UK to scrap the 4 hour KPI for ED’s after it’s introduction was associated with substantial excess mortality

Written by Gary on June 12th, 2010

The UK experience is sure to have a profound ripple effect around the world as governments and hospitals in their attempt to maximise ED efficiencies in the face of inadequate resourcing may have very serious but predictable consequences.

If administrative goals force already busy and over-stretched ED staff to cut corners more than they already must do, then some patients will suffer the consequence of inadequate management or observation.

Time based KPI’s are only a proxy for quality care indicators, and over-emphasis on these without appropriate recognition of the quality of care itself is fraught with danger.

We all want patient flow through ED’s to be efficient and the menace of bed access block and ED over-crowding to be eradicated – but not if it means quality of care is adversely impacted.

There are many lessons to be learned from this unfortunate experience.

 

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Department of Health and Ageing is looking for doctors and medical students in remote or rural regions to tell their story

Written by Gary on May 3rd, 2010

Department of Health and Ageing is seeking doctors and medical students working in rural, regional or remote areas of Australia to share their experiences.

Working in a rural, regional or remote area?  Would you be interested in talking about your experiences?

Doctors and medical students living and working in regional, rural or remote settings have a unique opportunity to tell their urban colleagues of the rewards and challenges of working in these areas.

The Federal Department of Health and Ageing is looking for doctors and medical students who might be interested in talking or writing about their experiences. This might take the form of being interviewed for short videos or writing a blog or online journal.

If you are interested, or for more information, please contact doctorconnect@health.gov.au

 

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New drugs on PBS: alfuzosin, clofarabine, melatonin, nebivolol, rizatriptan and ustekinumab

Written by Gary on April 16th, 2010

New drugs on Australia’s PBS schedule:

Alfuzosin:

  • Xatral SR 10mg prolonged release tablets
  • alpha-1 adrenergic blocking agent for use in Rx of benign prostatic hypertrophy, similar to prazosin, tamulosin and terazosin
  • vasodilator so may cause postural hypotension
  • only modest benefit over placebo and no difference in efficacy between the alpha-1 adrenergic blocking agents.

Clofarabine:

  • Evoltra
  • a purine nucleoside analague used in Rx of paediatric acute lymphocytic leukaemia

Melatonin:

  • Circadin 2mg prolonged release tablets
  • a natural hormone available for Rx of primary insomnia in those aged over 55 years
  • only marginal benefits over placebo for most patients with only 30% responding

Nebivolol:

  • Nebilet 1.25mg, 5mg and 10mg tablets
  • beta1 blocker with mild vasodilatory properties via nitric oxide release
  • used in Rx of hypertension (1.25mg up to max. 40mg once daily) and stable chronic heart failure (1.25mg, gradually increase to 10mg once daily if tolerated)
  • benefits over other beta blockers are not yet clear clinically

Rizatriptan:

  • Maxalt 10mg wafers
  • Rx of acute migraine
  • mainly acts as agonist on 1B and 1D serotonergic receptors
  • more patients respond to 10mg rizatriptan than to 100mg sumatriptan, but headache was more likely to return and necessitate a 2nd dose after 2 hours
  • overall efficacy is similar to sumatriptan

Ustekinumab:

  • Stelara 45mg for injection
  • a humanised monoclonal antibody which suppresses the immune system by blocking the inflammatory actions of IL-12 and IL-23, and is thus used in Rx of unresponsive psoriasis.
  • a s/c dose is given at 0,4 and then every 12 weeks
  • serious side affects include angina, stroke, hypertension, intervertebral disc prolapse, dactylitis, clavicular fracture, sciatica and nephrolithiasis, while one 33 yr old man died suddenly while taking a 90mg dose and the death was thought to be related to a dilated cardiomyopathy
 

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Apple’s new iPad – sorry, Apple fans, it doesn’t look like it’s going to make it in ED

Written by Gary on February 8th, 2010

Apple’s iPad will probably be a big hit with many people with its nice interface for browsing the net, reading magazines, viewing photos and videos, and running innumerable Apple iPhone style apps.

But I must agree with the results of this little study from Software Advice which seems to indicate that whilst ED doctors are wanting a tablet style point of care computing tool to make their data entry and patient management more efficient, unfortunately the iPad won’t cut it for a number of reasons including:

  • resistance to dust and liquids for disinfecting
  • user authentication such as fingerprint or RFID
  • barcode reader for patient identification
  • integrated camera or at least an SD card reader transfer photos from a camera for improved documentation
  • voice to text dictation
  • ability to run hospital software – almost no enterprise-wide medical software will run on Apple iPhone operating system

We will have to wait a few more years yet before an ideal tablet hits the medical market.

 

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Want a new easy way to write a medical knowledge article and have full control over it rather than use a wiki or personal website? Try a Google Knol.

Written by Gary on January 26th, 2010

Google has created a new knowledge-based system which allows experts (such as us), to write knowledge-oriented articles complete with images, multimedia and links which only the author can update.

This may suit doctors who wish to help share knowledge but wish to still retain control and have all their articles linked in the one place.

For instance, this US dermatologist has written articles on:

A wiki such as the Ozemedicine wiki is great for collaboration and keeping everything linked together and searchable without ending up getting lots of extraneous search results from the millions of non-authoritative authors which have taken over the internet world.

Wikipedia itself is useful, but there is no easy way of protecting your efforts from being edited by non-authoritative authors – hence the reason for the creation of the Ozemedicine wiki – only authorised persons can edit these wiki pages.

But for many, a wiki does not give them the control and recognition they would like, while the effort of creating a personal website is not the way they would like to spend their spare time.

Furthermore, a blog system such as this is not a great way of archiving and updating knowledge-based articles given that articles posted on a blog are ordered according to date initially posted and linking to older posts  is a bit of a chore.

A Google Knol may be the answer if you find yourself in this category – easy to create, edit and publish, even host your images, etc.

However, be aware, your articles will be listed amongst the thousands of bogus Knol articles promoting health products – if you want isolation from such marketing forces, then becoming an author on the Ozemedicine wiki may be a better option – there are no ads!

If you do create a nice article, please let me know so I can link to it from within the wiki – as the Ozemedicine wiki is still potentially the most powerful and efficient portal to timely useful ED-oriented material for Australians.

For instance, I have added links to the above Knols to the wiki dermatology index page and thus these will appear in a wiki search.

 

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New Victorian notifiable conditions

Written by Gary on January 7th, 2010

Victoria’s Dept of Health have updated their notifiable conditions:

  • Giardia has been removed
  • Chikungunya virus infection (mosquito spread infection in Africa, Asia and the nearby islands including Papua New Guinea) has been added
  • Blood lead levels greater than 10 microgram/dL has been added
  • Hepatitis A is now  Group A condition-  no longer in Group B

Secure online notifications and downloadable forms can be accessed via this website.

 

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New PBS drugs: Prasugrel, Pramipexole and Olanzapine depot injection

Written by Gary on December 23rd, 2009

NPS RADAR for December 2009 reports 3 new PBS listings:

Prasugrel (Effient):

  • new antiplatelet drug from same class as clopidogrel with even less risk of non-fatal myocardial infarction but greater risk of bleeding.
  • TRITON-TIMI 38 trial which excluded high risk of bleed patients showed that for every 1000 patients, 22 fewer would have composite of death from CVS causes, non-fatal AMI or non-fatal stroke, but 6 more would have major bleeding. Patients who underwent CABG had 102 more major bleed events per 1000 patients.
  • irreversibly blocks P2Y12 adenosine diphosphate receptors.
  • authority required for use in Mx of ACS via percutaneous coronary intervention in combination with aspirin.
  • recommended dosing: 60mg load (6×10mg tabs) then 10mg daily.

Pramipexole (Sifrol):

  • a non-ergot dopamine agonist used for Rx of Parkinson’s disease and Restless Legs Syndrome
  • it’s use instead of levodopa as initial Rx for early disease, delays the development of motor complications but increases somnolence and oedema.

Olanzapine Depot Injection (Zyprexa Relprevv):

  • allows deep im injection every 2 or 4 weeks, but risk of post-injection syndrome of sedation +/- delirium for up to 3 hours with every dose.
  • recommended starting dose is 210-300mg every 2 weeks depending upon current daily oral dose.
 

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Propofol, erotic dreams and chaperones

Written by Gary on December 17th, 2009

Seems Australian and New Zealand College of Anaesthetists (ANZCA) is concerned that anaesthetists may become exposed to complaints made by patients who have erotic dreams coming out of propofol anaesthesia and falsely accuse the anaesthetist of sexual abuse.

See report here.

They also suggest doctors in ED are potentially exposed unless they use chaperones, but I would think it would be rare that an ED doctor administers propofol without other staff being present during the procedure.

Nevertheless, it is important to be aware of such issues.

 

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Updating your trauma Mx knowledge – Victoria’s trauma outreach program

Written by Gary on December 14th, 2009

The Victorian State Trauma System (VSTS) outreach program (VSTOP) has been developed to promote the VSTS across Victorian hospitals. It provides clinicians not working at a major trauma service (MTS) with an opportunity to observe trauma patient management at a MTS. The MTSs are The Royal Melbourne Hospital, The Alfred and the Royal Children’s Hospital.

See this link for more information NB. PLEASE NOTE – seems the govt has taken this page down and although it appears in their search, it is not on their website, you may need to re-check later – if a new link is found, please let me know!

 

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New TIA and stroke ED Mx care bundle provided by NICS

Written by Gary on December 14th, 2009

The National Institute of Clinical Studies (NICS) has posted a new care bundle of documents to assist in the ED management of TIA and stroke.

These documents can be found on their website at NICS

 

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