Archive for category ACEP News
The ACEP Board Directors accepted a recommendation last week from its Clinical Policies Committee to begin working on a tPA policy exclusive to ACEP instead of a joint project with the American Academy of Neurology.
The 2013 Council had asked that ACEP reconsider its current “Clinical Policy: Use of Intravenous tPA for the Management of Acute Ischemic Stroke in the Emergency Department,” which had been developed with the AAN and published in February 2013.
After an open 60-day comment period in early 2014 and a subcommittee review of the comments and literature findings, the Clinical Policies Committee recommended to pursue an independent policy, which will include updated evidence and grading criteria. The Board unanimously approved this recommendation.
Once the draft is developed, it will be available for members to review and comment for 60 days prior to the Committee’s presentation to the Board. An estimated timeline was not available.
Additionally, the Board confirmed its commitment to the clinical policy development process and agreed to add three methodologists to the committee, additional meetings, and another staff person to ensure a robust review process.
Editor’s Note: In lieu of flowers, please consider a memorial donation to the Emergency Medicine Foundation. The family will be notified of any gifts received in his memory.
By Brian J. Zink, MD
Author, “Anyone, Anything, Anytime: A History of Emergency Medicine”
November 5, 2013
Life has sweet and sad moments, sometimes too closely juxtaposed. At the October 2013 ACEP Scientific Assembly meeting in Seattle, emergency physicians, residents, medical students, and long-time colleagues were pleased and intrigued to watch Dr. George Podgorny in the premiere of the EMRA Legacy Initiative 24/7/365 documentary, and then to hear him interviewed later that evening and in a panel discussion the following day. Many learned about the key role that Dr. Podgorny played in establishing emergency medicine (EM) as a legitimate US medical specialty through the creation of the American Board of Emergency Medicine (ABEM). At the time of the approval of ABEM by the American Board of Medical Specialties in 1979, Dr. Podgorny was clearly in the mix – serving as both President of ACEP and President of ABEM that year. He was integrally involved in the negotiations that created the approved “modified conjoint” ABEM board after the original ABEM proposal had been roundly defeated in an American Board of Medical Specialties (ABMS) House of Delegates vote in 1977. After ABEM was approved, Podgorny was the Chief Examiner for the first ABEM exam. He also became the head of the newly created Residency Review Committee and served in that capacity for 6 years. He tirelessly surveyed and approved residencies, helping to ensure the quality of new emergency medicine residency programs.
Unfortunately, after gracing us with his encyclopedic memory, wit, and insights at ACEP, Dr. Podgorny fell ill after his trip to Seattle and died in Winston Salem, North Carolina on November 5th, 2013.
George Podgorny was born in Iran, but his heritage was Czech and Armenian. His father taught physical education to the children of the Shah of Iran, and his mother wrote children’s books. It was decided that George would come to the United States after high school because the family felt that a US university education would be superior. Podgorny left his family and came alone to Maryville College in Tennessee and decided to go in to medicine. He became enamored with Wake Forest University School of Medicine (then the Bowman Gray Medical School) and its Baptist Hospital, was accepted there for medical school and never left the region. Podgorny excelled as a medical student and was accepted in to the general surgery residency. As a surgery resident he spent a great deal of time in the emergency department, and was struck by the fact that the sickest patients were cared for by the least trained residents who were rarely supervised. He worked diligently to improve care in the ED even as a resident. Podgorny then completed vascular surgery training and was in a cardiothoracic surgery training fellowship when he began to learn more about physicians who were practicing full time in emergency departments (EDs). He attended the 1970 ACEP meeting and met many of the early leaders. After this, he joined with a couple friends to work in the ED of Forsyth Hospital in Winston-Salem. He loved this work, and the possibility of being involved in a new specialty of medicine, and did not return to surgery.
As someone who was academically-oriented and had 7 years of residency training, Podgorny linked with the early ACEP leaders and began to push for formation and approval of a specialty board in EM. His background and connections in the surgical world helped to lend some credibility to the early group, and allowed him to battle the opposition that came from surgical fields. He came across as a unique individual, always sporting a handlebar mustache, with an exotic sounding accent and an eloquent but raspy voice. People paid attention when he spoke.
One of his most important roles came at the “Workshop Conference on Education of the Physician in Emergency Medicine” in Chicago in 1973. Podgorny was an important, persuasive figure in a comprehensive gathering of medical leaders from government, the other medical specialties, and academia. The fate of EM going forward hinged on the early EM leaders convincing others that the field was credible and that residency training and specialists in EM were just as important as in other medical fields. The outcome of the meeting was favorable and Podgorny and other early leaders in EM then made a concerted push, against considerable odds, to get ABEM established over the next 6 years. Podgorny was a key negotiator in the process, particularly in the final compromise that allowed ABEM to be approved in 1979.
George Podgorny continued to practice emergency medicine for many years in Greensboro, North Carolina after his direct leadership in ACEP and ABEM ended. However, he was a constant presence at the annual Scientific Assembly and offered advice and counsel to the new leaders in EM. On a personal level, George loved his Persian heritage, and his home was lavishly decorated with Persian art and furniture. He was a widely read intellectual, and an astute scholar of the history of medicine. He also loved his adopted home state of North Carolina, and was a regular at the local barbeque restaurants.
Dr. Podgorny is one a handful of people who can be considered to have been truly essential to the formation of emergency medicine. Without his forceful, scholarly, and gracious diplomacy, some of the early deliberations of the future of EM could have gone the other way. His loss leaves us greatly saddened, but we can also warmly reflect on how his determination, skill in negotiation, and perseverance made EM become a reality in the US. This is his tremendous legacy. We are grateful to have had the pleasure of seeing and hearing this senior icon of emergency medicine one last time at the ACEP Scientific Assembly 2013.
The American College of Emergency Physicians is set to undertake a new editorial direction for our monthly news magazine, ACEP News, which coincides with a new publishing contract with Wiley Periodicals Inc. beginning in 2014.
Kevin Klauer, DO, EDJ, FACEP will take over as medical editor-in-chief in January 2014, helping to set the tone and editorial direction of the publication. In June, Dr. Klauer will resign as editor-in-chief of Emergency Physicians Monthly, a position he has held since 2008.
Robert Solomon, MD, FACEP, ACEP News’ current medical editor, has served in this role for almost eight years. Under his leadership, the magazine has grown from a small, insider newsletter to a robust and trusted source of up-to-date clinical information, valued articles on practice trends, and entertaining features on emergency physicians worldwide. Dr. Solomon will continue as ACEP News’ medical editor through December 2013.
ACEP would like to thank Dr. Solomon for his tireless dedication and the progress he has helped ACEP achieve with ACEP News.
Dr. Klauer will bring a new voice to ACEP News that will resonate with the 31,000 ACEP members and additional 8,000 emergency physicians who read the publication each month. He has a following in the emergency medicine community, where he is a respected, popular and dynamic faculty member at emergency medicine educational conferences. He will augment the current 21-member ACEP News Editorial Advisory Board with different perspectives and additional columnists.
Dr. Krome graduated from the Wayne State University surgery residency in 1969 and was assigned staff-oversight responsibility for the Detroit General Hospital emergency room – a position that became necessary after the 1967 Detroit riots.
By the early 1970s, Dr. Krome had begun to develop an emergency physician staff that practiced exclusively in emergency medicine and the emergency department had become a formal part of the hospital’s administrative structure.
In 1971, he joined ACEP and ultimately became a life member. In 1972, he was chosen editor in chief of JACEP, which became Annals of Emergency Medicine in January 1980, due to the strong credibility established by the publication under Dr. Krome’s guidance.
He served as ACEP President from 1976-77 and was presented the John G. Wiegenstein Leadership Award in 1979 for effectively promoting excellence in emergency medicine education.
Dr. Krome was on the team that successfully negotiated recognition for emergency medicine as a specialty in 1979, and chaired the Test Committee appointed to develop the first certification exam. As an active chapter member, he served as a councillor from Michigan for nine years.
A decade after he was president, Dr. Krome received the John D. Mills Outstanding Contribution to Emergency Medicine Award in 1987 for his exemplary long-term contribution to both ACEP and the specialty.
Long after completing his tenure as an elected College leader, Dr. Krome continued to be diligent in striving for increased legitimacy of the specialty through expanding the body of research. His contributions to the Blue Ribbon Commission on the Future of Emergency Medicine and his commitment to Annals of Emergency Medicine has had lasting effects on emergency medicine, as has his work as a teacher and mentor of emergency physicians.
In addition to being a past president of ACEP, he was also a past president of the American Board of Emergency Medicine (ABEM).
He was the first recipient in 1983 of the Michigan ACEP chapter’s Meritorious Service Award, which was then named in his honor. He also published a book, “The Floaters’ Log,” about his emergency department experiences.
He served as chief of the division of emergency medicine at Wayne State University, Detroit, MI, as well as chief of emergency medicine at William Beaumont Hospital, Royal Oak, MI. He attracted many to the field, and mentored many physicians who have since achieved professional prominence.
In 2008, he was named one of ACEP’s Heroes of Emergency Medicine, and reported that his favorite saying was that he receives the greatest joy from seeing his students achieve successes even greater than his.
Contributions in his memory may be sent to the Emergency Medicine Foundation, PO Box 619911, Dallas TX 75261-9911 or online at www.emfoundation.org/donate.
After an extensive look at ways to provide cost effective care to emergency department patients, the American College of Emergency Physicians believes there is room to improve the use of specific tests or procedures in emergency medicine to participate in the national “Choosing Wisely” campaign.
“Choosing Wisely” is part of a multi-year effort of the American Board of Internal Medicine (ABIM) Foundation to help physicians be better stewards of finite health care resources. The campaign encourages medical specialty organizations to identify five tests or procedures commonly used in their field, the necessity of which should be questioned and discussed by patients and physicians.
ACEP had previously declined participation in the “Choosing Wisely” campaign because of the challenges of this approach with the unique nature of emergency medicine, liability concerns, and a potential harm to physician reimbursement.
The College meanwhile remained steadfast in its commitment to cost-effective care and a high-value health care system, and last year, Immediate Past President Dr. David Seaberg appointed a Cost Effective Care Task Force, chaired by Dr. David Ross. The Task Force was charged with considering tests, processes and procedures with little or no value to emergency care that might represent meaningful cost savings if eliminated.
In a report to the ACEP Board of Directors this month, Task Force member Dr. Jay Schuur said that their Delphi panel and ongoing member surveys have suggested that a number of tests will meet the criteria of the “Choosing Wisely” campaign. They also determined that these tests would not increase the physician’s liability, and would not negatively impact payments for emergency physicians.
After being reviewed by experts, emergency medicine leaders, and the ACEP Board, the report’s data indicates that it would be appropriate for emergency medicine to participate in the campaign. A letter of ACEP’s intention to participate was sent to the ABIM Foundation today.
The list of recommendations should be established by June. ACEP’s Task Force is finalizing the evidence base for these recommendations, in part though the Emergency Medicine Practice Research Network (EMPRN). Attaching estimates of potential real-dollar savings to the recommendations is also being completed. Members of the Task Force and the ACEP Board believe this responsible approach will validate the substance of our recommendations, and provide assurance that there will be a real savings to the health care system while not impacting patient care.
But joining this national campaign is not the only approach ACEP is using its in journey to identify cost savings measures without compromising patient care.
In order for there to be a serious reduction in unnecessary tests and costs of defensive medicine over time, meaningful liability reform and safe harbors are vital. ACEP is encouraging ABIM and its campaign partners to lend their voices to the need for medical liability reform. This remains a top priority in ACEP’s advocacy agenda.
Additionally, the College is working on other significant and impactful efforts, including proposing an elimination of the 3-day-stay rule and better management of transitions of care.
A variety of recommendations that strive to improve patient care and provide meaningful cost savings continue to be initiated, developed, and adopted by ACEP. We are dedicated to ensuring that our specialty can be leaders in health care system efficiency while maintaining a high quality of emergency care and patient safety.
[This article will be published in the November issue of ACEP News. See the entire ACEP News libary online at www.acepnews.com]
After considerable debate, the ACEP Council voted this month to refrain from participation in the national “Choosing Wisely” campaign in large part due to the other efforts being taken by ACEP to achieve the same and even larger goals.
“Choosing Wisely” is part of a multi-year effort of the American Board of Internal Medicine (ABIM) Foundation to help physicians be better stewards of finite health care resources, according to its website. As part of the campaign, specialty organizations identify five tests or procedures commonly used in their field, the necessity of which should be questioned and discussed by patients and physicians.
ACEP had considered joining this campaign three distinct times since its launch in December 2011. Three different workgroups of various ACEP members, committees and Board members looked at the campaign and decided that while the concept is positive, the scope of listing tests, especially for emergency physicians, was too narrow.
Despite this extensive review by ACEP members, a resolution was submitted by the New York Chapter asking the ACEP Council to decide if ACEP should join the “Choosing Wisely” campaign.
As part of the Council process, resolutions are first debated in a reference committee where members of the Council provide background about the resolution, give testimony to its merit or explain reasons why it should not be adopted. It was standing room only for the debate about this resolution and discussion was spirited. The debate continued the next day with many of the same reasons echoed on the open floor of the Council with mroe than 300 voting members in attendance.
Those in support of ACEP joining the campaign said that 26 medical specialties (except for emergency medicine and anesthesia) have joined or committed to participate. They added that participating could give ACEP more national visibility and bargaining power, and that ACEP could use its participation to educate other specialties about emergency medicine’s particular challenges.
Those opposed to ACEP joining the campaign said that the Choosing Wisely campaign does not involve any negotiation with others in medicine, and that it could lead to unintended consequences, including a lack of liability protection, vulnerability to the False Claims Act and automatic payment denials from insurance companies based on tests that the campaign deems to be “unnecessary.”
One large concern was that the intent of the campaign had already eroded, with several specialties offering only minimal savings and stepping outside of their field and including tests on their lists that are outside the scope of their practice.
The issue generated strong feeling on both sides and the majority of the Council ultimately decided to refrain from participation.
ACEP already had opted to strive to identify cost savings measures without compromising patient care. Three task forces were established in 2012 to work toward this idea – the Cost Effective Care Task Force, the Delivery System Reform Task Force, and the Transitions of Care Task Force.
ACEP’s Cost Effective Care Task Force is developing recommendations on ways to reduce costs in emergency care. Through member surveys, a Delphi approach, and use of the Emergency Medicine Practice Research Network (EMPRN), this group will not only consider unnecessary tests and procedures but also processes with emergency care that might represent meaningful cost savings while improving patient care. This task force is expected to complete its work and offer its report to ACEP’s Board in February of 2013.
It is hoped that these reports of significant recommendations can fuel a public campaign and support health policy advocacy concerning how emergency physicians are not just making a list of tests to cut, but instead are looking at much larger initiatives, processes and transitions that could result in real health care savings while improving patient care.
The Delivery System Reform Task Force gave its report to the ACEP Board of Directors on Oct. 5. It can be found online at www.acep.org/advocacy/federalissues/.
“The emergency department remains at least one of the reasonable solutions for addressing many of the health care system’s most vexing problems from a delivery system perspective,” the report states. “Emergency physicians are well positioned to provide innovation and leadership across the acute care continuum. Even from the perspective of employers, the patients, and payers, the allegedly high cost of care is incompletely characterized, often misconstrued, and lacks sufficient perspective in the broader context of community economics and the health care delivery system itself. Addressing these dynamics will require significant and intensive efforts to bring data, information, and solutions to a delivery system in rapid evolution.”
In addition to efforts that should be continued, the report also lists several recommendations of efforts that should be started or enhanced, including information sharing to primary care providers (and specialists), care coordination for high-cost users, regionalization of patient care resources (mobile technology, telemedicine), cost effective alternatives to hospital admission and others.
The report also recommends efforts that should be stopped or reduced (because emergency physicians are not trained or resourced for it, or could be more efficiently delivered in an alternative setting), such as longitudinal care for chronic illnesses, primary preventative care, non-value driven convenience care, and treatment of medical conditions that have no incremental benefit to the patient or value to the system.
The Transitions of Care Task Force also developed an information paper that was submitted to the ACEP Board of Directors in draft form on Oct. 5. When it is finalized, it will be announced to ACEP members and posted on ACEP’s website.
The Task Force paper notes that “The emergency department has an important, in fact pivotal, role in transitions of care and can enhance its value to the system by implementing more successful transition programs. As the emphasis and oversight of quality and cost increase, successful coordination of patients’ journeys through the health care system will help advance the triple aim of better population health, better patient experiences, and reduced cost to the system. “
To achieve this goal, the Transitions of Care Task Force made several recommendations, including
- improve residency training and continuing professional development for emergency physicians on the importance of handoffs in effective transitions of care
- work with emergency department information system vendors to produce transition support tools
- identify strategies that make handoffs successful, and use them to establish goals for emergency departments
- develop a web-based toolkit that includes resources, assessment and support tools, and best practices
- develop education resources on palliative care in the emergency department to enhance knowledge and increase the number of emergency department-based palliative care programs
- and more.
ACEP has a strong focus on these issues of improving patient care and providing cost savings. To that end, multiple recommendations continue to be developed and adopted by the College. We are dedicated to ensuring that our specialty brings ideas that truly will improve care for the millions of patients we treat and provide real, substantial savings to the nation’s health care expenses.
ACEP News, January 2011 — More than a decade after issuing its first report on suicides in hospitals, the Joint Commission has followed up with a new one, reminding clinicians that suicides and suicide attempts can occur anywhere – not just in psychiatric units.
But emergency physicians say that suicides in nonpsychiatric units are part of a broader and more difficult problem to solve: a lack of appropriate care for psychiatric patients that forces other units – particularly emergency departments – to hold these patients in environments not designed for their safety.
Since 1995, the commission wrote, there have been 827 reports of patient suicides, 14% of which occurred in nonpsychiatric settings, more than half of these in emergency departments. The 827 cases represented only those voluntarily reported, the commission noted, and therefore is likely an undercount.
The suicides occurred in bathrooms, bedrooms, closets, showers, or just after patients left the hospital against medical advice. Patients hung, shot, lacerated, or asphyxiated themselves, jumped from high places, or ingested drugs. A number of suicides were carried out using materials immediately available in the hospital – bell cords, bandages, sheets, plastic bags, or elastic tubing.
As an emergency medicine resident, I remember taking tests and wondering where I stood compared to my peers. I would review different materials and focus on areas that I did not feel strong in. As a resident, I took the Ohio Acep review course and took their 700 question CD and reviewed all the explanations. I later was able to review the quiz questions and make suggestions.
Interesting enough, I was able to create the iPhone, Ipod Touch, * iPad edition of the quiz question for Ohio Acep. The app was just released and should show up on the app store in the next 48hrs. The app allows users to take the test and review each answer. It allows the user to focus on the questions or course materials they need to work on by creating custom test. The app also allows users to “know their ranking”, the app will ask users for an alias and will upload their test scores on each section of the test and will give an overall rank based on the users that have already taken the test. The ranking will update every time someone takes the test and clicks on ranking. To see the current ranking of beta testers and updated ranking please click here. To download the app or to see screen shots of the app click here.
* on iPad you will be able to double the size of the screen but the images might be slightly distorted.
Below I have included more information about the app.
Emergency Medicine Quiz Questions
On Sale for limited time, Price is 20% off.
Includes a new, 50-question pictorial review! Contains 700 review questions and referenced answers in an easy-to-use multiple choice format.
** “New Rankings feature, only users to see where they are ranked compared to their peers around the world. The app will rank each person based on subject and overall ranking depending on percent correct! Visit our website for more information.” **
The Emergency Medicine Review Course held annually by Ohio ACEP offers a comprehensive review for the physician preparing for the Qualifying examination, ConCert examination or continuous certification, or who simply desires an intensive review of emergency medicine. Attended by hundreds of physicians each year from across the country, this premier review course promotes high pass rates and receives high compliments.
Email us your feedback so we can make this app even better.
They have created this CD based on years of experience with preparing Emergency Medicine Physicians. The CD edition of this program retails for 100$ US Dollars.
The iPhone app is easy to use.
Endocrine, Metabolic & Nutritional Disorders
LifeLong Learning Self Assessment (LLSA)
In late December, the American Board of Emergency Medicine (ABEM) sent out letters to its diplomates outlining the process for Part 4 of its Maintenance of Certification program.
ACEP does not set the requirements or mandate the process of continuous certification. However, because many ACEP members expressed confusion about the ABEM letter, ACEP leaders wanted to try to help clarify the process for its members.
ACEP President-Elect Sandy Schneider, MD, had a conversation with ABEM President Debra Perina, MD, for ACEP News to pose some FAQs, get ideas on how to meet the patient communication portion, and clarify what qualifies as a quality assurance project.
Here are a few snippets:
SS: Can you break this down so we can understand exactly what is going to happen? I see there are two parts. Start with the patient communication survey.
DP: The Communications Professional Activity must be conducted one time in your 10-year cycle, which starts at the point when you are certified or re-certified. At one time during that 10-year cycle, each physician must complete an activity related to communication and professionalism. There are multiple ways you can meet that requirement …
SS: Let’s talk about Quality Assurance.
DP: The Patient Care Practice Improvement Activity is a four-step process that you have to complete twice during your 10-year cycle. You collect data that reflects what you are doing with your patients now. Then you compare that data to evidence-based guidelines … A perfect example is the ubiquitous aspirin in suspected STEMI. You want to give aspirin to those patients 100% of the time. We know many hospitals are looking at this initiative and giving feedback on patients that should have received aspirin … This is one very clear example of a qualifying activity that physicians are already doing …
SS: I believe one of the biggest reasons for the reaction to the new requirement is simply that it is new …
DP: We believe most individuals are already engaged in most of the activities that are being required. We are just trying to create a system that makes it as painless as possible to report what folks are already doing.