Amita Parashar, �鶹Ů�� Health News Staff Writer, Author at �鶹Ů�� Health News

Want To Avoid Unnecessary Tests? Stick To One ER, Researchers Say

Amita Parashar, �鶹Ů�� Health News Staff Writer — Mon, 13 Dec 2010 16:35:06 +0000

On a recent Friday night at the Boston Children’s Hospital ER, Dr. Fabienne Bourgeois was having difficulty treating a 17-year-old boy with a heart problem. The teen had transferred in from another hospital, where he had already had an initial work-up including a chest X-ray and an EKG to check the heart’s electrical activity. But by the time he reached pediatrician Bourgeois, she had no access to those records so she gave him another EKG and chest X-ray. He was on multiple medications, and gave her a list of them. But his list differed from the one his mother gave doctors, neither of which matched the list his previous hospital had sent along.

Because it was nearly 10 p.m., the doctors couldn’t get in touch with the teen’s pharmacy or previous clinicians. It wasn’t until the next morning that the doctors confirmed which medication he was on and were able to insure that he had the correct drugs for his condition. Bourgeois says the best her team could do was care for him that night with medications “we hoped would be safe” and treat his symptoms.

That is not an isolated incident. Nearly one in three Massachusetts adults with multiple ER trips visited separate hospitals — some upwards of five — creating a host of dangerous and costly problems because full health information is not always shared between hospitals, according to a published today by the Archives of Internal Medicine. The reasons for choosing different facilities vary, sometimes patients move or change insurance between visits, while others get transferred between facilities like Bourgeois’ patient.

In the first state-wide study of its kind, the researchers, including Bourgeois, looked at 3.5 million adults who made 12.7 million visits to emergency rooms — in the state between 2002 and 2007. An individual’s visits could be for the same problem or for different illnesses.

Patients who visit multiple ERs are “exposed to the risk of medical errors, adverse events, duplication of testing, as well as delays in their treatment,” Bourgeois said in an interview.

People with psychiatric disorders and dementia are especially at risk of error or unnecessary treatment because they can’t always accurately convey what previous care they’ve had.

What’s more: patients who visited more than two different sites racked up nearly twice the bill ($12,050 on average) compared with patients who went to the same sites ($7,465).

The federal government has repeatedly pledged to invest in health technology and has to doctors and hospitals to move to electronic records that could be easily accessed by other qualified providers. In measuring the level of care fragmentation and the lack of information that is transferred, “we were able to confirm a very fundamental assumption that underpins a good fraction of [the government’s] $48 billion investment in health information technology,” says Dr. Kenneth Mandl, also a co-author of the study who is on the faculty at Boston Children’s and part of the hospital’s program to develop a health information technology system. And a called for even more federal government involvement in electronic health records.

It is clear, though, that bettering health technology is only one piece of a complicated care puzzle in response to the committee’s report, the American Hospital Association , “The true test of any health information technology is whether it improves care at the bedside.”

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In Emergency Rooms, It’s Getting Tougher To Say ‘No’ To CT Scans

Amita Parashar, �鶹Ů�� Health News Staff Writer — Mon, 29 Nov 2010 15:28:00 +0000

Anyone who has made a recent trip to the emergency room knows the visit is likely to set off a round of routine diagnostic tests: blood work, electrocardiogram, urine sample. And a routine ? A new study shows that the emergency department use of these scans also known as computerized tomography — has increased nearly six-fold since 1995 and shows no sign of tapering off.

Is it too much?

CT, a pricey technology that once to complete, was used in 2007 to diagnose 16.2 million headaches, stomach aches, back pain, chest pain and the like a huge increase from 1995’s figure of 2.7 million, according to the new study published online in the journal Radiology. Other studies have also about the technology’s possible overuse including radiation exposure or the significant costs.

Dr. David Larson, author of the study, says it’s getting more difficult for doctors to decide when to do a CT scan. “Because it’s so widely available, because the images are so exquisite, there’s the temptation to use it for anything.” The findings suggest, he adds, that “we may be heading toward overutilization or inappropriate utilization.”

But Dr. Jeff Goldsmith, co-author of the book “The Sorcerer’s Apprentice: How Medical Imaging Is Changing Health Care,” says it’s different when you’re the one lying on the table with a stabbing pain in your gut. He has twice had CT scans for abdominal pain and says he was “grateful” the scan could diagnose his problem and lead to quick treatment.

“It could be viewed as an emerging standard of care rather than something we should be ‘concerned’ about,” he says. He even suggests that increased CT scanning might eventually lower health care costs by preventing unnecessary, even higher-cost, exploratory surgery. A typical CT scan of the heart $500 to $1500.

Meanwhile, because the most recent available data lags a few years behind the times, it’s hard to know what the current utilization rates are. If the trends observed in the study have held true, then “by now probably about 20 percent of patient visits are affiliated with a CT scan,” Dr. Larson says. He adds a note of caution about making such predictions, but preliminary data from 2008, which was not included in the study, seems to follow the trend.

Nonetheless physicians, including Dr. Larson and Dr. Goldsmith, see the need for into when CT scans might not be an appropriate tool so they can be sure they’re not missing an important diagnosis.

“The value that a CT provides, even if it’s negative, is reassurance. It’s hard to provide a dollar value on reassurance,” Dr. Larson says.

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