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FCEP NEWS



The Emergency Medicine Board Review course held annually by Ohio ACEP offers a comprehensive review for emergency physicians preparing for the Qualifying exam or ConCert exam. Please visit femf.org/emreview for more information.






FDA takes two important actions on drug shortages
U.S. Food & Drug Administration
The U.S. Food and Drug Administration is taking two actions to further enhance the agency's ongoing efforts to prevent and resolve drug shortages, a significant public health threat that can delay, and in some cases even deny, critical care for patients. Following the president's 2011 Executive Order on reducing drug shortages, the number of new shortages in 2012 was 117, down from 251 in 2011.
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Telemedicine bill focuses on insurers
The Florida Current
Rep. Mia Jones, D-Jacksonville, is sponsoring HB 167 which would prohibit insurance companies from requiring face-to-face visits between doctors and patients in order for services to be reimbursed. The prohibition would also apply to Medicaid services. Currently, 21 states have such legislation. The Florida Insurance Council supports Jones' bill. A spokesman points out that a face-to-face meeting is required by a state Board of Medicine rule and not by insurance companies.
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IRB approved study
FCEP
This IRB approved study provides ED physicians the opportunity to express their opinions regarding economic and regulatory factors influencing the management of patients manifesting "drug seeking" behavior.

The survey takes approximately 10 minutes and, in appreciation for your time, a password will be provided at the conclusion of the survey which you may use to view a CME webinar on prescription opioid abuse. This webinar has been approved for 6.5 hours of Category 1 credit and these hours will be awarded to you at no charge. The webinar is hosted separately from the online survey and therefore no linking can occur between the two sites so as to insure anonymity.

The survey may be taken in two ways:
  1. Online: www.research.net/s/EDphys

  2. Brief telephone interview: 813-240-9835

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CPR in nursing homes
FCEP
Nursing homes will face survey citations for facility- wide policies that prohibit cardiopulmonary resuscitation (CPR) for residents.

Research has shown that CPR is not very effective in the elderly nursing home population, and some facilities have put in place general no-CPR policies. However, this does not comply with federal regulations that guarantee the right of residents to formulate advance directives. Therefore, nursing homes are prohibited from establishing and implementing these no-CPR policies.

An advanced directive with the Facility CPR policy requires providers, including skilled nursing facilities (SNFs) and nursing facilities (NFs), to provide written information to residents about their rights to make decisions about medical care, including the right to formulate advance directives at the time of admission.

When reviewing facility policies and procedures related to emergency response, surveyors should ascertain that facility policy directs staff to initiate CPR as appropriate. Facility policy should specifically direct staff to initiate CPR when cardiac arrest occurs for residents who have requested CPR in their advance directives and not limiting staff to only calling 911 when cardiac arrest occurs. Prior to arrival of EMS, nursing homes must provide basic life support including CPR and CPR- certified staff must be available at all times to provide CPR when needed.

The right to formulate an advance directive applies to each and every individual resident and facilities must inform residents of their option to formulate advance directives. Therefore, a facility- wide no CPR policy violates the right of residents to formulate an advance directive.

For questions, please contact Cathleen.Lawrence@cms.hhs.gov.

References:
1. Ethics: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (Circulation)

3. Nursing Home Data Compendium 2012 Edition (The Centers for Medicare & Medicaid Services)

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Polk County seeking EMS medical director
FCEP
Polk County is seeking Medical Director Services capable of overseeing a large, progressive Fire Rescue based EMS System which utilizes comprehensive protocols for paramedics to provide immediate critical interventions including use of Rapid Sequence Intubation.

For more information on the position please visit faemsmd.org/pdfs/EMSMDpolkCounty.pdf

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Congratulations to this year's Florida's ACEP Fellows!
FCEP
The following new ACEP Fellows have been honored as this year's American College of Emergency Physicians Scientific Assembly.

Abigail L Adams, MD, FACEP Henry Kurusz, III, MD, FACEP
Elijah Benioni, MD, FACEP Jose Felipe Llach, DO, FACEP
David Bojan, MD, FACEP Adrienne M McFadden, MD, FACEP
Danielle M Christiano, MD, FACEP Caroline Marie Molins, MD, FACEP
Julio M De Pena Batista, MD, FACEP Patrick Mularoni, MD, FACEP
Karen M Estrine, DO, FACEP Sanjay Pattani, MD, FACEP
Michael L Falgiani, MD, FACEP Vanessa C Peluso, MD, FACEP
Faheem Guirgis, MD, FACEP Jayant Rao, MD, FACEP
Brenda Jacobsen, DO, FACEP Alfredo Tirado-Gonzalez, MD, FACEP
Randy Katz, DO, FACEP Christine M Van Dillen, MD, FACEP

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EMERGENCY MEDICINE IN THE NEWS


5 ways health systems can reduce emergency department usage
HealthLeaders Media
A new study finds reductions in emergency department usage can be achieved through patient education, interventions in patient financial incentives, and the adoption of population health strategies such as patient-centered medical homes. "With the roll out of the Affordable Care Act and especially with new payment models that are being developed, there is a much greater focus on reducing high-cost utilizations ... such as ED use and inpatient hospitalizations and on improving the efficiency of healthcare in general," says Jesse Pines, MD, study co-author
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ED nurse rallies the community to demonstrate the tragedy of teen drunk driving
Hospitals & Health Networks
Heading to Des Moines a couple of years ago for a seminar on drunk driving among teenagers, Judi Nelson, R.N., was feeling rushed and not particularly enthusiastic. Neither she nor her boss, who'd signed her up for this two-day training, knew what to expect. A busy emergency department nurse at Cass County Memorial Hospital, Nelson hadn't had time to look up the program called "Every 15 Minutes" on the Internet. Every 15 Minutes takes its name from the frequency with which American teenagers die in alcohol-related vehicular accidents. It uses vivid re-enactments to drive home the dangers of drinking and driving. Nelson returned to Cass County ready to take on a project with all the intricate planning and coordination of a Broadway show, involving costumes, props and audience participation.
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Providers, patients and finances: New guidelines offer a roadmap for communication
Becker's Hospital Review
With the rise of high-deductible health plans, patients are paying more out of their own pockets for healthcare, and subsequently they're becoming more concerned about the cost of a trip to the hospital or physician's office, says Joe Fifer, president and CEO of the Healthcare Financial Management Association. At the same time, providers have been operating without a roadmap for talking to patients about the financial aspect of care. In order to address that problem, HFMA recently published industry-wide best practices for improving and standardizing provider communication with patients about financial responsibilities.
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ED visits by nursing home residents 'disproportionately high'
HealthLeaders Media
An emergency medicine physician and researcher suggest that skilled nursing facility residents with "ambulatory care-sensitive conditions" may be treated appropriately in healthcare settings other than the emergency department. Going to the emergency department can actually be somewhat traumatic for a nursing home patient, says Renee Hsia, MD. Yet nearly 1 in 5 patients taken to a hospital emergency department from a skilled nursing facility are treated for so-called ambulatory care-sensitive conditions.
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EXCLUSIVE CONTENT


How ICD-10 implementation affects ED physicians
By Tom Ward, M.D., FACEP
Time is precious in the emergency department, where patients arrive unscheduled, the broad scope of medicine is fully encountered and rapid decisions are frequently made — in some cases with great impact on a patient's survival. Adding greater burdens on physicians in this setting is both unproductive and unwise. The transition to ICD-10 may present yet another burden on the ED physician, but picking the right approach for generating ICD-10 codes can make a big difference.
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Conversion disorder or misdiagnosis in the ED?
By Maria Frisch
Misdiagnosis of serious neurologic conditions such as conversion disorder represents a significant challenge in emergency medicine. However, by becoming familiar with the understanding that these errors are possible, a proactive stance develops that helps to reduce future errors. Following a thorough history and physical examination, adequate ordering and interpretation of tests, and necessary outside consultations, understand that conversion disorder is certainly possible. But for many emergency physicians, it may also be a trap.
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FCEP EMnews
Colby Horton, Vice President of Publishing, 469.420.2601
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Lisa Smith, Senior Content Editor, 469.420.2644  
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Shannon Costello, FCEP Director of Communications, 407.281.7396, ext. 231  
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