Core Measures

[Arcan57]

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Thinking about the ED as PCP thread, I got thinking "What if we had core measures that actually improved the practice of emergency medicine?"

Possible examples:
% of URIs that leave without abx
% of lumbar strain that leave with NSAIDS and a list of back exercises
% of chronic pancreatitics that leave with documented PO intake as a result of their keeping down a single dose of an oral narcotic.

 

[The White Coat Investor]

Possible examples:
% of URIs that leave without abx

I thought if you wanted to give them antibiotics you just called it bronchitis or "early pneumonia" instead of URI 🙂

 

[docB]

People want what they want. If you're gonna tick them off by not giving it to them you need to fix the three things that make us cater to their desires rather than their needs:
-Medical malpractice - If they don't like me they're more likely to sue. What makes them like me more, sitting down to talk to them, really listening to their issues in the most touchy feely way possible or playing candyman?
-"Patient Satisfaction" survey results - Thanks for coming down to the CEO's office docB. We have found that while you're practicing excellent EBM your Gallup results are down so we're pulling your group's contract. And that applies to the horse you rode in on too. Taa.
-The patients pay the bills and decide where to go. - If I annoy a paying patient with the "Here's some albuterol. Tough it out." routine that guy won't come back to my ER for his MI. That's like flushing cash down the toilet.

Here's the deal. Medicine sucks as a business. Giving people what they want and what they need are contradictory ideals. You're right in all your idealistic goals. They'll eventually grind you down and suck your life force out until you'll be asking "How much Dilaudid do you want with your Z-Pack?" I just heard myself saying that the other day. The only good thing is that soon health care will collapse completely and we won't have to put up with this crap any longer. Yes, I just worked a night shift.

 

[ccfccp]

People want what they want... Yes, I just worked a night shift.

So... uh... that would be a no on the 'core measures' from docB?

 

[docB]

So... uh... that would be a no on the 'core measures' from docB?

I suppose so. As mentioned I was post night and I'm pretty cynical to begin with. The current core measures that were inflicted on us by CMS are an unqualified disaster. The data is starting to stack up against some of the stupider ones like blood cx and abx in less than 4 hours and so on.

I would love to be able to really adhere to some of the things the OP mentioned like no abx for URI and no narcs for simple/chronic back pain but we are bound by all the things I mentioned. Fix those issues and we'll be on the way to real EBM.

There's one more thing we'd have to fix. It's tough to refuse abx for the URIs and the likeley viral OMs knowing that they'll never see a PMD and will just come back to the ED. The closest I get is telling them to wait a few days before they fill the rx.

 

[Apollyon]

There's one more thing we'd have to fix. It's tough to refuse abx for the URIs and the likeley viral OMs knowing that they'll never see a PMD and will just come back to the ED. The closest I get is telling them to wait a few days before they fill the rx.

Post-date the Rx. Then, they can't get it filled until then, and I doubt many will now waste the double time in the ED.

 

[docB]

Post-date the Rx. Then, they can't get it filled until then, and I doubt many will now waste the double time in the ED.

Yeah, I used to do that. We have a script writer that won't let us change the date.

 

[Apollyon]

Yeah, I used to do that. We have a script writer that won't let us change the date.

When I need to do it, I hand-write them, and notate on the chart. Or, also, I put it in the notes on the script writer.

 

[roja]

Thinking about the ED as PCP thread, I got thinking "What if we had core measures that actually improved the practice of emergency medicine?"

Possible examples:
% of URIs that leave without abx
% of lumbar strain that leave with NSAIDS and a list of back exercises
% of chronic pancreatitics that leave with documented PO intake as a result of their keeping down a single dose of an oral narcotic.

Sounds like you are asking knowledge translation questions, fast becoming a hot topic. The SAEM consensus conference will be on this topic and deals with many of these topics.

If you are interested, feel free to PM me. There are some good websites that look at many of these type of questions.