As the opioid epidemic deepens, Yale researchers say starting treatment with medication is the most cost-effective way to treat patients in hospital emergency departments. People with opioid addiction often seek treatment in EDs for overdoses and other ailments. Those who receive buprenorphine, a medication that reduces drug cravings, in the ED incur lower health care costs over the following month than those who get a referral to treatment services or receive a brief intervention with a facilitated referral, according to a new analysis of a randomized clinical trial. The analysis, published today in the journal “Addiction,” compared the estimated health care costs for patients over the 30 days following their ED visit. Those costs included ED care, addiction treatment, inpatient and outpatient costs and medications.
The state Medical Examining Board Tuesday fined a Yale New Haven Hospital doctor $10,000 for abandoning a patient who was detoxing and reached an agreement with a Norwalk doctor to stop practicing medicine because his lapse in care contributed to the death of a patient. Dr. Martin Perlin of Norwalk admitted no wrongdoing but agreed to stop practicing medicine on Aug. 31. The consent order the board approved Tuesday also reprimands him and places his license on probation. It said that Perlin’s lapses in care contributed to a patient death and serious injury to another patient.
In less than eight hours last June, Yale New Haven’s emergency department treated 12 patients who had overdosed on opioids. Three died; nine were saved. With opioids in wide circulation, Dr. Gail D’Onofrio, chief of emergency medicine at the hospital and chair of emergency medicine at Yale School of Medicine, isn’t sure that one-day spike will stand as a record. “To be honest, no, I don’t expect the numbers to get better,” D’Onofrio said. “We’re going to have more treatment options in Connecticut, I think, more safe prescribing — but I don’t know that we’ll see improvements in the numbers of people using.”
D’Onofrio’s concerns are borne out in a recent report by the Agency for Healthcare Research and Quality (AHRQ) that ranks Connecticut the 5th highest among 30 states in the rate of opioid-related emergency department (ED) visits — 254.6 per 100,000 population in 2014, well above national rate of 177.7.
The state’s efforts to direct children in mental health crisis away from emergency rooms, to other services, have fallen short, with major hospitals reporting staggering increases in patient visits since 2013: Up 32 percent at Connecticut Children’s Medical Center, and 81 percent at Yale New Haven Hospital. The children’s hospital (CCMC) reported nearly 3,300 visits last year – 275 a month, on average — with the average length of stay increasing to 15 hours from less than 12 in 2013. “I wish I could say we had made a lot of progress, but we haven’t,” said Dr. Steve Rogers, medical director of the emergency department’s (ED’s) behavioral health unit. “Unfortunately, I think it’s only going to keep trending this way.”
Similarly, Yale saw ED visits by children ages 15 and younger rise from fewer than 750 in 2013 to more than 1,350 in 2016 — and the numbers are running even higher this year, said Dr. Claudia Moreno, medical director for psychiatric emergencies in Yale’s children’s emergency department. At times, she said, all ED beds are full, and children wait on hallway gurneys.
A growing number of women are getting hurt by falling, and they are much more likely to suffer fall-related injuries than men, data show. From 2011 to 2014, 51 women per 1,000 population were hurt in falls, up from 47 per 1,000 from 2005 to 2008, according to recent data from the National Center for Health Statistics and the Centers for Disease Control and Prevention (CDC). Falls were the most common cause of nonfatal injuries to women, the report found, and significantly outpaced injuries from overexertion, the second leading cause of injury that afflicted just 14 per 1,000.
Hormone-related changes associated with menopause are the main reasons women are so prone to falling, especially as they age, said Dr. Karen Sutton, an orthopaedic surgeon, director of Women’s Sports Medicine at Yale New Haven Hospital, and associate professor of orthopaedics and rehabilitation at the Yale School of Medicine. “Their muscles are weaker, their bones are weaker,” she said, since hormone changes lead to reduced bone mass and the onset of osteoporosis in many women.
Nearly half of Connecticut hospitals – 14 out of 31 – will lose a portion of their Medicare payments in 2017 as a penalty for having too many patients who acquired preventable infections and injuries while hospitalized. The hospitals are among 769 nationwide that will lose one percent of their Medicare reimbursements this year as part of the Centers for Medicare and Medicaid Services’ (CMS) Hospital-Acquired Condition Reduction Program. The CMS program, now in its third year, penalizes the lowest-performing hospitals where a relatively high number of patients got infections from hysterectomies, colon surgeries, urinary tract catheters and central line tubes. It also takes into account patients who suffered from blood clots, bed sores or falls while hospitalized. New this year, CMS also factored in the incidents where antibiotic-resistant bacteria – namely, methicillin-resistant staphylococcus aureus (MRSA) and Clostridium difficile (C.
As the number of elderly drivers steadily increases, the decision about when it’s time to stop driving often falls to their children, who must make the gut-wrenching choice to take away the car keys, and often, their parents’ independence. But two Connecticut doctors are studying various aspects of elderly driving and their findings could eventually make the decision-making process easier or perhaps even keep elderly drivers on the road longer. At Yale New Haven Hospital, geriatrics researcher Dr. Richard Marottoli is studying driving longevity in women compared to men. He’s working to identify gender differences, determine whether women are more likely to stop driving sooner than men, and whether there is any relationship between brain volume, adverse driving experiences and medical history as it relates to the ability to drive safely. At UConn Health Center on Aging in Farmington, Dr. Kevin Manning, a neuropsychologist and assistant professor of psychiatry, is conducting a separate study using a Patterson Grant, defining what aging factors affect driving ability, identifying correctable difficulties that could help extend the driving lifetime and measuring how loss of a driver’s license is associated with the risk of depression and mortality.
Reported cases of tuberculosis jumped 17 percent in Connecticut from 2014 to 2015, mirroring a national and global trend and prompting federal officials to ask primary care providers to be on the alert for at-risk patients. The state Department of Public Health (DPH) said 70 people, in 29 towns, were reported with active TB, the contagious form of the disease, in 2015, compared with 60 the year before. About 80 percent of Connecticut patients were foreign-born, many from Asian countries. Nationally, TB cases totaled 9,563 last year, an increase of 157 over 2014. It was the first jump in cases after more than two decades of annual declines, the U.S. Centers for Disease Control and Prevention (CDC) reported.
Connecticut hospitals reported increases in patient deaths or serious injuries due to falls and medication errors in 2015 compared to 2014, but an overall drop in “adverse events,” according to a new state report. The report, by the Department of Public Health (DPH), shows that the total number of medical errors dipped by 3 percent – from 472 in 2014, to 456 in 2015. There were 90 instances when patients died or were seriously injured in falls, up from 78 in 2014. Seven falls that resulted in injury or death were reported at Yale New Haven Hospital, St. Vincent’s Medical Center and UConn’s John Dempsey Hospital.
A Superior Court judge is expected to decide by year’s end whether to limit the allegations in a lawsuit filed by the estate of a newborn, Calvin Jimmy Lee-White, who died after being given a dietary supplement at Yale New Haven Hospital in 2014. The infant’s grandfather, Rickie Hanes of North Haven, on behalf of the baby’s estate, is suing the hospital and the supplement manufacturer, Solgar, and its parent company NBTY. Yale New Haven, Solgar and NBTY argued in court in August that various claims against them—including reckless disregard for safety and fraudulent misrepresentation of a product’s safety—should be eliminated. Angelo Ziotas, an attorney representing the Lee-White estate, says a written ruling by New Haven Superior Court Judge Steven Ecker will likely come by the end of December, and the judge has set June 2017 as the date to complete discovery and fall 2018 as the trial date. Lee-White, the son of Samantha Pineapple Lee and Aaron White, was born prematurely by C-section on Oct.