Articles Posted in Hospitals

doc-sleep-300x225Must doctors be absolutely impervious to common sense improvements in the way they train their own? Their bullheadedness has reemerged with the revisited decision by a major academic credentialing group to allow medical residents yet again to work 24-hour shifts.

The Accreditation Council for Graduate Medical Education clearly was on the defensive when it issued its memo on residents’ learning and working hours, guidance that academic medical centers and hospitals nationwide will rely on in setting workplace standards for the young doctors in whose hands so many patients will put their lives. The council noted that it had established a high-level task force to reconsider criticisms of residents’ stress and overwork and how this might imperil patient care, responding to an early rollback of shift hours:

“… The Task Force has determined that the hypothesized benefits associated with the changes made to first-year resident scheduled hours in 2011 have not been realized, and the disruption of team-based care and supervisory systems has had a significant negative impact on the professional education of the first-year resident, and effectiveness of care delivery of the team as a whole. It is important to note that 24 hours is a ceiling, not a floor. Residents in many specialties may never experience a 24-hour clinical work period. Individual specialties have the flexibility to modify these requirements to make them more restrictive as appropriate, and in fact, some already do. As in the past, it is expected that emergency medicine and internal medicine will make individual requirements more restrictive.”

hospital-bed-300x144Although hospitals continue to try to shrug it off, the damning evidence is building that far more Americans die of preventable causes in their care than previously thought, and “approximately 200,000” such deaths each year in the United States is “not unreasonable” as an estimate.

Those are the top-line findings from a team of doctors and public health experts who have published new research in the Journal of Patient Safety. Theirs was the fourth study in recent times to try to quantify what one of the research groups has described as potentially the “third leading cause of death in the United States,” those from medical error, especially occurring in hospitals.

A year ago, the Heartland Health Research Institute looked at Iowa and six surrounding states to assess what experts call preventable adverse events, and examining the existing studies that might offer national insights on the issue. These researchers found that it was reasonable to conclude that “250,000 patients [die] annually in U.S. hospitals due to preventable mistakes.”

goodlatte-300x256We all know how con artists work the streets. One might bump into you in a train or in a crosswalk, while the other grabs your wallet. Or one might smile and chat with a mom at a playground, while her partner nabs the purse.

Patients and consumers may want to watch carefully for the congressional version of the distraction scam, a series of stealth bills that aim to strip them of valuable legal rights and protections they’ll need if harmed by big hospitals, rich doctors, big insurance companies, or giant corporations. With so much commotion under way with the new administration, Republicans sneakily have launched a furious, multi-pronged so-called “tort reform” campaign. They’ve wanted it for a long time. They insist it is needed to curb excess and frivolous lawsuits, to save money for Uncle Sam (who often is a defendant), to make the economy work better, and to add jobs, and to make life in general more wonderful.

Their arguments are counter-factual and lacking in evidence.

hospital-300x209When a giant institution like MedStar Georgetown University Hospital announces it will spend more than a half-billion dollars to improve, rebuild, and expand its facilities, few of us blink.

That’s because we know that hospitals, in general, are “among the most expensive facilities to build, with complex infrastructures, technologies, regulations and safety codes,” observes Druv Khullar, an M.D. and M.P.P. at Massachusetts General and Harvard Medical School.

Khullar, however, goes on to write in a trenchant Op-Ed column in the New York Times that, “evidence suggests we’ve been building [hospitals] all wrong — and that the deficiencies aren’t simply unaesthetic or inconvenient. All those design flaws may be killing us.”

HouseGregoryHouse-276x300Doctors, nurses, and hospitals should stop ignoring colleagues who act like jerks because obnoxious physicians—think of  Dr. Gregory House, the TV internist—may hurt patients, especially in surgery.

Researchers, who published a study in the JAMA Surgery, looked at two years of quality care data from seven medical centers, involving 800 surgeons and 32,000 adult patients. They also had information on physicians with “unsolicited patient observations,” meaning complaints from those undergoing care and their friends and families.

Stat, the online health information site, summarizes what the researchers found:

ryanMembers of Congress are home in their districts for a week-long break, and many lawmakers are expected to get an earful from voters upset over many issues at the start of the Trump Administration, especially this: What the heck’s going on with health care?

Republicans have insisted for years now—counter-factually, as the evidence has amply demonstrated—that they had a cheaper, better, more inclusive alternative to the Affordable Care Act, aka Obamacare. The promised to repeal the ACA on the day they gained control of Congress and the White House. That hasn’t happened. Nor has the GOP proffered its vaunted replacement. Instead, the party had talked in recent days about an ACA repair.

But under fire from their most conservative party members, Republican leaders have thrown up what they call an outline of Trumpcare. The GOP has moved from lots of R’s—repeal, replace, and repair—to some C’s and D’s: Costly, callous, divisive, and cruel. Those are some ways their retread plan elements (dubbed “déjà vu all over again” in one report) could be described. The outline still faces major challenges, not the least of which is whether a chaotic White House and a lumpen Congress can conduct the nation’s business and enact public policy.

harlanYes, there can be progressive steps in health care—and with all the controversy and change going on in the sector it’s worth spotlighting some of these:

Patients should get access to own health records, researchers say

  • Three researchers—Dr. Harlan Krumholz of Yale Medical School (photo right), Connecticut lawyer Jennifer L. Cox, and Yale student Austin W. Jaspers—deserve credit for publishing a pointed opinion piece in the JAMA Internal Medicine detailing the costs and needless obstacles patients confront when they want copies of their own health records. As Krumholz told Reuters of the study’s message about excessive records fees charged by doctors and hospitals:  “Higher costs are a higher barrier for people to get their own information. Without that information it is not possible to correct errors in the record, get informed second opinions, donate your data to research – or share with others what is happening with your care.”  That’s spot on, doctor, as I have written recently and in my book,  The Life You Save: Nine Steps to Getting the Best Medical Care, and Avoiding the Worst. Uncle Sam has stepped in and tried to make it easier and more affordable for patients to get their own records, which Krumholz and company point out should be even more available now that they are digitized (he’s working on software to help, too). But states aren’t doing enough to help, except for Kentucky, which requires a free first copy on request, he and his colleagues say. My firm’s site contains information that may be helpful to those struggling to get their records. Here’s hoping that doctors, hospitals, and other caregiving facilities read the Jaspers, Cox, and Krumholz viewpoint, and, because it appears in one of their publications and Krumholz is a physician-researcher of growing influence, they heed it more.

It wasn’t that long ago — see those classic black-and-white movies — when hospitals commonly cared for many different kinds of patients in large open wards. Young volunteers, women known as “candy stripers,” could be seen rolling carts down the aisles between the many rows of beds, selling cigarettes. Families might pop in for a visit, carrying for their sick kin a chicken dinner on a plate covered by a white napkin.

With the huge changes that the Affordable Care Act has brought to hospitals and American health care, and with the shifts that are yet to come if Obamacare gets repealed and replaced, it’s easy to forget how significantly and rapidly medical services continue to transform.

obamacare-cartoon-2-a-300x240As the already known complications to its demise have increased by the minute, there may be some detectable pauses in the partisan zeal to give the Affordable Care Act, aka Obamacare, the bum’s rush. That’s because the legislation’s repeal-and-replace proponents — despite seven years and several dozen U.S. House votes  to roll back the ACA — have yet to detail how 20 million Americans who have gotten health insurance under Obamacare will be covered in the days ahead.

Opponents also haven’t explained how they may change the far reach of the ACA, including how the law and the Obama administration have reshaped, and often, improved American health care, for example, by changing entrenched payment practices and forcing greater accountability.

The New York Times, in reviewing the presidential legacy, has reported on what it terms the transformational aspects of Obamacare that also may sustain, no matter the partisan attacks on the attempt to provide broader health insurance coverage. In brief, the paper says Obamacare forced health care in this country to become more data-driven and evidence-based, as well as refocused on patients and their needs. Although some of the major drivers of these reforms, including hefty spending for electronic health records, haven’t hit the high marks advocates hoped for, progress has occurred.

fireextinguisher-211x300They’re likely jammed into many of the toys and electronic gadgets that overflowed the house during the holidays. But they’ve also been linked to sufficient fires that products have been recalled because of them, and some devices with them have even been banned in the nation’s skies. Now federal regulators are warning hospitals and doctors’ offices to beware, too: Their many battery-laden medical carts may burst into flames or explode.

The federal Food and Drug Administration has written to caregivers nationwide with a new caution that, within the last three years, it has received a dozen reports of “smoke, fire, melting batteries, burning, and other hazards” with medical carts. No injuries have been recorded but facilities have been evacuated due to smoke and fire hazards from cart blazes or smoldering, the FDA says. The rolling stations have grown increasingly common so staffers can conveniently dispense medication, or carry equipment related to colonoscopes, ultrasound, and anesthesia machines.

They’re also prized because their electrical sources—lead acid or increasingly lithium batteries—pack the power needed, they’re portable, convenient, and they’re long lasting. But those batteries also can generate a lot of heat, and they have proven problematic in other uses.

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