EPtalk by Dr. Jayne 4/10/25

An article in Nature Medicine caught my eye this week. It examined the results of a tool that looks at real-time data for patient deterioration. These kinds of tools have been under evaluation for a while, but this one differs from some of the other ones out there because it looks at the content of nursing notes as opposed to the laboratory and vital signs data that are used by many other options. The Communicating Narrative Concerns Entered by RNs (CONCERN) tool was found to reduce sepsis risk by 7%, length of stay by 11%, and risk of death by 35%.

The study was conducted across two health systems with 60,000 hospital encounters and took place in 53 acute care units and 21 intensive care units. Examples of data that were found in nursing notes that wouldn’t otherwise be captured by some predictive tools include subtle mental status changes, changes in the tone of narrative comments, or increased frequency of nursing surveillance.

I would be curious to see the study taken a step further to look at how the tool performed based on the relative tenure of the nurses who are documenting the notes. We’re continuing to see a tremendous drain of bedside nursing experience and it would be helpful to have that kind of evidence to use when seeking funds for nursing retention initiatives.

From Jimmy the Greek: “Re: blood cleaning. This piece seems like the perfect thing to make Dr. Jayne shake her fist at the wind.” How could I pass up a clickbait headline like, “Clean blood is trendy, if you can afford it” when it’s served to me on the proverbial silver platter? Long story short, a London-based startup is looking to capitalize on microplastics fears with their $13K blood cleaning service. It sounds a bit like dialysis, but with a machine that removes microplastics “and other undesirable chemicals” from blood plasma before returning it to the body during a roughly two-hour session.

Claims abound as far as what the process is supposed to do, ranging from helping with chronic fatigue and long COVID to improving sleep. Although we don’t know the full risk related to microplastics, I was unable to find any high quality clinical trials that showed benefit from this approach in treating any diagnosed condition. Like other unproven interventions such as full-body scans, stem cell injections, and various unproven supplements, the only sure thing about this solution is its ability to part consumers and their cash.

I attended a seminar this week that featured several presenters who are from government-related entities. One agency in particular has put new rules in place such that everything that will be seen by an external audience has to go through a legal review. Despite having started the process a few weeks ago, the presenters from that agency were not able to get approval for their presentation, which covered some scholarly research on AI tools. They had no choice but to cancel, which was unfortunate as there was quite a crowd waiting to see the presentation. I wish the organizers would have been able to communicate this in advance, but I suppose that the presenters were hoping for a last-minute approval that never came.

I was able to connect with one of them between sessions later in the day. They mentioned that they’re attending the conference using vacation days and paying for it out of pocket because their agency will no longer cover travel to educational meetings. They’re actively seeking a new role because they’ve been told that if they stay, their work will be subject to censorship, which sounds like a way to get people to resign without actually terminating them. They were reluctant to say much more than that as they fear for their job and the wellbeing of their subordinates. Hopefully they will be cleared to present their work in the future because it sounded interesting enough to those of us in the packed meeting room.

I was able to slip into another session that was running at the same time and heard one of my former medical school classmates speak, which was great since I haven’t seen him in years. We’re all older and some of us are a bit grayer, but he still gives the same “nutty professor” vibe that he had while we were in school together. It has served him well over the years as he has received multiple teaching awards from his institution, where he’s been a fixture since residency. If we had created class predictions I don’t think I would have picked him as a long-term teacher, but after sitting through his lecture, I can understand why his students love him.

I also had the opportunity to catch up with a classmate who left her hospital-owned practice and set up shop as a direct primary care physician. She’s only been in that arrangement for a couple of years but is already making the same salary as she did as an employed physician while demonstrating higher clinical quality scores with less stress. Her panel of patients has gone from 2,500 to 500 and she spends between 30 and 60 minutes for each office visit. She’s about to add a second physician to the practice and mentioned that she had more applicants for the role than she thought she would see. The majority of her patients have high-deductible insurance plans coupled with healthcare spending accounts that make a direct primary care practice more appealing.

She mentioned the cost savings that she is able to pass along to her patients through her laboratory and pharmacy arrangements and I was shocked at how she’s able to deliver care with that level of cost effectiveness. It sounds like the majority of her patients are middle income, but find her care model to be a better value than traditional insurance as far as not having to take as much time off of work and being able to get all their needs addressed during a single longer visit compared to having to come back multiple times or see additional specialists. Talking to her was quite a contrast from what we were hearing from the mostly academic speakers, but I’m glad we were able to connect.

Are you part of a direct primary care, concierge, or retainer practice? Would you recommend it or not? Leave a comment or email me.

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