Many other states have implemented a "POLST" Program which directs physicians and healthcare providers regarding end-of-life care. These forms are called Physician Orders for Life-Sustaining Treatment (POLST). They have been met with great success in other states such as Oregon, California, West Virginia and Wisconsin. Here is a link to a sample form.
POLST forms directly address the patient's "DNR" or Do Not Resuscitate status very clearly. Often times, while a patient may already have an Advanced Directive or Living Will, these documents do not address what to do if the patient has no pulse and is not breathing. How many times have we seen elderly debilitated nursing home patients transported to the emergency department receiving CPR, intubation and life-sustaining treatments? Ambiguity regarding end-of-life issues leads to inappropriate (although well-intentioned) treatment by providers when the patient or family may wish otherwise.
These forms address CPR, medical interventions (such as IV fluids), antibiotics and artificial nutrition.
As emergency physicians, we need to stand up for our patients and families and champion these end-of-life issues.
Tuesday, March 31, 2009
Alabama Receives Poor Mental Health Grades
The National Alliance on Mental Health recently released it's 2009 Grading the States report on how states are faring with treating mental illness. NAMI is the National Alliance on Mental Illness, the nation’s largest grassroots mental health organization dedicated to improving the lives of individuals and families affected by mental illness. NAMI has over 1,100 affiliates in communities across the country who engage in advocacy, research, support, and education.
Alabama received a grade of "D" which has not changed since 2006. They noted the landmark case of Wyatt vs. Stickney that created an untenable environment for Bryce Psychiatric Hospital to sustain itself. They specifically cite a lack of psychiatric beds that ultimately lands many psychiatric patients into jail or prison. Alabama has one of the lowest per capita ratios of psychiatrists with no plan to address this disparity.
All emergency physicians experience the failure of our health care system to meet the needs of our psychiatric patients. With the tremendous lack of psychiatric beds, these patients are boarded in the emergency department for over 24 hours (or more) while waiting for a bed to open up. State law also does not allow for involuntary committals which directly places families and the general public at risk of potential dangerous psychiatric patients. More needs to be done in Alabama to address this crisis.
Alabama received a grade of "D" which has not changed since 2006. They noted the landmark case of Wyatt vs. Stickney that created an untenable environment for Bryce Psychiatric Hospital to sustain itself. They specifically cite a lack of psychiatric beds that ultimately lands many psychiatric patients into jail or prison. Alabama has one of the lowest per capita ratios of psychiatrists with no plan to address this disparity.
All emergency physicians experience the failure of our health care system to meet the needs of our psychiatric patients. With the tremendous lack of psychiatric beds, these patients are boarded in the emergency department for over 24 hours (or more) while waiting for a bed to open up. State law also does not allow for involuntary committals which directly places families and the general public at risk of potential dangerous psychiatric patients. More needs to be done in Alabama to address this crisis.
Friday, March 13, 2009
ACEP Introduces Bill to Congress
ACEP has introduced the "Access to Emergency Medical Services Act of 2009". It is very important that everyone supports this bill as it helps address critical issues facing emergency medicine. There are three aspects to this bill:
(1) Bipartisan Commission on Access to Emergency Medical Services: To examine factors, such as emergency department crowding, the availability of on-call specialists and medical liability issues, which affect delivery of emergency medical
services.
(2) Emergency/Trauma Physician Payments: Authorizes an additional payment through Medicare to all physicians who provide EMTALA-related care, including on-call specialists whose services are needed to stabilize the patient.
(3) Emergency Department Boarding/Diversion: CMS would develop hospital boarding and diversion standards.
Send your email to your representatives and Senators Shelby and Session now. Click here...
(1) Bipartisan Commission on Access to Emergency Medical Services: To examine factors, such as emergency department crowding, the availability of on-call specialists and medical liability issues, which affect delivery of emergency medical
services.
(2) Emergency/Trauma Physician Payments: Authorizes an additional payment through Medicare to all physicians who provide EMTALA-related care, including on-call specialists whose services are needed to stabilize the patient.
(3) Emergency Department Boarding/Diversion: CMS would develop hospital boarding and diversion standards.
Send your email to your representatives and Senators Shelby and Session now. Click here...
Wednesday, March 11, 2009
Letter to the Editor
The health care system in Alabama, like all other states, faces serious problems. The American College of Emergency Physicians just released a Report Card (http://www.acep.org/reportcard) detailing many of the issues mainly related to emergency care.
There are serious problems with access to care because of the shortage of providers, difficulty covering rural areas, and lack of insurance for many people. There is a major problem with boarding patients in Emergency Departments in this country for lengthy periods until resources become available. This is occurring more and more in Alabama too. Access to care problems may lead to delays and possibly worse outcomes when people have more serious illnesses or injuries.
Our country and our state already face difficult times with respect to funding of healthcare. This was already worsening quickly because of the rapidly growing healthcare needs of baby boomers. The bad economy may significant aggravate the funding problems.
Our population is not as healthy as it could be. We have high rates of violence, obesity, accidents, and other conditions that are very costly. We could do significantly better with our immunization rates and other prevention measures. Alabama is worse than most states. If we could make our individual lifestyles healthier and improve prevention we could save billions of dollars in this country.
While dealing with the serious economic issues confronting our country and state, it is important that we avoid the mistake of not addressing and making progress with healthcare issues and other long-term issues. Everyone can help by working individually and helping with family and friends to improve one’s own health. We can also advocate to our leaders.
Steve Baldwin, MD
AL ACEP Board of Directors
There are serious problems with access to care because of the shortage of providers, difficulty covering rural areas, and lack of insurance for many people. There is a major problem with boarding patients in Emergency Departments in this country for lengthy periods until resources become available. This is occurring more and more in Alabama too. Access to care problems may lead to delays and possibly worse outcomes when people have more serious illnesses or injuries.
Our country and our state already face difficult times with respect to funding of healthcare. This was already worsening quickly because of the rapidly growing healthcare needs of baby boomers. The bad economy may significant aggravate the funding problems.
Our population is not as healthy as it could be. We have high rates of violence, obesity, accidents, and other conditions that are very costly. We could do significantly better with our immunization rates and other prevention measures. Alabama is worse than most states. If we could make our individual lifestyles healthier and improve prevention we could save billions of dollars in this country.
While dealing with the serious economic issues confronting our country and state, it is important that we avoid the mistake of not addressing and making progress with healthcare issues and other long-term issues. Everyone can help by working individually and helping with family and friends to improve one’s own health. We can also advocate to our leaders.
Steve Baldwin, MD
AL ACEP Board of Directors
Alabama Receives D+ in EM Report Card
The American College of Emergency Physicians has recently released their National Report Card on the State of Emergency Medicine. Alabama received an overall D+ with poor marks in Public Health/Injury Prevention and Access to Emergency Care. The report details many trends that emergency physicians experience on a daily basis. We lack enough primary care physicians and mental health personnel to meet our population’s needs. Additionally, they show that Alabama lacks enough emergency physicians and board-certified emergency physicians as well. On the positive side, however, Alabama was commended for our efforts in Disaster Preparedness, particularly with regards to the statewide trauma system. More can be done to improve the care of emergency patients, and we hope this report card will serve as a sounding board for our issues to our hospital and government leaders. Please read the report card for yourself to see the details.
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