EPtalk by Dr. Jayne 4/24/25

I enjoy reading research articles that confirm what many of us have long suspected. It increases the ammunition that we need when we are trying to convince people to make changes.

A recent Research Letter in JAMA Internal Medicine looked at what happens when the EHR was changed to default to a 90-day supply of a particular medication that is used to treat a chronic condition. In the literature, previous studies show that 90-day prescriptions are linked to greater medication adherence and reduced mortality, so getting an adequate supply to patients is a significant benefit.

To no one’s surprise, the change in the default led to an increase in the number of patients who were prescribed a 90-day supply. The authors noted that before the intervention, the patient groups that were least likely to receive a 90-day supply included Hispanic patients, non-Hispanic black patients, those on Medicaid, and those with ZIP codes whose median household incomes is lower than $50,000.

After the change, all of those groups were equally likely to receive the recommended 90-day prescription except for Hispanic patients, and even then the gap for those patients decreased. The recommendation to prescribe 90-day supplies with a year’s worth of refills to patients who have stable, chronic conditions has been there for decades, but a lot of prescribers still don’t do it. I’m glad to have one more tool in my belt when I try to convince people to do the right thing.

I recently started studying French. As part of that, I’m making a point to read articles from European sources. I was excited to learn about Robeauté, which is creating microrobots to aid in neurosurgery. The devices are the size of a large grain of rice and are shaped a bit like protozoa. The company’s goal is to use them for minimally invasive brain surgery procedures.

The company has only raised $29 million, so my guess would be that they aren’t as far along as others might expect them to be given the typical trajectory for and cost of development of a new medical device. One of the sources that I saw mentioned the potential for a clinical trial in 2026 with a focus on brain tumors, using the devices to take micro biopsy samples. Thus far, they have been using sheep for preclinical trials as they measure the safety and effectiveness of the devices.

I spent the majority of my clinical time in emergency and urgent care, so I’ve experienced the phenomenon of emergency department boarding first hand. It’s a problem that hospital executives work diligently to solve, although the causes are multifactorial and you often have to make many adjustments to see improvement. It’s exacerbated by nursing shortages, housekeeping shortages, physical plant issues, and a host of other factors, including the number and types of patients arriving at the emergency department for care.

A recent article in Louisville Public Media caught my eye. It mentioned the rising numbers of older patients who have dementia, noting that 50% of patients who are boarded in the emergency department are age 65 and older. As the US population ages, this is going to be a greater issue. Organizations should be looking at their patient demographics and forecasting how their population will age in order to begin solving the future version of this problem, which is likely to be much worse than the current state.

Virtual nursing, home-based care, quicker discharges, improved staffing, streamlined discharge processes, internal float pools, telehealth, and improved advance care planning all play a role. From the healthcare IT perspective, all of them have technology components, so it’s good to learn about potential solutions if you want to expand your ability to jump into different work streams.

We’ve all heard the old adage that “time is money,” but apparently the marketing folks at my preferred parking vendor don’t value my time as much as I do. They sent an email about updates to the Parking Spot App that are “available now in the App Store and coming later this month to Google Play.” They went on to recommend that users “download these updates when available.”

I guess Android users just have to keep checking back to see when the new app is available? Would it have been too much to consider sending another email when the Android version is available? Some days when you’re exhausted from travel that serves up a host of tiny annoyances, it really is the little things that matter. This detail tells me that the folks who are in charge of customer communications don’t put themselves in the customer’s shoes anywhere near what they should. 

I got tapped to present at a residency program’s “procedure night” event this week. My particular area of expertise is how to do procedures in environments where you don’t have the resources you woud typically have at a tertiary medical center’s emergency department. Depending on their career choices, the adjustment can be pretty significant when you move from being at a facility that has everything you need at your fingertips to one where you have to get creative to just do the basics.

I’ve done a bit of wilderness first aid. I have also practiced medicine in a tent, cleaning, and stitching wounds by light of a hand-held shop light, so I’m definitely qualified to present the topic. I think some of my stories were a bit eye-opening, but hopefully will serve as inspiration to residents who are feeling a little stuck and overwhelmed as they approach the end of their training year.

We were doing some joking about practicing in alternate environments. I said that maybe I should come back and do a class on paper charting. Since the program’s faculty members are young, I’m betting that I have significantly more experience on paper charts than some of them added together. It’s a skill, and if you ever have to make your way in a downtime situation for more than a couple of hours, you might wish you had a few more skills. It’s something to consider.

Does your hospital teach about paper-based charting as part of its downtime plans, or do you just hope for the best? Leave a comment or email me.

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