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Biomedical subjects

Mark Hauswald

Publications and source records attributed to Mark Hauswald.

11 recordsLinked to original sources
PubMed2004

The ED is an efficient place to treat ED patients.

The purpose of this study was to determine what percentage of ED patients would be more efficiently treated in an offsite clinic. A stratified sample consisting of 650 ED visits were reviewed. Patient care was classified as more efficiently delivered in ED or clinic using prospectively developed criteria. Five hundred fifty-three (85%; 95% confidence interval [CI], 82-88%) visits met the definition of efficient ED utilization. One (0.15%; 95% CI, 0.01-0.99%) met the criteria for efficient clinic utilization. The other 96 (15%; 95% CI, 12-18%) failed to meet the definition of efficient for either site; 92 of these failed 2 or more clinic criteria. Only 25 (3.9%; 95% CI, 2.6-5.7%) were seen for nonacute problems. Few ED patients would be more efficiently seen in a clinic.

Ambulatory Care Facilities↗
PubMed2004

Effect of managed care on emergency department use in an uninsured population.

STUDY OBJECTIVE: The use of managed care to decrease emergency department (ED) use has been reported with some success among Medicaid and insured populations. Our objective is to determine the effect of a managed care program (the "Program") for uninsured patients on their use of emergency, inpatient, and outpatient services. METHODS: This was a retrospective, observational study with 3 groups of patients at an urban, academic medical center: uninsured patients enrolled in the Program, uninsured patients not enrolled in the Program ("Uninsured"), and commercially insured ("Commercial") patients. All patients received services at least once annually during the 5-year study duration. Administrative databases provided data on ED visits, hospital discharges, hospital days, primary care visits, and specialty care visits during the preprogram and 4 postprogram years. RESULTS: There were 1,676 Program, 335 Uninsured, and 844 Commercial patients (2,855 total patients). Use of emergency, inpatient, and outpatient specialty clinics by all groups did not change significantly after program implementation. There was a modest increase in outpatient primary care use by Program members. CONCLUSION: Implementation of a managed care program did not significantly alter ED or inpatient hospital use patterns in an uninsured, indigent population. Providing a primary care provider and health care benefits alone was insufficient to reduce ED use in this population.

Academic Medical Centers↗
PubMed2003

Use of a self-selected scheduling method in a large academic emergency medicine group.

We describe a method for scheduling shifts in a large academic emergency medicine group. The method starts with a survey of the faculty to assign shift equivalent values to each of the 13 different shifts used during the week. A weekday day shift is assigned a value of 1.0, and the shifts range in value up to 2.1 units. Each faculty member is then assigned a shift allocation for the academic year equally divided among the various shift types. Faculty members can request reallocation of shift types on the basis of the individual shift equivalent values. Once the number of the different shifts are allocated as required by the schedule, a lottery is held whereby individual faculty members choose specific shifts in turn for the upcoming year. The lottery selection is done by the faculty members accessing a common server from their office computers during a specified period. The lottery process continues until all shifts are filled. The creation of shift equivalent values facilitates the initial allocation of shifts and subsequent trades between faculty members.

Academic Medical Centers↗
PubMed2002

Spinal immobilization in trauma patients: is it really necessary?

The acute management of potential spinal injuries in trauma patients is undergoing radical reassessment. Until recently, it was mandatory that nearly all trauma patients be immobilized with a back board, hard cervical collar, head restraints, and body strapping until the spine could be cleared radiologically. This practice is still recommended by many references. It is now clear that this policy subjects most patients to expensive, painful, and potentially harmful treatment for little, if any, benefit. Low-risk patients can be safely cleared clinically, even by individuals who are not physicians. Patients at high risk for spinal instability should be removed from the hard surface to avoid tissue ischemia. Understanding the rationale for these changes requires knowledge of mechanisms of injury, physiology, and biomechanics as they apply to spinal injuries.

Adult↗
PubMedDate not supplied

Denial of ambulance reimbursement: can reviewers determine what is an emergency?

OBJECTIVE: Use of ambulances for nonemergency and routine transportation is thought to be a serious and growing problem. Third-party payers frequently refuse payment when ambulance use is deemed inappropriate. The authors attempted to determine whether cases in which ambulance transport was denied were done appropriately. METHODS: Consecutive ambulance run forms of transports in which payment was denied by the state Medicaid carriers and corresponding emergency department (ED) charts were reviewed. Medical risk was evaluated by using the Evaluation and Management (E&M) Level of Care for the ED visit. Appropriateness of ambulance transport was evaluated by extracting the final diagnosis and the most serious written (and worked up) diagnosis in the differential. If either diagnosis could benefit from treatment in an ambulance or by rapid transport to a hospital, the transport was defined as appropriate. RESULTS: A total of 146 run forms and 104 corresponding charts were evaluated. Ambulance transport was appropriate in 63 (61%; 95% confidence interval, 51%-70%). Risk was minimal for two transports, low for two, moderate for 62, and high for 38 cases. Final diagnoses included several life-threatening ones. CONCLUSION: In this population of patients for whom payment of their ambulance bill was denied, a high percentage of corresponding ED visits were for potentially serious medical problems.

Ambulances↗
PubMedDate not supplied

Can paramedics safely decide which patients do not need ambulance transport or emergency department care?

OBJECTIVES: To determine whether paramedics can safely decide which patients do not require ambulance transport or emergency department (ED) care. METHODS: This was a prospective survey and linked medical record review. Paramedics completed a brief questionnaire for each patient they transported to a university hospital ED during a one-month period. A faculty emergency physician masked to the survey results reviewed hospital records. Ambulance transport was defined as "needed" if the charted differential diagnosis included diagnoses that could necessitate treatment in an ambulance. ED care was defined as "needed" if treatment of these diagnoses would necessitate resources not available in local urgent care centers (UCCs). RESULTS: Two hundred thirty-six patients were transported; 183 corresponding ED charts were found. Agreement between paramedics and need determined by ED chart review was low for both transport method [kappa (kappa) = 0.47, 95% confidence interval (95% CI) = 0.34-0.60] and ED care (kappa = 0.32, 95% CI = 0.17-0.46). Paramedics recommended alternative transport for 97 patients, 23 of whom needed ambulance transport. Paramedics recommended non-ED care for 71 patients, 32 of whom needed ED care. CONCLUSION: Paramedics cannot safely determine which patients do not need ambulance transport or ED care.

Adult↗
PubMedDate not supplied

Regional blood flow after pneumatic anti-shock garment inflation.

OBJECTIVE: To determine whether fully inflated pneumatic anti-shock garments (PASGs) decrease blood flow to abdominal and retroperitoneal organs. METHODS: An experimental study was conducted using a convenience sample of ten healthy adults. A duplex Doppler ultrasound was used to image and measure blood flow at the aortic root (cardiac output), left carotid artery, left subclavian artery, superior mesenteric artery (SMA), left renal artery, and distal aorta. Each subject was imaged before and after inflation of all three compartments of the garment to 90 mm Hg. Data were analyzed with paired t-tests. RESULTS: PASG inflation did not affect cardiac output (5.45 vs. 5.83 L/min, 95% confidence limit (CL) for mean -0.97 to 0.30, p = 0.26), left carotid artery flow (0.34 vs. 0.35 L/min, 95% CL for mean -0.06 to 0.04, p = 0.70), or left subclavian artery flow (0.12 vs. 0.11 L/min, 95% CL for mean -0.01 to 0.03, p = 0.47). Inflation did cause the aortic flow immediately distal to the renal artery to decrease markedly in all subjects (1.01 vs. 0.11 L/min, 95% CL for mean 0.79 to 1.19, p < 0.001). Flow immediately above this point appeared unaffected. Physical interference with the ultrasound probe by the garment precluded measurement of SMA or renal artery flow in five subjects. In the remaining subjects, these values did not change significantly (SMA 0.40 vs. 0.28 L/min, 95% CL for mean -0.11 to 0.33, p = 0.23; renal artery 0.44 vs. 0.51 L/min, 95% CL for mean -0.09 to 0.08, p = 0.78). CONCLUSION: PASG inflation caused a dramatic decrease in aortic blood flow over a small area immediately distal to the renal arteries but had little or no effect above this point. This provides support for the use of PASG to decrease otherwise uncontrollable hemorrhage from the iliac, pelvic, and leg vessels, but not for injuries above them.

Adult↗