Repeat “Super Users” Are Swamping Emergency Rooms

Bean-thin and sallow, George tugged on a cigarette in the blistering parking lot of a Camden men’s shelter. Standing on the pavement, his foot on a picnic bench, he recalled how he took his first drink at 13. The hard living shows in the lines of George’s face — and in his medical history. When he gets sick, which is often, the 55-year-old has no place to go except one of the city’s emergency rooms. George is a “super user,” a new name coined to describe people who turn to the ER with astonishing frequency and at an astonishing cost to a health system under siege on all fronts. George said he has been admitted to a Camden emergency room 30, maybe even 40, times in the past year alone; sometimes with crushing chest pains, other times from shortness of breath, or surging blood pressure. Mostly, he said, it’s the pain from cirrhosis of his liver that sends him there. “I don’t like going to the hospital,” said George, who allowed himself to be photographed but asked his last name not be published. “But sometimes I have no choice. I get pain I would not wish on an enemy.” Researchers studying the crisis of America’s overcrowded emergency rooms are beginning to focus on this largely undocumented phenomenon, the super users who turn to hospital emergency rooms dozens, even hundreds, of times. Researchers say a seemingly intractable problem could be solved, in large part, by focusing on just the top 1 percent of emergency room users, who in Camden alone cost $46 million over five years.

Please click on the link below to read the NJ.com article:

http://www.nj.com/news/index.ssf/2008/07/repeat_super_users_are_swampin.html

For more information on defending medical malpractice and nursing home matters in Florida contact Howard Citron at The Citron Law Firm, P.A. – www.citronlegal.com.

Commentary: “Computers Wouldn’t Have Helped in Overdoses of Texas Babies”

After 17 babies got overdoses of the blood thinner heparin at a Texas hospital, a hospital-quality group pointed to the incident as one more reason to push for computerized systems for ordering drugs within hospitals. The call to action invoked one of the health-care buzz-phrases of the moment: computer physician order entry, or sometimes automated physician order entry. It means doctors give their orders electronically, instead of verbally or by scrawling instructions on paper. The idea is to reduce errors and complications. Computers can also check automatically for drug interactions, implausible doses and more. There’s just one problem in this case: automation wouldn’t have done much for the tots in Texas. A pharmacist made an error mixing heparin solution, often used to flush IV lines — and IV flushes often aren’t part of physician orders anyway. You can read the statement from Christus Spohn, which also says there’s no indication as yet that heparin contributed to the deaths in the NICU. Doctors typically prescribe a dose of a particular drug over a particular time, and whether it should be administered intravenously or by mouth, for example. But a pharmacist often decides just how the drug will be prepared, whether by syringe into an IV or pre-mixed with saline. The pharmacist may note that a heparin flush is indicated before and after administration, or the nurse may know that it’s just part of the standard procedure. “You wouldn’t order a tongue depressor to do a physical – you’d just expect it to be there,” says Dennis Tribble, a 30-year hospital pharmacist and chairman of the pharmacy-informatics section of the American Society of Health System Pharmacists. “There are lots of good reasons to be a strong proponent of computerized physician order entry. It simply doesn’t solve this problem.” CPOE might not have prevented the infamous overdose of actor Dennis Quaid’s twins either. That happened when a medication cabinet contained vials of heparin a thousand times stronger than the sort that should have been there.  Another up-and-coming technology might have helped the Quaids, but not the Texas tykes: Bar Code Medication Administration, or BCMA. Those systems require medications to be labeled with bar codes in the pharmacy identifying drug, dose and patient, and then checked — via scanner and computer — against codes in the medical record and a patient armband. But if the wrong dose is mixed and mislabeled in the pharmacy, overdoses can still occur.

Please click on the link below to read the Wall Street Journal article:

http://blogs.wsj.com/health/2008/07/11/computers-wouldnt-have-helped-in-overdoses-of-texas-babies/#more-2953

For more information on defending medical malpractice and nursing home matters in Florida contact Howard Citron at The Citron Law Firm, P.A. – www.citronlegal.com.