News Briefs

Aging population will add EOL demands on EDs

Emergency physicians and nurses require more training to manage the complex needs of growing numbers of patients who come to the emergency department for end-of-life care, according to a study published online Dec. 3, 2010, in Annals of Emergency Medicine.

The article is titled "Trajectories of End-of-Life Care in the Emergency Department."

"Patients and their families receive a lot of attention and support in the emergency department when there is an unexpected acute medical illness or a sudden, often traumatic event that results in death," said lead study author Dr. Cara Bailey of the College of Medical and Dental Services at the University of Birmingham in Birmingham, England, in a news release issued by the American College of Emergency Physicians.

"While the emergency department is not designed for end-of-life care, the reality is that many patients in this category go there for help, sometimes not realizing this is the end. Emergency resources are focused on saving lives, which tends to shortchange the patients who have terminal illnesses."

The study, conducted at and funded by the Centre for Social Research in Health and Healthcare at the University of Nottingham, England, is based on 1,000 hours of observation, plus interviews with health care professionals, patients with terminal illnesses and their relatives.

"Death, dying, and bereavement are daily occurrences in the emergency department, but it is a sadly neglected area of research, professional development, and practice," said Dr. Bailey.

Medicare finalizes new equal visitation rules

The Centers for Medicare & Medicaid Services (CMS) on Nov. 17 issued new rules for Medicare- and Medicaid-participating hospitals that are designed to protect patients' right to choose their own visitors during a hospital stay, including a visitor who is a same-sex domestic partner.

"Basic human rights — such as your ability to choose your own support system in a time of need — must not be checked at the door of America's hospitals," said U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius, in an HHS news release. "Today's rules help give 'full and equal' rights to all of us to choose whom we want by our bedside when we are sick, and override any objection by a hospital or staffer who may disagree with us for any non-clinical reason."

The new rules follow from an April 15, 2010, Presidential Memorandum, in which President Obama tasked HHS with developing standards for Medicare- and Medicaid-participating hospitals — including critical access hospitals — that would require them to respect the right of all patients to choose who may visit them when they are an inpatient of a hospital.

The President's memorandum instructed HHS to develop rules that would prohibit hospitals from denying visitation privileges on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity, or disability. It also directed that the rules take into account the need for a hospital to restrict visitation in medically appropriate circumstances, according to the HHS news release.

The new rules require hospitals to have written policies and procedures detailing patients' visitation rights, as well as the circumstances under which the hospitals my restrict patient access to visitors based on reasonable clinical needs.

A key provision of the rules specifies that all visitors chosen by the patient — or his or her representative — must be able to enjoy "full and equal" visitation privileges consistent with the wishes of the patient or his or her surrogate.

The rules update the Conditions of Participation, which are not only applicable to Medicare- and Medicaid-participating hospitals, but are applicable to all patients of those hospitals regardless of payer source.

President issues memo on human subjects

President Obama issued a Presidential Memorandum for Dr. Amy Gutmann, chair of the Presidential Commission for the Study of Bioethical Issues regarding a review of human subjects protections.

The memorandum cited the recent discovery of U.S. Public Health Service research on sexually transmitted diseases that was conducted in Guatemala from 1946 to 1948 involving the intentional infection of vulnerable human populations.

"In light of this revelation, I want to be assured that current rules for research participants protect people from harm or unethical treatment, domestically as well as internationally," the memorandum states.

The memorandum directs Dr. Gutmann to "convene a panel to conduct, beginning in January 2011, a thorough review of human subjects protection to determine if federal regulations and international standards adequately guard the health and well-being of participants in scientific studies supported by the Federal Government.

"I also request that the Commission oversee a thorough fact-finding investigation into the specifics of the U.S. Public Health Service Sexually Transmitted Diseases Innoculation Study."

President Obama directed Dr. Gutmann to complete the review and provide a report on the panel's recommendations and findings within nine months.

Health care orgs announce collaboration

Six of the United States' health care systems announced on Dec. 15 a collaboration among them designed to improve health care quality while reducing costs.

The six health systems include Cleveland Clinic, Dartmouth-Hitchcock, Denver Health, Geisinger Health System, Intermountain Healthcare, and Mayo Clinic, all of which will join The Dartmouth Institute for Health Policy and Clinical Practice to share data on outcomes, quality, and costs across a range of common and costly conditions and treatments.

The group expects to determine best practices for delivering care for these conditions and will quickly disseminate actionable recommendations to providers and health care systems across the country.

The collaborative will initially focus on eight conditions and treatments, for which costs have been increasing rapidly and for which there are wide variations in quality and outcomes across the country.

The conditions and treatments will be: knee replacement; diabetes, heart failure, asthma, weight loss surgery, labor and delivery, spine surgery, and depression.

"The intractable problems of quality and cost cannot be solved without getting to the fundamental issue of how we deliver health care in this country," Brent James, MD, chief quality officer at Intermountain Healthcare and executive director of the Intermountain Institute for Health Care Delivery Research, said in a news release.