Entries in ER (14)


Emergency Room Waits for Psychiatric Patients: Safe or Profitable?

iStockphoto/Thinkstock(BOSTON) -- Psychiatric patients waited an average of 11.5 hours to be admitted into the emergency room of a hospital, according to a recent study published by Annals of Emergency Medicine.
Study author Anthony Weiss of Partners Healthcare in Massachusetts says that most hospitals don’t even have mental health wards anymore.

"The reimbursement for mental health care within the country is among the lowest across the different disease states, and so it's not, in some cases, economically viable to support these types of units," Weiss said.
HealthOne, a hospital network in Denver, is taking a different approach by adding a psychiatric unit to provide more help for mental health patients, according to "Shots," an NPR health blog. They know that emergency rooms can often get backed up, especially when there are patients in the ER for particularly long periods of time.

Even though the mental health ward is the first of Colorado’s in years, it may still be a potential loss of money. The hospital expects that the loss will be gained back through a speedier flow in the emergency room where most of the hospital’s money is made, "Shots" reports.

Copyright 2012 ABC News Radio


More Kids in ER from Swallowing Batteries, Study Finds

iStockphoto/Thinkstock(NEW YORK) -- The number of children being taken to emergency departments with battery ingestions is on the rise, according to a new study published Monday in the journal Pediatrics.

In total, more than 65,000 visits involving kids who had ingested batteries occurred over the past 20 years.  In the overwhelming majority, button batteries were the culprits.

These tiny batteries are becoming more and more ubiquitous as more devices powered by small lithium batteries -- the shiny, button-sized variety -- make their way into our homes.

So what makes these batteries so dangerous?  Part of the problem is that lithium batteries are especially appealing to the child's eye, as they can mimic candies and can easily fit into small mouths, ears or noses.  Occasionally, if a child swallows one of these batteries, it can pass through his or her body without incident.  But this isn't always the case.

Dr. Ian Jacobs, associate professor of ear, nose and throat at the University of Pennsylvania in Philadelphia, explains that if a lithium battery stays lodged in the esophagus for more than two hours, the battery can erode through the soft tissue of the esophagus and cause a hole.  This can be fatal.

Children who survive still face serious health issues.  They may experience permanent paralysis of the vocal cords that may forever rob them of their speech.  These batteries can also be harmful if lodged in other places.  They can burn through the cartilage in the nose or into the inner ear, causing hearing loss or difficulty breathing.

Dr. Toby Litovitz, executive and medical director of the National Capital Poison Center in Washington, D.C., has done extensive research on the major and fatal outcomes associated with button battery ingestions and maintains a national database on these and other incidents.  She found in a separate study that from 1985 to 2009 there was almost a seven-fold increase in the percentage of button battery ingestions with major or fatal outcomes.

So what can parents do to prevent these potentially fatal ingestions?  The first step is to keep the batteries out of children's reach.

Lithium batteries can be found in laptops, iPads, remote car keys, calculators, cameras, bathroom scales, digital thermometers, talking books, video games and even musical greeting cards.

Litovitz recommended that parents "be vigilant and look at every product at home to see if it has a battery compartment that can be opened by the child and [if so, make sure it is] secured with heavy tape.  If not, it needs to be treated like a medication -- up high, out of reach and locked up."

Copyright 2012 ABC News Radio


A New Kind of ER for the Elderly

iStockphoto/Thinkstock(NEW YORK) -- Monitors beeping, loud voices and people scurrying about are just a few things people associate with a busy emergency department.  Many people may consider these factors a nuisance, but for older patients, it can be downright frightening and even affect their health.  A new trend in emergency department design is seeking to optimize the environment in which older patients are treated.

Referred to as "geriatric" or "senior" emergency departments, these facilities have been popping up across the country since the first one opened at Holy Cross Hospital in Silver Spring, Md. in 2008.  They are usually small areas, away from the hustle and bustle of the main emergency department.  Private rooms, simple layouts, natural lighting, more volunteers and soothing music are among the many features Holy Cross and other hospitals across the country are adding, all aimed at creating a calm and comforting environment.

Beyond making older patients more comfortable, the focus is really on keeping them safe.  Dr. James Del Vecchio, medical director and pioneer in the creation of Holy Cross Hospital's senior emergency center, thinks their follow-up service is one of the most important safety features of the care provided. 

Social workers are instrumental in this process. They not only set up home nursing services, but they make follow-up calls to every patient within 48 hours of being seen.

"They are checking to make sure the patient was able to get all the prescriptions or doctor appointments that they needed," Del Vecchio said.

Managing medications is another area where these senior facilities hope to intervene.  At the Holy Cross Hospital, any senior who comes in on five or more medications has their prescription list reviewed by a pharmacist before leaving. 

According to Bonnie Mahon, director of senior services, "We've had some real saves from this.  One woman kept falling until our pharmacist realized that the dose of one of her medications might be causing this."

Bed sores, one of the most common complications of hospitalization, are associated with higher costs and longer hospital stays.  Research shows that these wounds can occur in as little as four to six hours, suggesting they may be starting to form while the patient is still in the emergency department.  But the Geriatric ERs are addressing that problem as well.

Instead of the traditional thin layer of foam covered in plastic, thicker mattresses, such as the four-inch Tempur-pedic ones at Holy Cross, are being used in hopes of reducing the occurrence of these wounds.

Del Vecchio also points out that every senior who comes through the door is asked eight to 10 simple questions that help screen for problems that seniors are more prone to, ranging from memory impairment to risk for falls at home.

And to combat falls in the hospital, Holy Cross has modified the flooring and lighting.  Mahon explains that some types of lights can create shiny spots on the floor.  This interferes with depth perception and can lead to falls, especially in the elderly.

These changes in emergency care have been well received by the senior population.  DelVecchio and Mahon say their patient satisfaction scores are over 95 percent positive.

Copyright 2012 ABC News Radio


Study: Stair Injuries Are Falling, But Still Land 93,000 Kids in ER

Ryan McVay/Photodisc/Thinkstock(COLUMBUS, Ohio) -- Although stair-related injuries among young children are on the decline, they still prompt more than 93,000 emergency room visits per year, according to a new study published Monday in the journal Pediatrics.

"The good news is that in 10 years these injuries have dropped by 11 percent," said study author Dr. Gary Smith, director of Nationwide Children's Hospital's Center for Injury Research and Policy.  "But the wake-up call is that we're still seeing a child less than 5-years-old injured every six minutes.  To me that means we have a lot more work to do."

Smith and colleagues used the U.S. Consumer Product Safety Commission's National Electronic Injury Surveillance System to track stair-related ER visits between 1999 and 2008.

"We need to know how these injuries are happening to know how to prevent them," said Smith, whose research on baby walkers helped fuel policy changes linked to a 76 percent decrease in related injuries.  "These are kids who have good parents.  We just need to design the environment so parents aren't expected to do the impossible."

While some children were injured in strollers, walkers or other vehicles such as a laundry basket, 87 percent tumbled on their own.

"Stair gates should be standard in homes where young children live or visit," said Smith.  "These kids have the mobility and curiosity, but they don't have the sense of danger."

Dr. Estevan Garcia, director of pediatric emergency medicine at Maimonides Medical Center in New York City, said it's important to have gates at the top and bottom of every staircase.

"A lot of people forget that if a kid can get up, they can come down," he said.

In another sobering statistic, one-quarter of children younger than 12 months old were injured while being carried by a parent or caretaker.  And they were three times more likely to be hospitalized with serious injuries.

"As a parent, I can relate," said Garcia, whose 1-year-old broke his leg on the stairs while he was being carried.  "Here I was thinking it was the safest way, and that's when he got hurt."

Broken arms and legs, while common, were vastly outnumbered by head and neck injuries, which accounted for 76 percent of ER visits.

"The biggest concern is bleeding or bruising in the brain," said Garcia, describing damage that can't be fixed with a plaster cast.  "We worry about long-term consequences of head injuries."

While gates and easy-to-grip railings can help prevent accidents, Garcia said it's just as important to teach kids how to tackle stairs safely from an early age.

"Show them how to scoot down on their bottoms," he said.  "You don't want them to be afraid, but you want them to understand the risks."

Copyright 2012 ABC News Radio


Emergency Rooms Levy Fees for Non-Emergency Visits

Stockbyte/Thinkstock(NEW YORK) -- Talk about adding insult to injury. More and more U.S. emergency rooms won't admit patients until they pony up a fee of $100 dollars or more for non-emergencies.

The fees are meant to discourage people suffering from nothing worse, say, than a sore throat or a skinned knee from taking up time and resources better reserved for the seriously ill.

Both for-profit and non-profit hospitals are levying the charge.

Ed Fishbough, spokesman for the nation's biggest for-profit chain, HCA Healthcare in Nashville, Tenn., says the company first started imposing such fees in 2004, at one of its Houston-area hospitals.

The practice has since spread to 76 other hospitals in the 163-hospital chain. The purpose, he says, is to "help reduce crowding in the ER and to educate people about appropriate use of ER resources."

Critics of ER fees include the American College of Emergency Physicians, which says that two to seven percent of patients determined to have non-emergency conditions are admitted to a hospital within 24 hours.

Patient advocacy groups, likewise, blast the policy, saying it discourages the sick from seeking help. "It seems the point of the policy is to put a financial barrier between the patient and care," Anthony Wright, executive director of advocacy group Health Access California, told Kaiser.

Either way, here's how it works at HCA:

You show up at the ER wanting treatment. A clinician checks you out, and decides whether your case qualifies as a true emergency. If it doesn't, but if you want to stay in the ER and get treated there anyway, you are asked to pay a fee, which at HCA runs between $100 and $150.

Pregnant women, children younger than 6 and people older than 64 are exempt.

HCA says it had six million emergency room visits at its hospitals last year. Of those, 314,000 (about five percent) were from people who, after screening, were determined not to have an emergency condition. They were offered the choice of paying the fee and remaining in the ER for treatment, or leaving and seeking treatment at what HCA calls a "more appropriate setting," such as a clinic or doctor's office. About 233,000 patients chose to stay and pay. About 80,000 didn't, and took a hike. It's unknown where they ended up.

Such ER fees are common now at other big, for-profit chains (including Health Management Associates of Florida, and Community Health Systems of Tennessee) and nonprofit hospitals, as well.

Tomi Galin, vice president for corporate communications at Community Health Systems, says patients who choose to leave "are provided with information about other community health resources for their non-emergency medical conditions." Imposing a fee, she argues, helps reduce costs for the patient and the hospital alike because "the ER is the highest cost environment to receive non-emergency care."

The U.S. Centers for Disease Control and Prevention says patients with non-urgent problems account for about eight percent of ER visits. Other studies have put the figure considerably higher. One by Health Affairs policy journal in 2010 concluded it was closer to 27 percent.

The non-profit Midland Memorial Hospital in Texas implemented a $150 ER fee in 2009, as part of an exercise in cost-control, according to a Kaiser Health News story. Kaiser says the hospital had lost $14 million in 2008, in part because of millions of dollars in ER bills left unpaid.

Since imposing its fee, the hospital has seen a drop in debt, according to its chief financial officer, whom Kaiser quotes. He estimates that about 75 percent of patients with nonemergency conditions leave the hospital rather than pay the fee. "More people now know," he says, "that our ER is not a walk-in clinic or a primary-care office."

Copyright 2012 ABC News Radio


Paintball Ruptures Breast Implant; Injuries Cause Thousands of ER Visits

Sean Murphy/Getty Images(LONDON) -- A British woman's silicone breast implant recently ruptured after she was shot in the chest during a paintball game, throwing a spotlight onto the potential dangers of a hobby that attracts millions.

"Due to an incident at our Croydon Paintballing centre...we respectfully ask that any ladies with surgical breast implants notify our team at the time of booking," UK Paintball wrote in a statement after the incident, which happened in Croydon, a town in south London.

"You will be given special information on the dangers of paintballing with enhanced boobs and asked to sign a disclaimer," the statement continued. "You will also be issued with extra padding to protect your implants while paintballing."

Symptoms of a ruptured implant include burning or tingling in the affected breast, lumps around the implant or armpit, change in breast size and softening or hardening of the breast.

Staff at UK Paintball confirmed with the BBC that the woman is expected to make a full recovery.

About 10 million Americans participate in paintball activities, and many more worldwide, according to a new U.S. report. In 2008, more than 20,000 emergency department visits were related to injuries caused by air guns, including paintball guns and BB guns, according to the study.

The data, published by the U.S. Department of Health & Human Service's Agency for Healthcare Research and Quality, found that hospitals around the country saw an average of 56 visits associated with these guns each day. Males were five times more likely to visit the hospital for the injuries than females.

"We saw a strong demographic association," said Ryan Mutter, senior economist at AHRQ and lead author of the study. "Most people were male, young, poorer, Southern and rural."

"As an urban ED, we see very little of these injuries," Dr. Carl Ramsay, chairman of emergency medicine at Lenox Hill Hospital in New York, wrote in an email. "In my previous experience in more rural areas, as reflected in this report, these injuries were commonplace."

Children 17 and younger made up most of the documented visits for paintball and air gun wounds, and the majority of injuries consisted of open wounds on the arms, legs, head and neck. About four percent of the visits related to eye disorders.

Chris Fermoselle, manager of NYC Paintball, said eye injuries are the biggest concern on a paintball field.

"Basically, our safety is all about wearing your mask," said Fermoselle. "Safety is number one on any paintball field, and we're always enforcing keeping the mask on even if you get shot or paint is all over it."

Fermoselle noted that most players will just wear a couple layers of clothing to protect from the pelts. While the game can leave players bruised and battered sometimes, he said he was surprised by the report's findings because the facility has only been host to about 20 injuries since it opened seven years ago. All players must sign a waiver noting the risk of injury and death while playing.

But experts noted that the number of injuries is likely higher than in the report because not everyone who's hurt visits the emergency room.

"The data is impressive but certainly reflects only those who...decide to seek care," said Ramsay. "Many other injuries occur in a subset of patients who, for a variety of reasons [among them: legal, lack of insurance, parental scrutiny] do not seek medical attention and thus are not reported in these statistics."

"While gun safety classes rarely are utilized for air guns in particular, they certainly would contribute to a reduction of injuries," continued Ramsay. "Proper protective clothing, head and eye gear would also significantly reduce the severity of many of these injuries."

Copyright 2011 ABC News Radio


Heat Wave Linked to 7 Deaths in Chicago Area, Including 18-Year-Old

Burke/Triolo Productions/Comstock/Thinkstock(CHICAGO) -- The massive heat wave that is now suffocating the East Coast and pushing power grids to near capacity has contributed to at least seven deaths in the Chicago area this week, autopsies by the Cook County Medical Examiner's Office revealed Friday.

One of the victims Cesar Rodriguez, 18, collapsed in front of his home Thursday while riding his bike and running around. He died later that day. His family said that he had no known medical conditions but may not have consumed enough water.

The most recent report from the National Weather Service said that at least 22 people had died because of the extreme heat and humidity. Emergency rooms reported Thursday that they were "stacked up" with patients.

"We're up in overall cases by 10 percent every day this week," the Detroit Medical Center told ABC News. "The chief of emergency medicine estimated that 15 percent to 20 percent are heat exhaustion or heat-related cases."

The worst day for the heat index is yet to come for the East Coast and the Mid-Atlantic region -- from North Carolina to New York -- where heat index values could exceed 115 degrees.

Half of the country is under a heat advisory, although the East Coast might have a slight break in the not-too-distant future.

According to senior forecaster Michael Eckerdt at the National Weather Service, the 100-plus degree temperatures might take a dip later this weekend.

"There is a cold front that is going to be dropping into the eastern U.S. this weekend," Eckerdt said. "The heat will continue into Saturday and then we will see moderating temperatures back down into around the 90-degree range as we move into Sunday and Monday. But it's going to still remain very warm."

The National Weather Service has safety tips for adults looking to keep cool.

  • Slow down. Try to reduce or cancel any strenuous activities, or reschedule them for the coolest part of the day.
  • Wear lightweight, light-colored clothing to reflect sunlight and heat.
  • Eat lighter foods. Meat and other proteins increase metabolic heat production and could cause even more water loss.
  • Drink plenty of water, but avoid alcohol and caffeinated drinks.
  • Spend more time in air-conditioned places. If you don't have an air-conditioner in your home, go to a library, store or other location for part of the day to stay cool.
  • Avoid getting too much sun. Sunburn can reduce your body's ability to release heat.

Copyright 2011 ABC News Radio


Extreme Heat: Emergency Rooms Report Increase in Patients

Ryan McVay/Photodisc/Thinkstock(NEW YORK) -- The extreme heat system scorching the nation was on the move eastward toward major cities Thursday as it impacts airports, tourist spots and emergency rooms.

At New York's Statue of Liberty, officials closed the statue's crown area as temperatures inside reached 110 degrees Thursday afternoon.

Meanwhile, emergency rooms say they are "stacked up" with patients due to the heat that has scorched the Southwest and Midwest.

"We're up in overall cases by 10 percent every day this week," the Detroit Medical Center reported to ABC News Thursday. "The chief of emergency medicine estimated that 15 percent to 20 percent are heat exhaustion or heat-related cases."

The center said that one man with diabetes was found unconscious on the floor of his non-air-conditioned home. "He's still not out of the woods," the center said.

There are 141 million people in more than two dozen states under heat advisories.

As many as 22 people have died because of the extreme heat and humidity, the National Weather Service reported Wednesday -- and there is no immediate end to the scorching temperatures in sight.

Heat indexes from 105 to 115 degrees were expected from the Midwest to the East Coast Thursday.

Across the Midwest, people were being treated in hospitals for illnesses related to the heat. In Wichita, Kan., hospitals saw 25 heat-related illnesses, while in Des Moines, Iowa, they saw 16.

According to hospital officials, a person can die within half an hour once they get heat exhaustion. Officials warned people to watch for signs of heat exhaustion. In these conditions, the body, even at rest, can lose a quart of fluid an hour.

The National Weather Service has safety tips for adults looking to keep cool:

-- Slow down. Try to reduce or cancel any strenuous activities, or reschedule them for the coolest part of the day.

-- Wear lightweight, light-colored clothing to reflect sunlight and heat.

-- Eat lighter foods. Meat and other proteins increase metabolic heat production and could cause even more water loss.

-- Drink plenty of water, but avoid alcohol and caffeinated drinks.

-- Spend more time in air-conditioned places. If you don't have an air-conditioner in your home, go to a library, store or other location for part of the day to stay cool.

-- Avoid getting too much sun. Sunburn can reduce your body's ability to release heat.

Copyright 2011 ABC News Radio


Boozed-Up Boys Visit the ER Twice as Much on July 4th Weekend

George Doyle/Stockbyte/Thinkstock(WASHINGTON) -- The holiday weekend is almost here -- a time to celebrate the nation's birthday with parades, barbecues, fireworks and yes, booze.
A new study shows that alcohol-related visits to the emergency room more than doubles among underaged boys on the Fourth of July weekend compared to the rest of the month.

The Substance Abuse and Mental Health Services Administration reports that on the July 4th holiday weekend in 2009, an average of 942 people under the age of 21 visited the ER with alcohol-related issues. The majority of them, 622, were males.
Less than one-third of the visits, 304, were by underaged females. Their trips to the hospital ER do not spike, but remain steady in July.
To discourage underage drinking,  the organization says parents should be very clear about their disapproval of the behavior. They advise parents to discuss alcohol with their children early and often.
For help with a plan of action, parents can go to
Getting the message across to their children now could prevent a holiday celebration from turning into a tragedy.

Copyright 2011 ABC News Radio


More Women 50 and Older Landing in ERs for Drug-Related Suicide Attempts

Comstock/Thinkstock(NEW YORK) -- Evidence of the troubling increase in prescription drug abuse has reached hospital emergency rooms, which report increasing medication-related suicide attempts among women 50 and older.

From 2005 to 2009, suicide attempts in which drugs played some role rose from 11,235 to 16,757 among women ages 50 and up, a federal survey found. The increase, driven in part by the last of the Baby Boomers entering their sixth decade, provides a new example of the toll wrought by the nation's prescription painkiller epidemic. In 2009, 16 million Americans age 12 and up had taken a prescription pain reliever, tranquilizer, stimulant or sedative for non-medical reasons in the previous year, according to the National Survey on Drug Use and Health.

The trends involving women and suicide appeared in a Drug Abuse Warning Network (DAWN) report dated May 12, 2011, but were released Thursday to coincide with a meeting of the public-private Action Alliance for Suicide Prevention. The report, prepared by the Substance Abuse and Mental Health Services Administration, wasn't limited to suicide attempts involving deliberate overdoses; its authors counted any suicide attempt in which drugs were involved, such as a woman slashing her wrists while smoking marijuana.

Among women of all ages, emergency hospital visits for attempted suicide involving alcohol or illicit drug use remained "relatively stable" from 2005 to 2009, but increased for particular drugs such as pain relievers or anti-anxiety drugs.

Copyright 2011 ABC News Radio

ABC News Radio