Mike Smith, MD, MBA, FACEP, FACPE, FACHE

The editorial team at Journal Of Emergency Nursing would love to hear about what you are reading in the May issue of JEN. Thank you Casey Green BSN, RN, RRNA, CCRN-CMC, CTRN, CFRN, CEN, TCRN, CPEN, CNRN, NRP and Sarah Wells, MSN, RN, CEN, CNL for giving our readers a tour of the May issue and starting this trend. What is your favorite article in the May issue? What would you like to see published in JEN?

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🌟 Whether you’ve determined now is the time for you to begin the process toward FACHE or you’re still deciding, the next stop on your journey is our FACHE Overview Webinar. This webinar is free for you to attend but it requires registration. Learn more and save your place here: https://bit.ly/3MkxxT8

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Sullivan senior consultant Shawn Craddock, DNP, RN, CNOR, NE-BC, discusses procedural sedation and analgesia considerations for ASC leaders and the effect on patients in this article from OR Manager. Hear from Shawn about balancing anesthesia practices based on therapeutic effects, patient safety, practitioners' skills and credentials, and cost-effectiveness. Read more from OR Manager here.

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APP Highlight: Dr. Laura L. Ardizzone – 3 Key Lessons from a Remarkable CRNA Leader 1. CRNA Expertise: Laura’s journey as a CRNA underscores the critical role anesthetists play in patient outcomes, managing complex anesthesia to prevent respiratory depression, and ensuring patients safely emerge from surgery. She emphasizes being well-prepared academically and clinically to excel in this high-stakes field. 2. Assertive Advocacy for Patient Safety: As Laura has shown, CRNAs must be assertive, advocating relentlessly for patient safety. She believes that confidence and communication with the entire surgical team are essential skills that make a life-saving difference in complex scenarios. 3. Commitment to Continuous Learning: With her MBA from Cornell University, Laura gained vital financial skills, especially leveraging P&L insights to advocate for staff resources and hospital improvements. This commitment to lifelong learning drives her leadership of CRNA strategy across multiple facilities at Memorial Sloan Kettering Cancer Center, where she’s preparing for the future of anesthesia care, particularly as AI reshapes healthcare delivery. Laura’s career is an inspiring blend of clinical excellence, strategic thinking, and mentoring future CRNAs. We really connected as individuals who both integrated MBA and DNP learnings in our leadership practice. Her story reminds us of the profound impact continuous growth and assertive patient advocacy can have on both professional and personal success.

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Interesting read

"However, these savings—as much as $50 billion annually1—are unreported and not shown to improve care access for patients without adequate insurance.2,3" ---Well, the financial design is so bad that it has closed over 600 hospitals since DRG and the era of cost cutting. The financial design is the reason for closures and compromises. The 50 billion distributed to hospitals serving vulnerable populations (40 - 50% of US pop) would be some help due to the Era of Cost Cutting 1983 to 2030 or longer. "Per CMS’s budget neutrality principle in the Outpatient Prospective Payment System (OPPS), the $9 billion repayment must be offset by $7.8 billion of cuts to nondrug reimbursements." ---Budget neutrality and regulatory capture prevent any true reform to add support to the hospitals and practices serving most Americans most behind. Once again CMS is not accountable and must be reigned in even if it takes 50 years as it did for physician accountability over the last half of the 19th century and for human subject researchers over the last half of the 20th century. Medicare and Medicaid have failed for 2621 counties (40% of US) most behind and has primary care and basic health access except 1965 to 1978. What about the Belmont Principles and numerous violations? What about protection of vulnerable populations, informed consent (which requires prior study of consequences poorly done by CMS), or beneficent intent - especially with all three lining up consistently against the majority of the nation most behind time after time! Strike 1 for ethical and moral violations - CMS has demonstrated time and again the inability to protect their charges - vulnerable Americans. CMS most fails where there are concentrations of elderly, poor, disabled, and their worst public plans. Strike 2 - CMS has failed to do adequate studies of consequences prior to the implementations of policies since 1983 and including Medicaid Waivers which will steal more from team member support and give more for team members to do - with worst impacts on Community Health Centers with 50% Medicaid and in the most vulnerable populations highest in concentrations of Medicare, Medicaid, and Dual plans. Studies are done more to justify what CMS is doing rather than to protect most Americans most behind from consequences such as their providers rated poorly or penalized just for caring for these populations inherently lower in outcomes and drivers of outcomes (Readmissions, ACO shared savings, Star Ratings, others) Strike 3 - CMS fails for beneficent intent. The intent is cost cutting. CMS harms tens of millions with designs that have killed hundreds of hospitals and countless practices, delivery team members, and local leaders in health and other community areas. We know about some economic and access impacts from these losses, but the full impact and cascades of impacts are never studied. See comments for losses of jobs, income, leadership, and better health insurance

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Most viewed in the last 7 days from JAMA Health Forum: This JAMA Forum discusses the responsibilities of public health agencies that overlap with those of the CDC and argues that the role of the CDC could be redirected to better meet the needs of its core mission. https://ja.ma/40jMUU6

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It's #NationalHospitalWeek which provides an opportunity to highlight the innovative ways that hospitals and health systems are supporting their communities. Take it from me, many pioneering and cutting edge hospitals are deploying geographic information systems (#GIS) in myriad ways to manage population health, understand accessibility issues, examine inequitable outcomes, improve the use of their brick and mortar facilities, and streamline their planning and operations. My paper shares several example use cases that are making hospitals stronger and communities more resilient. https://lnkd.in/euQ2xAha #HealthGIS #Hospitals #HealthSystems #DigitalTransformation

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Respiratory failure is far and away the number one query at every hospital we consult at. I think the ACDIS white paper highlighted by Brian Murphy is great, except this statement: "Acute hypoxic respiratory failure is defined as PaO2 < 60 mmHg, SaO2 <88%–90% on room air, oxygen needs of 30% or greater to maintain SaO2 > 90%" I agree with the <88-90% (hospital dependent) but the 30% use of oxygen is not based on science or accepted standard from any pediatric organization. Exactly how much oxygen a patient is getting isn't even clear when on nasal cannula or face mask. There are some guidelines people use that discuss each LPM (liter per minute) being X% of oxygen, but most pulmonologists don't agree with those numbers. So does a child need to be on 2-3 LPM of oxygen to qualify for resp failure? Absolutely not. Any amount of oxygen needed to maintain saturations > 88-90% plus acute resp symptoms should qualify for "acute resp failure" according to the many children's hospitals that my team at Pediatric Resource Group (PRG) represents. I don't want hospitals to limit their use of this diagnosis/query based on that 30% (2-3 LPM) criteria in this paper.

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I will continue to push back and say that criticizing the staffing mandate without mentioning how many Federal dollars are siphoned away to real estate and related parties does a great disservice to the discussion. That includes non-profit operations that have for-profit related parties and real estate. There are also thousands of quality facilities that staff at adequate levels and are financially viable. My inspiration comes from the thousands of facilities that are understaffed and provide poor quality care, and articles like this one: https://lnkd.in/grNSU3eS

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Exciting to see the 2024 Draft Federal FHIR Action Plan from ONC! This is a critical step forward in advancing healthcare interoperability and improving patient care. Nursing informaticians have a key role in leveraging FHIR standards to streamline data exchange and enhance outcomes. Looking forward to the impact this will have on healthcare IT! #HealthcareIT #FHIR #NursingInformatics #Interoperability

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I totally agree with you Tom Parker on many fronts. A one-size fits all staffing model unfairly ties a facility's proverbial hands behind their backs given the need to take into account resident's diverse requirements, geographic/demographic differences, facility size and core competencies within a building. All of that has to be dealt with before any consideration can be given to team member preferences to promote retention. Flexibility and adaptability are essential for long term care providers to survive. They need the ability to be agile and pivot based upon their needs NOT another barrier. #skillednursingfacilities #ltcstaffing #ahca #ahcancal

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CMS posted the final rule this afternoon. Still reading through it, but the aggregate is basically flat. It's a .5% increase ($85 million) net increase. LUPA add on factor of 1.7238% for OT, and updates for the LUPA Rate for other disciplines. Wage Index Rates seem to be what was published with no CBSA code allowed to go decrease more than 5%. Some new CBSAs, and some updates from rural to urban and urban to rural. COPs were adopted as proposed as far as I can tell. Agencies have to post plans on patient acceptance to service policy. "Acceptance-to-service policy that is applied consistently to each prospective patient referred for home health care. We are finalizing a requirement that the policy must address, at a minimum, the following criteria related to the HHA’s capacity to provide patient care: the anticipated needs of the referred prospective patient, the HHA’s caseload and case mix, the HHA’s staffing levels, and the skills and competencies of the HHA staff. This final rule does not prevent HHAs from maintaining their existing acceptance-to-service policies; rather, it is intended to complement them. Additionally, CMS is finalizing that HHAs must make available to the public accurate information regarding the services offered by the HHA and any service limitations related to types of specialty services, service duration, or service frequency." Agencies need to be careful to have documented plans on accepting or not accepting patients AND remain consistent in that policy. https://lnkd.in/gdzwRmQ6

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Viewpoint discusses the importance of researcher access to federal health care data following a CMS decision to limit the use of physical data and proposes solutions to maintain access and security. https://ja.ma/3Rh7uzg

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KH's most recent Flash Report unveils promising signs of financial performance, with a notable slowing of margin decline. The widening gap between lower and higher performing organizations highlights the focus on long-term investment and innovation in high-performing orgs. Lower performing organizations must focus on enhancing efficiencies and reworking key elements like their operating model and portfolio management. Explore the insights in the report here: [National Hospital Flash Report May 2024 Metrics](https://lnkd.in/ggUcyDPh). For resources to boost performance, visit us at https://lnkd.in/enBa3Tp

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