Jan. 29, 2014

ACEP Clinical Policy on IV tPA for Ischemic Stroke
posted for 60-day comment period

"In response to the 2013 Council and ACEP Board-adopted Amended Resolution 32(13), the Clinical Policy: Use of Intravenous tPA for the Management of Acute Ischemic Stroke in the Emergency Department, published in 2013 in Annals of Emergency Medicine, is being posted for a 60-day additional ACEP membership comment period. Comments received along with supporting evidence and any new evidence will be carefully reviewed and the evidence graded. References should accompany comments so that the evidence can be carefully considered and graded. Findings will be reported to the ACEP Board. Also, future clinical policy developments will include a 60-day comment period before finalization."

Please see the following link to the posted clinical policy and to the comment form. Comments should be submitted by March 24.


If you have questions, please contact Rhonda Whitson at rwhitson@acep.org.More

Trauma litigation piles up
With Surgeon General John Armstrong describing court fights as the "unpleasantness," the Florida Department of Health recently said it faces 19 legal cases related to decisions about approving new trauma centers. Armstrong and agency General Counsel Jennifer Tschetter gave a presentation to the House Health Innovation Subcommittee about the trauma system, which has been embroiled since 2011 in legal disputes about new trauma centers.

Many of the cases, pending in the 1st District Court of Appeal and the state Division of Administrative Hearings, focus on department decisions that have allowed trauma centers to operate at Blake Medical Center in Manatee County, Regional Medical Center Bayonet Point in Pasco County and Ocala Regional Medical Center in Marion County. Hospitals that have long operated trauma centers in the Tampa Bay, Jacksonville and Gainesville areas have challenged new trauma-facility approvals.

The Department of Health recently sent nine cases, most involving Blake Medical Center and Regional Medical Center Bayonet Point, to the state Division of Administrative Hearings. But the department also faces legal challenges because of decisions to deny trauma-center approvals at Osceola Regional Medical Center in Kissimmee and at Jackson North and Jackson South hospitals in Miami-Dade County, according to information presented to the House panel.

A major part of the litigation stems from decisions by an administrative law judge and the 1st District Court of Appeal that the department had used an invalid rule in approving new trauma centers. The department has tried to put together a replacement rule, but that also has led to divisions in the hospital industry. As a result, the department will hold a public negotiating session Jan. 23 that will be led by former Florida Supreme Court Justice Kenneth Bell.More

Save the date!
FCEP Board Conference Call
Feb. 6-10, 2014 Ohio ACEP, FCEP, FEMF Board Review Course
Feb. 11, 2014 FCEP Board Conference Call
Feb. 12, 2014 FEMF Board Meeting
Feb. 19, 2014 FCEP Committee Meetings
March 4, 2014 First day of Legislative Session
March 10-13, 2014 Emergency Medicine Days
March 11, 2014 FCEP Board of Directors Meeting
April 8, 2014 FCEP Board Conference Call
May 7, 2014 FCEP Committee Meeting
May 8, 2014 FCEP Board Meeting at FCEP
May 18-21, 2014 ACEP Leadership and Advocacy Conference
June 10, 2014 FCEP Board Conference Call
June 16, 2014 FCEP Board Conference Call
July 17-20, 2014 ClinCon
Aug. 7-10, 2014 Symposium by the Sea
Aug. 7, 2014 FCEP Board of Directors Meeting

Plan to tighten access to drug database in trouble
The News Service of Florida
On Jan. 14, 2014, Senate Health Policy Chairman Aaron Bean, R-Fernandina Beach, pulled his proposal, SB 1076, making it harder for investigators to access the controversial prescription drug monitoring program, according to the News Service of Florida. Under his plan, investigators would have to get subpoenas to access records. That means before information could be released to a law enforcement agency, it would have to show a reasonable suspicion of criminal activity, fraud, or theft involving a controlled substance. Bean cited that law enforcement thought that the bill would "take away a tool." Attorney General Pam Bondi thinks that requiring judges to sign off on requests for records would slow down the courts and the process to limit prescription drug-related crimes. Bean said, "Certainly no one wants to prevent them from going after bad guys. I'm just tired of getting spied on. Our government listens to our phone calls. Our government reads our emails. I just want government out of our medicine chest."More

Florida Blue enrollees face glitches
Health News Florida
It appears that Florida Blue's computer systems and customer-service staff may be overwhelmed by the number of enrollees coming from the health exchange, according to Health News Florida. The state's largest insurer, with more than 1 million people covered, offers 76 health plans on the exchange, which is more than all other insurers put together. Some of the new enrollees described situations where payments were made, but subsequently lost, so insurance was not provided. Florida Blue declined a request for an interview, but sent an email saying the company is working to process the high volume of enrollments. It says it has added staff and extended hours in both the call and retail centers. The Department of Financial Services reported on Jan. 15, 2014, it has received several calls, and 42 of them filed official complaints.More

When hospitals share patient records, emergency patients benefit
As hospitals and doctors' offices across the country race to join online systems that let them share medical information securely, a new study suggests that these systems may already be helping cut unnecessary care. The study looked at the impact of health information exchanges, which allow hospitals to share medical records. Fewer emergency patients got repeated medical scans when they went to a hospital that takes part in a health information exchange.More

Synthetic pot tied to surge of emergency cases
HealthDay News via WebMD
Doctors are sounding an alarm about the dangers of synthetic marijuana after seeing a surge of emergency cases tied to its use. According to a report from the U.S. Substance Abuse and Mental Health Services Administration, the number of emergency department visits associated with use of synthetic pot more than doubled from 2010 to 2011, with the case count increasing from about 11,400 to more than 28,500 nationwide.More

'Medscape Physician Lifestyle Report 2014'
In the latest U.S. Centers for Disease Control and Prevention report on obesity, about 35 percent of the U.S. population is obese, which is a body mass index of ≥ 30. Although far fewer physicians of the total number who responded to the Medscape survey are obese (8 percent), being overweight is still a problem for 34 percent of them. According to investigators of a recent study using data from the 2003-2006 National Health and Nutrition Examination Survey, looking at BMI alone may miss many people at risk for cardiovascular disease. More

Emergency rooms not curbing overuse of antibiotics
HealthDay News
The inappropriate use of antibiotics among adult patients at U.S. emergency departments is not falling, despite increasing concerns about antibiotic resistance, a new study reveals. They analyzed U.S.-wide data collected from 2001 to 2010 and found that there was no decrease in emergency department use of antibiotics for adults with respiratory tract infections such as sinusitis and bronchitis, even when those infections were caused by a virus.More

Silencing many hospital alarms leads to better healthcare
Health News Florida
Go into almost any hospital these days and you'll hear a constant stream of beeps and boops. To most people it sounds like medical Muzak. But to doctors and nurses, it's not just sonic wallpaper. Those incessant beeps contain important coded messages. Alarms are good and necessary things in hospital care, except when there are so many of them that caregivers can't keep track of the ones that signal a crisis that requires immediate attention. Then it may be that less technology can actually be more effective. More

Emergency department observation units: A double-edged sword?
By Dorothy L. Tengler
What emergency department wouldn't like millions of dollars in cost savings? Theoretically, this could happen by keeping selected patients under observation in a dedicated hospital unit with defined protocols. The issue has been that many patients seeking ED treatment are clearly not well enough for immediate discharge yet are not sick enough to be admitted. According to a recent study, such patients are not expected to stay in the ED for more than 24 hours and are treated as outpatients using observational services. About one-third of EDs in the United States have observation units in place, using protocols specific to different conditions.More