Health : Health Buzz: Number of Emergency Rooms Declines

Health Buzz: Number of Emergency Rooms Declines
Health Buzz: Patients May Suffer From Delusional Infestations
Our Methodology: Inside the 2011-12 Best Children's Hospitals Rankings
Best Children's Hospitals 2011-12: Guide to the Terms
2011-12 Best Children's Hospitals: the Honor Roll

Health Buzz: Number of Emergency Rooms Declines

Posted: 18 May 2011 08:03 AM PDT

Study: Emergency Rooms Closing as Patient Demand Rises

Nearly 30 percent of hospital emergency rooms closed over the last two decades—an alarming trend as ER visits continue to jump, new research shows. In 1990, there were 2,446 hospitals with emergency rooms in non-rural areas; that number dropped to 1,779 in 2009, according to findings published Tuesday in the Journal of the American Medical Association. Meanwhile, total emergency room visits rose by more than 35 percent. The emergency rooms that closed typically had low profit margins; served patients below the poverty level with poorer forms of insurance, like Medicaid; and were located in competitive markets. The trend is problematic because it means remaining ERs are overcrowded, require patients to wait longer for care, and can't provide optimal care, the researchers said. "This is a continuously deteriorating situation," study author Renee Hsia, an emergency physician at the University of California--San Francisco, told Reuters. "It's a threat to everyone's care."

When a Hospital Is Bad for You

The U.S. News Best Hospitals rankings and other resources can help steer you to a top-notch hospital when a procedure or condition requires exceptional skill. For routine care, such as repairing a torn rotator cuff or inserting a heart stent, most hospitals will do a fine job. Still, "most" is not "all." Sometimes a particular hospital can be the right choice for some patients but the wrong one for you.

There aren't many hospitals so terrible that they're lethal. A 50 percent death rate or other glaring red flag would prompt padlocks on the doors. But you don't want a place that has little experience with your surgical or medical needs—or is less alert than it should be for anything that could go wrong. Rates of postsurgical complications such as bleeding, infection, and sudden kidney failure vary surprisingly little, according to a study last year of nearly 200 hospitals across the country.

What does differ are deaths from such complications, says John Birkmeyer, a professor of surgery at the University of Michigan Medical School and the study's coauthor. Mortality rates at some hospitals in the study were almost twice as high as at others. A good hospital, says Birkmeyer, catches problems and responds quickly. [Read more: When a Hospital Is Bad for You.]

What Hospital Certifications Say—and Don't Say

Someone diagnosed with a deadly brain tumor is likely to seek out one of the U.S. News Best Hospitals. But let's be honest. If you suffer from diabetes or even breast cancer—and certainly if you're in an ambulance battling a heart attack or stroke—you're going to head for a hospital in town.

How to choose among the ones near you? Research shows that most people ask friends and relatives, especially those in the medical profession, says Eric Schneider, associate professor of medicine at Harvard Medical School and a senior scientist at the Rand Corp. But growing consumer demand for measures that are more objective has professional groups scrambling to provide official certifications for hospital programs that meet standards for treating specific diseases. The American Heart Association, for example, recognizes institutions that treat heart attacks or strokes according to specific evidence-backed guidelines, while a consortium led by the American College of Surgeons flags breast cancer centers that go the extra mile. To qualify, hospitals typically report in categories from physician credentials to patient testing to medication timing—in other words, how closely they adhere to practice guidelines established by the top medical groups in the field. Next comes a visit by the certifying group's outside experts.

Certifications can be valuable tools for consumers because they encourage participating hospitals to find (and presumably fix) systemic problems, Schneider says. Moreover, those taking the trouble to get these stamps of approval (aside from considerable time, applying can run from several thousand dollars to as much as $50,000) likely specialize in treating the specific disease. And the fact that outside experts peer over the hospital wall means patients can assume at least minimal standards of care. [Read more: What Hospital Certifications Say—and Don't Say.]

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Health Buzz: Patients May Suffer From Delusional Infestations

Posted: 17 May 2011 08:20 AM PDT

Some Patients Suffer From Delusional Infestations

Sometimes, creepy-crawly sensations are all in the head. People who complain that they're infected with bugs, worms, eggs, or fibers typically have a clean report on medical exams, according to a study published Monday in the Archives of Dermatology. Researchers tested the skin of more than 100 people who believed they were infested with parasites, and in all but one case, physicians came up with nothing—calling the condition "delusional parasitosis." Most of the patients involved in the study had inflamed, itchy skin, and many had ulcers; the researchers say that dermatitis or another condition could be misinterpreted as the feeling of bugs in the skin. "Patients become desperate because they feel their skin is infested with things like insects, bugs and worms," study author Mark Davis, a professor of dermatology at the Mayo Clinic in Rochester, Minn., told HealthDay. "They become very preoccupied with it and try to extract it with forceps and knives, and they go to lots of doctors to try to get a diagnosis so they can get an antibiotic to get rid of it. We see many patients whose lives are ruined."

Our Methodology: Inside the 2011-12 Best Children's Hospitals Rankings

Seriously sick kids need a level of expertise that most hospitals don't have. At the vast majority of hospitals, all but a few inpatients are adults, and children, as medical school instructors drum into into student physicians, aren't small adults. They are more vulnerable to infections because their immune systems aren't fully developed. They respond to medications faster and are more sensitive to too much or too little. Their treatment may be much different than for an adult with the same condition. Moreover, kids are smaller; operating on hearts the size of a walnut and starting IVs in tiny veins are only two of the challenges that pediatric specialists face day in and day out.

Best Children's Hospitals focuses on medical centers whose young patients come with cancer, cystic fibrosis, defective hearts, and other life-threatening, rare, or demanding conditions. The rankings showcase the top 50 children's centers—20 more than last year—in each of 10 specialties: cancer, cardiology and heart surgery, diabetes and endocrinology, gastroenterology, neonatology, nephrology, neurology and neurosurgery, orthopedics, pulmonology, and urology.

In all, 76 different hospitals are ranked in at least one specialty. The Honor Roll recognizes 11 hospitals with high scores in at least four specialties. [Read more: Our Methodology: Inside the 2011-12 Best Children's Hospitals Rankings.]

2011-12 Best Children's Hospitals: the Honor Roll

The average kid will never get sick enough to see the inside of a hospital room. But "average" means nothing if it's your child who is admitted, and less than nothing if she has a problem that calls for the utmost in medical skill. What do you do if your child has a heart defect, or a disorder that interferes with digestion? Out of all of the roughly 5,000 U.S. hospitals, only about 1 in 30 has deep expertise in caring for children with serious problems. For youngsters who need that quality of care, the Best Children's Hospitals rankings showcase the medical centers that every day see kids who have cancer, cystic fibrosis, defective hearts, and countless other life-threatening or rare conditions beyond the capabilities of most hospitals, even those with sizable pediatric departments.

In this year's Best Children's Hospitals, 76 different hospitals ranked among the top 50 in at least one of 10 specialties: cancer, cardiology and heart surgery, diabetes and endocrinology, gastroenterology, neonatology, nephrology, neurology and neurosurgery, orthopedics, pulmonology, and urology. Eleven were named to the Honor Roll for high scores in four or more specialties.

The rankings rely on a reputational survey sent to pediatric specialists and a data survey sent to a handpicked set of hospitals. For the specialist survey, 150 physicians in each specialty were asked to name up to five hospitals they consider best for children with serious or difficult problems in their field, without regard to cost or geography. The last three years of responses were totaled. [Read more: 2011-12 Best Children's Hospitals: the Honor Roll.]

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Wednesday, May 18, 2011

Health : Health Buzz: Number of Emergency Rooms Declines

Health : Health Buzz: Number of Emergency Rooms Declines

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