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How Mental Health & SUD Bias Impact ED Physical Care

Physician's Weekly

Patients with documented mental illness or substance use disorders (SUDs) continue to encounter a mixed—sometimes starkly divergent—quality of emergency department (ED) care when they present with chest pain, abdominal pain, or other non‑psychiatric complaints, according to a patient‑interview study published in Health Services Research.

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Using technology to reclaim our time

Today's Hospitalist

OUR ENTIRE FIELD of hospital medicine grew out of the need to innovate to address the growing complexities of inpatient medicine. At its core, the technology utilizes sophisticated speech recognition to transcribe a conversation in the exam room or at the bedside. That’s the essence of ambient dictation. References: 1.

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You don’t need X-Rays in a child with bronchiolitis, croup, asthma, or first time wheezing

PEMBlog

The Choosing Wisely Pediatric Emergency Medicine Recommendations The Choosing Wisely Campaign Toolkit Expert Contributors Michele Nypaver, MD University of Michigan Ann Arbor, MI, USA michelen@med.umich.edu Jennifer Thull-Freedman, MD Alberta Children’s Hospital Calgary, Alberta, Canada Jennifer.Thull-Freedman@albertahealthservices.ca

Asthma 52
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Nudges for Prognosis and Comfort Care in the ICU: Kate Courtright, Scott Halpern, & Jaspal Singh

GeriPal

Prior podcasts on the ethics of nudging , and a different trial conducted by Kate and Scott in which the default for hospitalized seriously ill patients was to receive a palliative care consult. Many were community hospitals. Participants were critically ill and intubated. What is sludge? The prognosis nudge did nothing.

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POLST Evidence and Update: Kelly Vranas, Abby Dotson, Karl Steinberg, and Scott Halpern

GeriPal

Certainly SOME of those avoided hospitalizations, CPR, and ICU stays were due to documentation of those orders in the POLST. Additional links mentioned in the podcast: Recent JGIM article on POLST in California nursing homes, hospitalization, and nursing home care Karl’s GeriPal post on appropriate use of POLST Enjoy! Good to know.

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Who should get Palliative Care? Kate Courtright

GeriPal

Palliative care, in contrast, saw explosive growth in US hospitals. We can’t possibly meet the needs of all people with newly diagnosed serious illness. She’s also a member of the PAIR Center, which stands for Palliative Advanced Illness Research Center. I do tend to focus in the hospital setting.

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RCT of PC in ED: Corita Grudzen, Fernanda Bellolio, & Tammie Quest

GeriPal

I asked emergency medicine clinicians what they thought when a patient who is seriously ill and DNR comes to the ED, and some responded, (paraphrasing), what are they doing here? Most emergency providers wanted to do the right thing for seriously ill patients, but they didnt have the knowledge, skills, or experience to do it.