November • 2017
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Help from the sky Company launches first drone defibrillator service in the US Associated Press
SCOTT CLARK/WISCONSIN NEWS CONNECTION
Medical assistant Becky Peterson, left, prepares to check a patient’s blood pressure.
Future
Continued from page 7 medical-quality officer. At this year’s kickoff for an elective curriculum on data and performance measurement, he said, students packed the auditorium. And all medical schools are trying to emphasize teamwork. At the University of Colorado medical school, the idea that doctors should treat non-doctors as partners – not subordinates – is impressed on students from day one, said Harin Parikh, a second-year student. The medical school shares a campus with education programs for six other health professions. Students hang out on the same quad, grab lunch in the same places and even take some classes together. In a required first-year class, students from a mix of health fields are split into teams and are asked to plan a response to a given scenario. One day a nursing student might lead the team; the next, a pharmacy student. Parikh said the team-based approach makes sense to him. “From a provider perspective, it’s about checks and balances,” he said. When multiple people with different kinds of expertise come together around a patient, one may notice something the others don’t. Reorienting medical schools, like reorienting hospital systems, will take time. Scheduling barriers can make it hard to have students from different health fields in one room, for instance. Some faculty members aren’t prepared to teach a new kind of curriculum. And when students leave school for their clinical training, they work in real-life settings that are all over the spectrum when it comes to teamwork. “We’re working on an ideal,” said John Luk, assistant dean for interprofessional integration at the Dell Medical School at the University of Texas at Austin. “But the reality is, many of us have not been practicing at the ideal.” Sophie Quinton is a reporter for Stateline, a nonprofit journalism project funded by the Pew Charitable Trusts.
RENO, Nev. — A drone delivery service has announced a new partnership with a Reno, Nev.-based ambulance company to send out defibrillators and other emergency equipment by air during responses to cardiac arrest. The drone delivery company Flirtey announced in early October it is joining forces with the Regional Emergency Medical Services Authority, allowing responders to send an automated external defibrillator by air in addition to an ambulance dispatch for every emergency call involving cardiac arrest. The program uses a rapid drone deployment program that combines Flirtey’s flight-planning software technology with Regional Emergency Medical Services Authority’s patient care and transport programs, the Reno Gazette-Journal reported. The goal is to help improve response times, especially in locations where traffic
can slow down the arrival of paramedics on the scene. “We have the ability to deliver lifesaving aid into the hands of people who need it. Why aren’t we as a society doing it already?” Flirtey CEO Matthew Sweeny said. “This is one of the most important uses of drone-delivery technology, and we believe that by democratizing access to this lifesaving aid, our technology will save more than a million lives over the decades to come.” Every minute literally counts in increasing the odds of survival for a person experiencing cardiac arrest. The chance of survival drops between 7 percent to 10 percent for each minute that a cardiac arrest victim does not get CPR or defibrillation, according to the American Heart Association. An estimated 359,400 cases of cardiac arrest occur in the United States outside of a hospital setting each year. Less than 10 percent of such victims survive, according to the heart association. “Cardiac arrest occurs when the electrical activity of the heart stops,” said J.W. Hodge, chief operating officer of the Regional Emergency Medical Services Authority. “Someone in cardiac arrest will
Nursingmatters
FLIRTEY
Flirtey’s new delivery service aims to help improve response times at cardiac arrest emergencies.
be unresponsive with no pulse, no breathing, no movement at all.” “They’re technically clinically dead,” Hodge added. The joint delivery program will allow a person on the scene to use the defibrillator on the person suffering cardiac arrest before paramedics arrive. The equipment used for the program is designed to be used by anyone, including those without a health care or emergency background, Hodge said.
Is your MD the best in the hospital? Study shows benefits of family doctor over hospitalist care LINDSEY TANNER Associated Press
CHICAGO — The old-fashioned, family doctor style of medicine could be lifesaving for elderly hospitalized patients, a big study suggests, showing benefits over a rapidly expanding alternative that has hospital-based doctors overseeing care instead. Medicare patients with common conditions including pneumonia, heart failure and urinary infections who were treated by their own primary care doctors were slightly more likely to survive after being sent home than those cared for instead by hospitalists — internists who provide care only in hospitals. While hospitalist care can shorten stays and reduce costs, the new results suggest that, for at least some patients, getting taken care of in the hospital by a doctor who knows them can have important advantages. Almost 11 percent of patients cared for by a hospitalist died within 30 days of leaving the hospital, compared with just under 9 percent of primary care patients. While that difference was small, it “was certainly a startling finding,” said Dr. Jennifer Stevens, the study’s lead author at Harvard Medical School.
Also, among hospitalist patients, 36 percent were sent to a nursing home or other long-term care center, versus about 30 percent of primary care patients. Studies show that elderly patients who are discharged to nursing homes are less likely than others to ever return to their homes, Stevens said. Reasons for those advantages are unclear. Stevens noted that primary care doctors who know their patients’ health and family histories may be more attuned to how well they can manage at home after hospitalization and which potentially risky follow-up tests or medicines they can avoid. Stevens and her colleagues analyzed Medicare claims data on nearly 600,000 hospital admissions in 2013. Their results were published Monday in JAMA Internal Medicine. The researchers don’t advocate replacing hospitalists, but Stevens said the study “opens the door” to limiting their use with certain hospital patients, particularly the elderly. Patients in the study were aged 80 on average. The hospitalist specialty has grown since the 1990s amid insurance industry changes, rising demands on primary care doctors’ time and research showing hospitalists can shorten patients’ stays and reduce costs.
In 1995, hospitalists provided 9 percent of general medicine services in hospitals, but by 2013 that had grown to nearly 60 percent, a journal editorial noted. Hospitalists may bring “new eyes” to patients’ problems, but the study results, if valid, suggest there’s a trade-off, the editorial said. In the study, 60 percent of patients got their hospital care from hospitalists versus only 14 percent from their primary care doctors. The rest got care from other general physicians including partners of patients’ primary physicians. These were physicians who likely didn’t know the patients or the hospital well, Stevens said. The average length of stay was about 5 days for primary care or general care and about half a day shorter for hospitalists. Those treated by other general physicians were slightly more likely than the others to die within 30 days of discharge and to be readmitted to the hospital.