Imaging during low back pain ED visits: a claims-based descriptive analysis.

OBJECTIVE: Low back pain (LBP) is a common reason for emergency department (ED) visits. This study aimed to determine the frequency and type of nonindicated imaging during LBP ED visits and to describe demographic and prior health care use characteristics among the nonindicated population. METHODS: This study included index ED events for LBP occurring during 2011 through 2012 for Blue Cross Blue Shield of Michigan commercial members ages 18 to 64 years. We identified LBP imaging indications within 12 months before the index event. Frequency estimates of patient demographics, imaging prevalence, type of imaging, and prior health care use characteristics stratified by imaging and indication status are presented with 95% confidence intervals (CIs). RESULTS: Of the 14838 total events, 51.9% (95% CI, 51.1%-52.7%) did not have indications for imaging. Patients without imaging indications were less likely to have had ED visits, hospital stays, LBP, lower back imaging, primary care physician visits, and back-related specialist visits in the past year compared with patients with indications. Among nonindicated patients, 30.1% (95% CI, 29.1%-31.1%) received imaging; of these, 26.2% received advanced imaging (computed tomography or magnetic resonance imaging). Nonindicated patients who received imaging were slightly older than those who did not receive imaging (27.6% [95% CI, 25.8%-29.4%] were ages 55-64 years vs 20.6% [95% CI, 19.6%-21.7%]) and had a higher prevalence of observation/treatment room use (7.3% [95% CI, 6.2%-8.4%] vs 1.2% [95% CI, 0.9%-1.4%]). CONCLUSIONS: Our results suggest that a substantial proportion of the patient population presenting to the ED for LBP receives nonindicated imaging, revealing opportunities to reduce costs and radiation exposure.

Evaluation of the B-SAFE campaign to reduce clinically significant warfarin-drug interactions among fee-for-service Medicare beneficiaries.

The objective of this study was to evaluate the effectiveness of a health communication campaign designed to reduce the rate of serious warfarin-related drug interactions. The B-SAFE campaign was conducted in 2009 to educate patients located in a Michigan hospital's service area about the risk of serious adverse drug events associated with warfarin. The rate of warfarin-related drug interactions among Medicare fee-for-service (FFS) patients admitted to the exposed hospital with hemorrhagic complications was compared with the rate of warfarin-related drug interactions among a similar cohort admitted to a control hospital before and after the campaign. The χ(2) test and logistic regression were used to analyze differences. The authors observed a marginally significant decline in the rate of warfarin-related drug interactions (odds ratio [OR] = 0.66; 95% confidence interval [CI] = 0.33-1.29) among FFS Medicare patients admitted for bleeding complications to the hospital targeted by the B-SAFE campaign. The same association was not observed in the control hospital (OR = 1.15; CI = 0.42-3.14). These findings suggest that patient exposure to the B-SAFE campaign may have resulted in a decrease in the rate of clinically significant warfarin-related drug interactions.

The effect of selected hospital characteristics on the timeliness of antibiotic administration for pneumonia.

In this study, we compared large urban teaching hospitals (group 1) with small nonurban nonteaching hospitals (group 2) in terms of administering antibiotics to patients admitted with pneumonia within 4 hours of hospital arrival. The following 2 independent data sets were used: hospital-reported data (comprising 22 193 patients with pneumonia discharged from Michigan hospitals in 2003) and hospital surveillance data (comprising 1053 randomly selected patients with pneumonia in Michigan from 2002 to 2004, reviewed by a central data abstraction center). Using hospital-reported data, the mean antibiotic timeliness rates were 65.9% (95% confidence interval [CI], 61.5%-70.2%) for group 1 and 79.5% (95% CI, 76.8%-80.2%) for group 2 (P<.001). Using hospital surveillance data, the mean antibiotic timeliness rates were 58.2% (95% CI, 52.9%-63.5%) for group 1 and 70.1% (95% CI, 63.7%-76.6%) for group 2 (P = .01). These results support efforts to reduce logistical barriers to pneumonia antibiotic timeliness at large hospitals.

The Emergency Medical Treatment and Active Labor Act: what emergency nurses need to know.

The Emergency Medical Treatment and Active Labor Act (EMTALA) is a federal statute that should be recognized and understood by all nurses who work in an emergency department or other settings where patients with potential emergencies may present themselves for care. It is a law that imposes specific legal requirements on hospitals in terms of medical screening, stabilization, and transfer of patients, regardless of whether they are outpatients or inpatients. As agents of the hospital, nurses are responsible for maintaining compliance with EMTALA regulations. This article reviews the components of EMTALA and the ways in which they are applied to clinical nursing practice.