ED management : the monthly update on emergency department management
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As the benefits of palliative care become more evident in clinical trials, there is growing interest in making such resources available to patients at an earlier stage, such as the ED. However, experts note that emergency staff first must identify available resources and make sure that providers have the primary palliative care skills needed to effectively introduce the topic to appropriate patients and families. ⋯ For EDs that lack resources in house, experts advise staff to form partnerships with hospices in the community; some offer sophisticated services and will come to the ED to evaluate patients. Emergency staff should establish flexible criteria to identify when palliative care is an appropriate option to introduce to patients and families.
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Determined to make a dent in the growing problem of opioid addiction, the CDC has unveiled new guidelines for opioid prescribing for chronic pain. The recommendations urge providers to be more judicious in their prescribing, opting for opioids only after carefully weighing substantial risks and benefits. ⋯ The new guidelines are designed to help frontline providers balance the need to manage their patients' chronic pain with the duty to curb dangerous prescribing practices. The recommendations are built around three principles: favor non-opioid alternatives for most cases of chronic pain, use the lowest effective dose when prescribing opioids, and exercise caution/monitor patients who are treated with opioids.
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With the Zika virus disease spreading rapidly through Latin America, public health authorities in the United States are racing to contain the outbreak. By the end of February, the CDC had confirmed 147 Zika cases in U. S. residents who had traveled to Zika-endemic areas. ⋯ For frontline clinicians, travel history is key to identifying potential cases of Zika in pregnant women who may have been exposed. The FDA has expedited approval of a new test that can detect antibodies to Zika. The CDC is in the process of providing the test to labs across the country, with a priority on public health departments.
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With deaths from opioid overdoses up sharply, a number of organizations are calling for systematic changes to curb the prescription of opioids while also making it easier for patients with addiction problems to access evidence- based treatment. New data from the National Center for Health Statistics un- derscore the scope of the problem: Deaths related to prescription overdoses reached an all-time high in 2014, nearing the 19,000 mark. Deaths linked to heroin reached 10,574, a three-fold increase from 2010. ⋯ This is to identify patients who may be supplementing their prescribed dosages. New research reported in JAMA Internal Medicine suggests that the over-prescribing of opioids is a problem shared by a broad cross-section of health professionals, not a small subset, as some have suggested. A new report, led by researchers at the Johns Hopkins School of Public Health, recommends significant improvements in the way opioids are prescribed and dispensed as well as in the way patients with addictions or overdoses are identified and managed in the healthcare system.
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Two different hospital systems have made sizable dents in their sepsis mortality rates through a collaborative process between emergency and ICU staff. At Northwest Hospital in Randallstown, MD, success occurred, in part, by lowering the threshold for transfer of emergency patients with signs of sepsis to the ICU. ⋯ Clinical leaders at Kennedy Health report that they have lowered sepsis mortality from the mid-20% range to less than 12% through a collaborative approach involving all stakeholders. Sources from both hospitals stress the importance of using data to achieve buy-in to improvement efforts, and giving interventions enough time to take hold.