A new set of studies from the Institute of Medicine of the
National Academies reported that America's
emergency rooms are overrun with patients. So much so, the report said,
that ambulances get turned away and patients stack up in hallways for
hours -- even days -- awaiting beds to open up. The uninsured use emergency
rooms for care and the insured are sent to ERs by doctors for tests
that the doctors won't perform. All the while, there are fewer
Emergency Departments (EDs) and more patients in the ones that are left.
In addition, the report said it is getting more difficult for hospitals
to find specialists who are willing to be on call for ER duty.
Liability risk is a big factor.
The report said:
There were 113.9 [Emergency Department (ED)] visits in 2003, for example, up from 90.3
million a decade earlier. At the same time, the number of facilities
available to deal with these visits has been declining. Between 1993 and 2003, the total number of hospitals in the United
States decreased by 703, the number of hospital beds dropped by 198,000,
and the number of EDs fell by 425. ...
The result has been serious overcrowding. If the beds in a hospital
are filled, patients cannot be transferred from the ED to inpatient
units. This can lead to the practice of "boarding" patients -- holding
them in the ED, often in beds in hallways, until an inpatient bed
becomes available. It is not uncommon for patients in some busy EDs to
be boarded for 48 hours or more. These patients have limited privacy,
receive less timely services,
and do not have the benefit of expertise and equipment specific to
their condition that they would get within the inpatient department.
Another consequence of overcrowding has been a striking increase in the number of ambulance
diversions. Once considered a safety valve to be used only in the most
extreme circumstances, such diversions are now commonplace. Half a
million times each year -- an average of once every minute -- an ambulance
carrying an emergency patient is diverted from an ED that is full and
sent to one that is farther away. In 2004, according to the American
Hospital Association (AHA), nearly half of all hospitals -- and close to
70 percent of urban hospitals -- diverted patients at some point during
the year. Each diversion adds precious minutes to the time before a
patient can be wheeled into an ED and be seen by a doctor, and these
delays may in fact mean the difference between life and death for some
patients. Moreover, the delays increase the time that ambulances are
unavailable for other patients.
The report also pointed to other trouble spots:
Six
percent of U.S. EDs have all the supplies necessary for handling
pediatric emergencies and only about half of the departments had even
85 percent of the essential supplies. ... A
number of large cities do have children's hospitals or hospitals with
pediatric EDs that offer state-of-the-art treatment for children.
Unfortunately, the vast majority of ED visits by children are made
instead to general hospitals, which usually do not have either the
specially trained staff or the special equipment necessary to provide
the best care to these younger patients.
Doctors Told to Stop Shaving Surgical Sites
New
research suggests an end to a time-honored practice of shaving the area
of a person's body that will undergo surgery. The Texas Medical
Association said in an April report that it is time for doctors to stop:
Several organizations
ranging from the Institute for Healthcare Improvement (IHI) to the
National Patient Safety Foundation to the Texas Medical Association
have taken up the issue. And they hope to ban the razor from the
operating room once and for all.
The TMA said:
Shaving
the surgical site before an operation once was as routine as taking a
patient's blood pressure in a physical examination. But beginning more
than 40 years ago, medical experts began questioning whether the
microscopic skin abrasions caused by shaving might actually increase
the risk of postoperative infections, even in clean wounds.
In 1971, the American Journal of Surgery
published research indicating that unseen razor injuries released
bacteria into the surgical site. Several other studies conducted during
the 1970s reached similar conclusions.
And in 1981, physicians in Alberta, Canada,
published the results of a 10-year study of surgical site infections
that showed having patients shower with antimicrobial agents before
surgery and not shaving the surgical site reduced clean wound infection
rates.
But dropping the razor in favor of clippers, depilatories, or no hair removal at all has been a painstakingly slow process.
[TMA President Dr. Robert T.] Gunby [Jr.] says the tradition of shaving
surgical sites is so ingrained in the medical culture that change is
difficult.
"The
problem is the infection rate is so low, just 1 or 2 percent. Nobody
really sees many infections, so it's hard to get people to change. They
really don't believe that it's important."
Houston
neonatologist [Dr.] Michael Speer, ... a member of the TMA Board of Trustees
and chair of the Texas Patient Safety Alliance, says it's the "tyranny
of small numbers." If physicians, nurses, hospital administrators, or
others don't see large numbers of infections, they don't perceive that
there is a problem.
Even
though the rate of surgical site infections is statistically low, they
impact hundreds of thousands of patients each year in the United States.
According to a study published in 2004 by the National Surgical Infection Prevention Collaborative, surgical site infections complicate 780,000 operations annually in this country.
And,
IHI says surgical site infections account for 14 to 16 percent of all
hospital-acquired infections. What's more, patients who develop
surgical site infections are twice as likely to die as other surgical
patients, IHI says.
Understanding the CPI
The Consumer Price Index caught everyone's attention
yesterday when the Labor Department disclosed that the May CPI rose 0.4
percent. That comes after a 0.6 increase in April.
Once you exclude
energy and food (but then again, why would you?), core inflation is up 0.3
percent. All of this is important because it helps the Fed to
understand how fast inflation is rising. The Federal Reserve also found signs of a weakening economy yesterday.
At its June 28-29, experts say,
the Fed is almost sure to increase interest rates. Oddly enough, Wall
Street, having already baked in worse numbers than were released,
responded with a 100-point gain in the Dow.
So
what is the CPI and what does it really mean? Is it right to call it, as many
journalists do, The Cost of Living Index? How exactly
does the Labor Department measure inflation? The Bureau of Labor
Statistics explains:
The Consumer Price Index (CPI) is a measure of the average change
over time in the prices paid by urban consumers for a market basket of
consumer goods and services.
The CPI affects nearly all Americans because of the many ways it is used. Following are major uses:
-
As an economic indicator. More.
- As a deflator of other economic series. More.
- As a means of adjusting dollar values. More.
Is the CPI a cost-of-living index?
The CPI frequently is called a cost-of-living index,
but it differs in important ways from a complete cost-of-living
measure. A cost-of-living index is a conceptual measurement goal,
however, not a straightforward alternative to the CPI. A cost-of-living
index would measure changes over time in the amount that consumers need
to spend to reach a certain utility level or standard of living.
Both the CPI and a cost-of-living index would reflect changes in the
prices of goods and services, such as food and clothing that are
directly purchased in the marketplace; but a complete cost-of-living
index would go beyond this to also take into account changes in other
governmental or environmental factors that affect consumers'
well-being. ... More. ...
... BLS
has classified all expenditure items into more than 200 categories,
arranged into eight major groups. Major groups and examples of
categories in each are as follows:
- Food and Beverages (breakfast cereal, milk, coffee, chicken, wine, service meals and snacks)
- Housing (rent of primary residence, owners' equivalent rent, fuel oil, bedroom furniture)
- Apparel (men's shirts and sweaters, women's dresses, jewelry)
- Transportation (new vehicles, airline fares, gasoline, motor vehicle insurance)
- Medical Care (prescription drugs and medical supplies, physicians' services, eyeglasses and eye care, hospital services)
- Recreation (televisions, pets and pet products, sports equipment, admissions)
- Education and Communication (college tuition, postage, telephone services, computer software and accessories)
- Other Goods and Services (tobacco and smoking products, haircuts and other personal services, funeral expenses)
Also
included within these major groups are various government-charged user
fees, such as water and sewerage charges, auto registration fees, and
vehicle tolls. In addition, the CPI includes taxes (such as sales and
excise taxes) that are directly associated with the prices of specific
goods and services. However, the CPI excludes taxes (such as income and Social Security taxes) not directly associated with the purchase of consumer goods and services.
Whose buying habits does the CPI reflect?
The CPI reflects spending patterns for each of two population
groups: all urban consumers and urban wage earners and clerical
workers. The all-urban consumers group represents about 87 percent of
the total U.S.
population. It is based on the expenditures of almost all residents of
urban or metropolitan areas, including professionals, the
self-employed, the poor, the unemployed and retired persons as well as
urban wage earners and clerical workers. Not included in the CPI are
the spending patterns of persons living in rural nonmetropolitan areas,
farm families, persons in the Armed Forces, and those in institutions,
such as prisons and mental hospitals. ...
[What is the difference between CPI, PPI and ECI, which I often hear about on the business channels?]
... The
CPI measures inflation as experienced by consumers in their day-to-day
living expenses; the Producer Price Index (PPI) measures inflation at
earlier stages of the production and marketing process; the Employment
Cost Index (ECI) measures it in the labor market; the BLS International
Price Program measures it for imports and exports; and the Gross
Domestic Product Deflator (GDP Deflator) measures combine the
experience with inflation of governments (Federal, State and local),
businesses, and consumers.
The final question: How do they get this data?
It is an interesting
untold story that you may be able to localize. BLS data collectors,
called "
economic assistants," go out to retail stores, doctors' offices
and so on to price goods and services. These assistants determine the prices of 80,000 items each month.
You can see specific details of the CPI by going here. It shows, item by item, what is up or down and by how much.
Here are regional and major urban areas broken down:
BLS publishes three major metropolitan areas monthly:
-
Chicago, Ill./Gary, Ind./Kenosha, Wis.
- Los Angeles/Riverside/Orange County, Calif.
- New York/Northern New Jersey/Long Island, N.Y./Pennsylvania
Data
for the following additional 11 metropolitan areas are published every
other month -- on an odd- (January, March, etc.) or even- (February, April,
etc.) month schedule -- for the following areas:
- Atlanta (even)
- Boston/Brockton. Mass/Nashua, N.H/Connecticut/Maine (odd)
- Cleveland/Akron, Ohio (odd)
- Dallas/Fort Worth, Texas (odd)
- Detroit/Ann Arbor/Flint, Mich. (even)
- Houston/Galveston/Brazoria, Texas (even)
- Miami/Fort Lauderdale, Fla. (even)
- Philadelphia/Wilmington, Del./Atlantic City, N.J./Maryland (even)
- San Francisco/Oakland/San Jose, Calif. (even)
- Seattle/Tacoma/Bremerton, Wash. (even)
- Washington, D.C./Baltimore/Virginia/West Virginia (odd)
Semi-annually, data is available for these cities:
- Anchorage, Alaska
- Cincinnati/Hamilton, Ky./Indiana
- Denver/Boulder/Greeley, Colo.
- Honolulu, Hawaii
- Kansas City, Mo./Kansas
- Milwaukee/Racine, Wis.
- Minneapolis/St. Paul, Minn./Wisconsin
- Pittsburgh
- Phoenix/Mesa, Ariz.
- Portland, Ore./Salem, Wash.
- St. Louis/Illinois
- San Diego
- Tampa/St. Petersburg/Clearwater, Fla.
Pet Mummies
Want to keep Fido around forever? Maybe mummification is the answer. For a small animal, it could cost you $6,000 -- and more than $100K for a big one.
The fee will buy you a bronze, marble, gold leaf or patina encasement
for your preserved pet. You can get birds, cats -- you name it --
mummified.
Summum, a Salt Lake City
company, says it takes four to eight months to complete the process. They
will even place special toys or blankets in the mummiform.
You know, Egyptian animals were mummified just as humans were. The oldest-known cat is a 9,500-year-old kitty found on Cyprus.
We are always looking for your great ideas. Send Al a few sentences and hot links.
Editor's Note: Al's Morning Meeting is a compendium of ideas,
edited story excerpts and other materials from a variety of Web sites,
as well as original concepts and analysis. When the information comes
directly from another source, it will be attributed and a link will be
provided whenever possible. The column is fact-checked, but depends
upon the accuracy and integrity of the original sources cited. Errors
and inaccuracies found will be corrected.
