctors now work 9 to 5 or its equivalent, but patients can and often do become
acutely ill or injured between 6 p.m. and 8 a.m. They turn to emergency rooms for help, where,
rightly or wrongly, they expect access to all manner of tests and medical specialists.

Emergency rooms are open 24/7, and every hospital that accepts Medicare and Medicaid is
obliged by law to treat everyone who comes in, regardless of citizenship, legal status or ability to
pay.

Contrary to what many think, the rising use of emergency rooms for routine medical issues is
not caused by poor people without insurance or a personal physician. The biggest increase has
involved insured middle-class patients and those with personal physicians who could not reach
or see their own doctors when they needed care.

The overuse of emergency rooms is a growing and increasingly costly problem that results in
overcrowding, long waits, overly stressed health professionals and compromised care for
people with true emergencies.

In a research brief issued in 2010, the New England Healthcare Institute reported that overuse
of emergency rooms is responsible for up to $38 billion in wasteful spending in the United
States every year. The institute estimated that avoidable visits to emergency rooms range as
high as 56 percent of all visits.

In a study of emergency department use by patients with medical insurance, the California
HealthCare Foundation found that 46 percent of the problems could have been handled by a
primary care physician, but two-thirds of the patients said theyd been unable to get care outside
the emergency room.

Of course, patients cant always know what is and what is not a true emergency. Is that
pounding headache a migraine or portent of a stroke? Is that pain in the arm a pulled muscle or
a symptom of a heart attack? Is the bad stomach pain a case of indigestion or appendicitis?

Researching a symptom on the Internet sometimes exacerbates a patients fears with lists of
serious, even deadly, diseases that the symptom might represent. Those with chronic medical
problems may lack a clear understanding of their disorders and may not know how to cope with
changes in their conditions.

When patients in distress call their doctors, they often cannot get appointments for that day or
the next. What used to be the proverbial advice to take two aspirin and call me in the morning
has become a recorded message to go to an emergency room if they think the problem cant
wait.

Many cities and towns now have urgent care or walk-in clinics, sometimes attached to
hospitals, where patients can be seen without appointments or long waits.

Very early one morning, a friend took her 3-year-old son to urgent care when he awoke with a
fever and sore throat on the day they were to fly to Puerto Rico. A throat swab indicated that it
was unlikely to be strep throat, and the child was given acetaminophen to reduce his fever and
relieve his discomfort.

Many more such clinics are needed, staffed perhaps by newly licensed doctors, physician
assistants and nurse practitioners. Or, as Dr. Marvin Moser, a professor of medicine at Yale,
suggested in an interview, Parts of hospitals that are closing could be kept open as walk-in
clinics, where costs are considerably less, there are no four-hour waits and no automatic
tendency to admit patients to the hospital.

Group practices can and often do rotate having a doctor on call during off-hours,
weekends and holidays. Virtually every doctor has a cellphone, and those in solo practices
should be asked to give patients the number or include it in the recorded message when the
office is closed.

If you have a chronic medical problem, such as a heart condition or asthma, your doctor should
devise a care plan that will reduce the chances of a crisis that requires emergency care.
Comprehensive patient education, especially for those with chronic conditions, can help to
alleviate concerns when a symptom occurs. If your doctor does not provide such information
verbally or in print, ask for it or educate yourself by researching your ailment on the Web. Better
yet, get a new doctor who tells you what to expect and when to seek medical help.

Adding to problems with emergency room care are high and widely ranging out-of-pocket costs
to patients for seemingly identical conditions.

Dr. Moser said his 11-year-old granddaughter, who had a bad stomachache, received
questionable tests at outrageous charges at an emergency room in California where the childs
doctor had told the family to take her. The bill included $356 for a routine blood count, $1,212
for a blood analysis and $1,135 for a sonogram not to mention $1,288 just for walking in the
door.

In a new study, Dr. Renee Y. Hsia of the University of California, San Francisco, and co-authors
found that among the 10 most common outpatient conditions seen in emergency rooms
nationally, charges ranged from $4 to $24,110 for sprains and strains; $15 to $17,797 for
headaches; $128 to $39,408 for kidney stones; and $50 to $73,002 for urinary tract infections.


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Big ER Diagnosis for Kids: Constipation
STUDY FINDS IT'S THE NO. 1 DIAGNOSIS FOR KIDS WITH ABDOMINAL PAIN

By Evann Gastaldo, Newser Staff
Posted Jun 11, 2013 6:56 AM CDT


(NEWSER) Researchers recently looked at nearly 10,000 emergency room visits at one
hospital by children who were experiencing abdominal pain, and what they found may surprise
you: The most common diagnosis, found in more than 25% of the kids who were diagnosed with
anything, was constipation. "Parents are shocked that that's their child's diagnosis," says the
lead author. Even the pediatrician who wrote up the study in the New York Times was surprised
by her own child's constipation diagnosis, because she had asked him about that exact issue.
But, as her child's pediatrician explained, "Sometimes kids don't want to tell their mom."

Constipation is a touchy subject, since many link it to a poor diet or a sedentary lifestyle, but it
can start very early in children as they struggle against their parents' potty training methods. As
they get older, kids may not want to use the bathroom at school. "Withholding" in either of these
cases can lead to problems, and they can get worse as children develop "defecation anxiety," a
pediatric psychologist explains. All the while, parents may have no idea; they may even think
their children are dealing with diarrhea (extreme cases of constipation can lead to liquid stool;
see the Times if you need the gory details). Unfortunately, the problems can persist for years,
even into adulthood.

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Life and death in Winnipeg's emergency rooms

Nurses talk about long lineups, understaffing in hospital ERs
By Donna Carreiro , CBC News Posted: Sep 09, 2013 5:20 AM CT Last Updated: Sep 09, 2013

Winnipeg health authority 'setting us up to fail,' says nurse
Brian Sinclair ignored by Winnipeg ER: report
It took a good seven hours before an ER nurse finally had the chance to call maintenance
about a locked-up bathroom door only to discover the body of a woman who had shown up at
the hospital, seeking treatment.

"She was dead on the toilet, in full rigor," the nurse recalls. "She'd been dead for a while."

Welcome to life and death in Winnipeg's emergency rooms. Plagued for years with
overcrowding, understaffing and a slew of casualties along the way.

"I'll tell you something: We are a Brian Sinclair incident waiting to happen," says the nurse, who
asked not to be identified.

Brian Sinclair ignored by Winnipeg ER: report
Key nurse reassigned during Brian Sinclair's 34-hour ER wait
Winnipeg health authority 'setting us up to fail,' says nurse
It's also a prediction shared by others, both local front-line workers and national experts in the
field.

"Oh, I think it's absolutely true," says Dr. Alan Drummond of the Canadian Association of
Emergency Physicians.

"Brian Sinclair? I think it will happen again."

'No support for us'

History also supports this prediction.

Take the woman who died in the bathroom. She was a regular in that emergency room,
addicted to drugs and occasionally overdosed.

This time, however, she saw the lineup in triage and made a quick trip to the bathroom first. She
didn't come out.

INTERACTIVE: Brian Sinclairs 34-hour ER wait
And the triage nurse on duty that night was so busy, it was hours before she had the chance to
call maintenance to report what she thought was just a jammed bathroom door.

"It was a really busy shift, so one of the public came up and said, 'You know, we hear water
running all the time,'" the ER nurse, who was on duty that night, recalled.

"You know, 'OK, OK, we'll get maintenance, we'll get maintenance'. So then finally
maintenance opened the door and, of course, I was first responder."

The woman's death occurred before Brian Sinclair died, but after the Winnipeg Regional Health
Authority (WRHA) had made the first of several commitments to add an extra triage nurse to
watch over patients like her.

"Are you kidding? There was no support for us," the nurse said.

In light of Brian Sinclair's death, the WRHA once again vowed that things would get better. They
didn't.

In 2009, a man was rushed to the Health Sciences Centre with slurred speech and partial
numbness. Deemed a possible stroke victim, he should have been reassessed regularly while
waiting to see the doctor.

But the ER was swamped, and nurses short-staffed. Five hours later, he was finally sent for
tests.

But they were the wrong tests they'd been ordered for someone else. By that time, the man
had suffered permanent brain damage.

Died after 7-hour ER wait

In February of this year, a woman went to a city emergency room with a possible head injury,
but the ER was crowded and they were short-staffed.

So once she was triaged, she was sent to the waiting room for almost seven hours.
Frustrated, her family took her home.

She was dead the next day.

"You know, that tore up the nurses, I'll tell you," one ER nurse said. "They still cry about it today.
They did everything in their power. She was a high-risk head injury."

So if she was so high-risk, why was she still waiting to see a doctor after seven hours?

"No beds," the nurse said.

And that, along with the chronic staffing shortage, is at the heart of what ails Winnipeg's ERs,
experts say.

For all the WRHA's pronouncements about beefing up triage and then scaling it back the
real problem is much deeper.

"I mean, fair enough, nobody can really dispute the benefit of continuity of care by better access
to primary care," said Drummond.

But as long as there are not enough beds for nurses to direct patients to, and as long as there's
not enough support to monitor those patients while they're waiting for those beds, nurses will
continue to be set up to fail.

And the results will continue to be fatal.

"We leave every shift defeated," the ER nurse said. "Day in and day out."



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Debt Collectors Go After Patients ... in the ER
'PATIENTS ARE HARASSED MERCILESSLY,' ONE HOSPITAL EMPLOYEE SAYS

By Evann Gastaldo, Newser Staff
Posted Apr 25, 2012 12:08 PM CDT
STORY COMMENTS (42)

(NEWSER) One of the country's biggest medical debt collectors has reached a new low:
sending employees into hospital emergency rooms to "encourage" patients to pay past medical
debts before receiving treatment. The Minnesota attorney general is investigating Accretive
Health's practices; its debt collectors are allegedly instructed to all but pose as hospital
employees, use scripts to demand payment, and in some cases even discourage patients from
getting care. Debt collectors have also approached patients after surgery or in the labor and
delivery department.

There are concerns that such practices may not be isolated to Minnesota's hospitals, the New
York Times reports, as hospitals become increasingly desperate to collect on outstanding debts.
(Accretive has contracts with large hospital systems in Michigan and Utah, among others.) "The
mission of these companies is in direct opposition to the supposed mission of these hospitals,"
says one consumer advocate, and many are concerned that patient care will be affected.
Making the situation even worse, the Minnesota attorney general also alleges that debt
collectors, in some cases, had access to private patient health information. Click for the full
report.



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Hospitals Open Special ERs for Elderly
SPECIAL EMERGENCY ROOMS MOVE SLOWER, ACCOUNT FOR COMPLEXITIES

By Kevin Spak, Newser Staff
Posted Apr 10, 2012 3:30 PM CDT

(NEWSER) America is getting older, and the elderly account for 15% to 20% of emergency
room visits, so hospitals have come up with a new way to cater to them: the geriatric ER.
Dozens of these facilities are opening across the country, the New York Times reports, looking
more like soothing clinics than bustling command centersthe one at Mount Sinai even has a
fake sun behind a faux skylight. They've proved wildly popular with patients, which is crucial for
hospitals, because under ObamaCare patient satisfaction affects Medicare reimbursement.

Supporters say the slower pace ensures that doctors don't miss anything; many seniors are on
a host of medications, complicating their care. One hospital says it's seen unscheduled ER
return visits fall from 20% to 1%. But some decry geriatric ERs as marketing gimmicks. "What's
the best outcome for the patient?" asked one chief of emergency services. "I don't miss your
diagnosis, I treat you appropriately or, I miss all of those things, but son of a gun, we look like
the Four Seasons."
Many hospitals are opening special ERs just for geriatric patients.

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Kid, 17, Dupes Fla. Hospital, Snags ER Job
POLICE SAY MATTHEW SCHEIDT WORE LAB COAT, EXAMINED PATIENTS, GAVE CPR

By Mark Russell, Newser Staff
Posted Sep 4, 2011 7:45 AM CDT

(NEWSER) A 17-year-old boy has been arrested on charges of impersonating a physician's
assistant and working in a Florida hospital's emergency room for a week, reports the Orlando
Sentinel. Police say Matthew Scheidt dressed in a lab coats and surgical scrubs, conducted
physical exams, and reportedly even gave CPR to a man suffering a heart attack. Scheidt told
the hospital he was a 23-year-old physician's assistant from a nearby university, bragging that
his mother was an executive at the company that owned the hospital and that he was a surgical
assistant.

When the hospital confronted Scheidt about his deception, he claimed to be on a "top secret"
investigation for the police. It wasn't Scheidt's first time faking an important job. He was kicked
out of a program at the local Sheriff's office for teens with an interest in law enforcement
careers, allegedly for trying to pass himself off as a deputy. "They're going to have real
problems if somebody got hurt as a result of this kid," said one lawyer. "There's being duped
and there's being stupidIf this is their level of competence, God help anybody who goes there
for other matters."




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ERs Grab Organs Faster From Accident Victims
CONTROVERSIAL PROGRAM LOOKS TO INCREASE TRANSPLANTS

By Nick McMaster, Newser Staff
Posted Mar 15, 2010 5:38 PM CDT

(NEWSER) A federal project exploring the securing of donor organs from patients who die in
emergency rooms is raising questions of medical ethics. Traditionally, organs are not taken from
ER patients and are removed only after all brain activity has ceased. The project, under way at
two Pittsburgh hospitals, aims to facilitate removing organs after the heart has stopped but
before brain death is declared.
"This is about helping people who have declared themselves to be donors, but die in a place
where donation is currently not possible," said the project leader. Critics fear doctors will start
regarding patients as potential donors before they even expireone bioethicist described the
approach as "ghoulish." But "right now, every single person who dies in the emergency
department, even if they designated themselves as an organ donor, their organs go to the
morgue," the lead researcher tells the Washington Post.


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