Next Journal Club TBA
Journal Club – February 28, 2023 at 12:00 noon EST
Presenter: Guy Nuki, MD
Journal Article: Variations in ED Admission Rates Smulowitz hlthaff.2020.00670
ABSTRACT: Hospitalizations account for the largest share of health care spending. New payment models increasingly encourage health care providers to reduce hospital admissions. Although emergency department (ED) physicians play a major role in the decision to admit a patient, the extent to which admission rates vary among ED physicians even within the same hospital remains poorly understood. In this study we examined physician-level variation in ED admission rates for Medicare patients.
SUMMARY: Dr. Guy Nuki presented this large review of Medicare data showing that individual emergency physicians have substantial variability in their rates of admission, even within a single ED. For those of us in clinical practice, we already know that some of our colleagues admit more patients than others, but the challenge is that there is no established optimal rate of admission. The article implies that the high outliers should be admitting fewer patients, but a major limitation of the article is that it did not look at patient outcomes. Another limitation is that the data is from the pre-COVID era, and it is likely that the constraints on admission capacity have already made us more adept at discharge planning.
We had an interesting conversation about how to drive policy changes. A lot of change comes from insurance companies’ desire to lower costs, and we want to keep the levers pro-patient and pro-physician. Research can help us with validated decision rules that allow us to determine who can safely be discharged (the PESI score, HEART score, etc). Dr. Nuki made the point that physicians need to be in the driver’s seat to reduce admission variability, or the decisions will be made for us. He also offered assistance if anyone would like to create a funnel plot to see the variation in admission rates between staff physicians for their own ED. He suggested that this exercise would be particularly interesting in the context of planning an intervention intended to allow us to safely discharge patients (a decision score, improved access to an outpatient resource, etc).
Journal Club – November 14, 2022 at 4:00 pm EST
Presenter: Angus Beal, MD
Risk of delayed intracranial haemorrhage after an initial negative CT in patients on DOACs with mild traumatic brain injury (American Journal of Emergency Medicine) American Journal of Emergency Medicine
Evaluation of Outcomes Following Hospital-Wide Implementation of a Subcutaneous Insulin Protocol for Diabetic Ketoacidosis (Jama Network Open) Jama Network Open
Journal Club – November August 24, 2022 at 4:00 pm EST
Pulmonary Emboli: YEARS Criteria RCT – REGISTER TODAY
Presenter:
- Ina Hunt, MD, FACEP, St. Joseph Hospital
For our next Journal Club, we are going to discuss the YEARS criteria RCT. The YEARS criteria join Wells and PERC in striving to reduce unnecessary chest imaging while maintaining an acceptably low rate of missed pulmonary emboli. This discussion is particularly timely as we are experiencing a national shortage of IV contrast dye. If you are interested in presenting a brief summary of the article at our meeting, please let us know. Our meeting will be Wednesday, August 24th, and we are hoping to have a virtual option for our rural members as well as some small local gatherings.
Journal: August Journal Club Article | Click to go to web article | Click to download abstract
Journal Club – May 19, 2022 at 4:00 pm EST
Management of Febrile Infants 8 to 60 Days Old
Presenters:
- Brandon Libby, MD, FACEP, Northern Light
- Ina Hunt, MD, FACEP, St. Joseph Hospital
- Andy Ehrhard, MD, FACEP, Northern Light
Please join your Emergency Medicine colleagues from around Maine to discuss the American Academy of Pediatrics Clinical Practice Guidelines for Febrile Infants from August 2021. The guidelines strive to provide safe care while minimizing testing performed on infants. They also encourage shared decision making with patients’ families. Let’s take a closer look at the evidence and talk about how we can incorporate them into our practice. Read the guidelines ahead of time if you can, but if you can’t then Dr. Brandon Libby is going to give a quick summary.
Journal: Click to go to web article | Click to download article