"The Daily Dose"

There’s no phone and no television. Only a screen offers privacy. But heart patient Edward Gray understands why the hospital put him in a cardiac unit hallway.

“They sent me up here to make room for other emergency patients,” Gray, 78, said last week from his bed in the hall of a New York area hospital. “This is the way things are in hospitals.”

It may not sound like ideal health care, but hospital officials nationwide are being urged to consider hallway medicine as a way to ease emergency department crowding, and some are trying it.
Leading the way is Stony Brook University Medical Center at Stony Brook, N.Y., where a study found that no harm was caused by moving emergency room patients to upper-floor hallways when they were ready for admission.

The study’s lead author says all hospitals should look at the program’s success.

“This is yet another battle cry for hospitals to get off their duffs and stop stacking people knee deep in the emergency department,” said Dr. Peter Viccellio, who is clinical director of the hospital’s emergency department.

He is to present the study’s findings Tuesday at a meeting of the American College of Emergency Physicians in Chicago.

Hospital-wide problem
Crowding is a hospital-wide problem that has been handed off to emergency departments, Viccellio said. His idea hands the problem back to the entire hospital.

Before the change, when his hospital filled up, patients were admitted but held in the ER in a common practice called boarding. On busy days, “things would grind to a halt and people would wait to be seen,” Viccellio said. Infectious patients would wait in the ER’s hallway for isolation rooms to open up elsewhere in the hospital.

Holding patients in ERs can cause deaths, doctors say. In a 2007 survey of nearly 1,500 emergency doctors, 13 percent said they personally experienced a patient dying as a result of boarding in the emergency department. The survey was conducted by the American College of Emergency Physicians.

The new study found slightly fewer deaths and intensive care unit admissions in the hallway patients compared to the standard bed patients. That was no surprise, Viccellio said, because the protocol calls for giving the first available rooms to the sickest patients. Intensive care patients never go to hallways.

The study is based on four years of Stony Brook’s experience with more than 2,000 patients admitted to hallways from the ER.

Other hospitals resist the idea, doctors say. Dr. Michael Carius, who heads the emergency department at Norwalk Hospital in Norwalk, Conn., would like it adopted at his hospital. But nurses and government regulators have resisted, citing safety issues, “as though the emergency department hallway is a safer environment,” he said in frustration.

“When you’re full of admitted patients, you’re no longer an emergency department, you’re just a holding area,” Carius said.

‘They could see the problem’
In Texas, all it took to convince nurses at Harris Methodist Fort Worth Hospital was a tour of the ER, said Barbara VanWart, emergency nurse manager.

“They could see the problem and help us make things happen because now it’s before their eyes,” VanWart said. The hospital started its hallway protocol in 2005.

Dr. Kirk Jensen of the nonprofit Institute for Healthcare Improvement in Cambridge, Mass., said the best reason to adopt the concept is the way it gets the whole hospital involved in finding rooms more quickly for admitted patients.

“It’s out of sight, out of mind, even if they know that patients are there in the emergency department,” Jensen said. With patients in their own hallways, “they get a lot more creative and aggressive with workflow practices.”

When Stony Brook began the hallway practice, the staff noticed “the miracle of the elevator,” said Carolyn Santora, who heads the hospital’s patient safety efforts. Somehow, rooms became available by the time hallway-bound emergency patients made it upstairs, she said.

Nurses hate seeing patients in their hallways, Santora said, and that’s fine with her.

“I want them to hate it. I want them to do everything to expedite flow to get the patient out of hallway.”

Gray, the hallway patient at Stony Brook, came to the ER with chest pains and was stabilized before being sent upstairs. He is a retired nurse and said hospital crowding deserves attention from lawmakers.

“I wish the $700 billion went for hospitals, roads and bridges and not to bail out those folks on Wall Street,” he said.

Read entire article at http://www.msnbc.msn.com/id/27389321/

Food and milk from the offspring of cloned animals may already have entered the U.S. food supply, the Food and Drug Administration said on Monday, but it would be impossible to know because there is no difference between cloned and conventional products.

The FDA said in January meat and milk from cloned cattle, swine and goats and their offspring were as safe to eat as products obtained from traditional animals. Before then, farmers and ranchers had followed a voluntary moratorium that prevented the sale of clones and their offspring.

“It is theoretically possible” offspring from clones are in the food supply, said Siobhan DeLancey, an FDA spokeswoman. “I don’t know whether they are or not. I could imagine there are not very many of them.”

Proponents, including the Biotechnology Industry Organization, say cloned animals are safe and a way to create animals that produce more milk and better meat and are more disease-resistant. There are currently an estimated 600 cloned animals in the United States.

The small cloning industry and the FDA have maintained cloned animals and their offspring are as safe as their regular counterparts. Cloning animals involves taking the nuclei of cells from adults and fusing them into egg cells that are implanted into a surrogate mother.

U.S. Agriculture Department spokesman Keith Williams said ”there is no way to differentiate” between cloned animals, their offspring and conventionally bred animals, making it difficult to know if they are in the food supply.

Even as the FDA unveiled its final rule, USDA asked in January for the cloning industry to prolong the ban on selling products from cloned animals during a “transition” period expected to last at least several months. That ban would not extend to meat and milk from the clone’s offspring.

Read the entire article at http://www.msnbc.msn.com/id/26512009/