Hospital safety and access are still big problems

dc-va-hospitalHospitals can be risky, troubled, and even downright scary spots, as some recent news and other reports indicate:

Inspector general slams DC VA Medical Center

Almost 100,000 patients of the VA Medical Center in Washington, D.C., have been put at unnecessary risk because hospital staff and administrators, a government watchdog said, failed to “ensure that appropriate medical supplies and equipment were available to providers when needed; that recalled supplies or equipment were not used on patients; and that sterile supplies were stored appropriately.”

The Veterans Affairs inspector general found conditions so bad at the facility that he released his interim report as a public warning. It is rare for an IG to do so before a full investigation is complete. VA officials responded swiftly, ousting the hospital’s chief and reassigning him to administrative duties. They said more disciplinary actions likely would follow.

Acting on a tip, investigators descended on the hospital and found woes that included: the operating room recently had run out of patches to seal blood vessels and ultrasound probes used to map blood flow; doctors had to borrow bone material for knee replacements;  a dialysis unit had run out of needed tubing and had to request the materials from a private-sector hospital; a surgeon used expired equipment on a patient; 18 of 25 sterile storage areas were contaminated; more than $150 million in equipment had not been inventoried or accounted for in the past year, which led to medical procedures being canceled or delayed.

Investigators are continuing their work and have not found instances as of now in which patients were harmed.

safety-grade-logo-color-jpeg-300x159With 1,000 patients per day dying of medical error, safety group grades hospitals

The Leapfrog Group, a national nonprofit that was founded by large employers and other purchasers and that seeks to improve quality and safety in U.S. health care, has issued its annual hospital grades. Those controversial marks, much disputed by hospitals across the country, can provide patients some insights about care they get at more than 1,800 institutions.

Beyond the letter grades, however, the group highlights a persistent, frightening data point: Despite concerted efforts to improve safety practices, more than 1,000 patients a day die in American hospitals due to medical errors, Leapfrog says.

The group says it tries to make its hospital survey (on which its grades are based) as clear and open as possible, in part to help patients and caregivers better understand the risks and causes of harms in hospitals and to address them. Leapfrog says its grades provide one yardstick by which many hospitals have made progress.

It gave failing marks to 10 hospitals, none in the Washington, D.C., area. It gave an A to more than 800 hospitals, including some in Virginia:  the Virginia Hospital Center, Arlington Health System; Inova Mount Vernon Hospital; Inova Fair Oaks Hospital; and Sentara Northern Virginia Medical Center.

No Maryland hospitals were rated, because state law does not require them to publicly report pertinent safety information, Leapfrog said.

Three DC hospitals received D grades: Howard University Hospital (which I’ve written about); MedStar Washington Hospital Center; and Providence Hospital of Washington.  Two DC hospitals got C grades (George Washington University Hospital and United Medical Center), while two got Bs (MedStar Georgetown University Hospital and Sibley Memorial Hospital).

I’ve written how savvy patient-consumers need to scrutinize hospital grades with care, taking valuable information from them without being gullible about them. Uncle Sam has sought to grade hospitals, too, with lots of griping from institutions from coast to coast. To be fair, it isn’t easy to roll up complex issues of safety, quality, and access to medical services in one letter, and hospitals that tackle sicker, poorer patients with tougher illnesses and conditions have some cause for complaints.

Caveat emptor.

In rural America, hospitals are dying—but are their glimmers of hope, too?

Rural America is struggling with a devastating medical crisis: a dearth of hospitals. Correspondent Amy Goldstein of the Washington Post trekked to small town Tennessee to show the pain and suffering the sick and poor but working people suffer as hospitals in far flung parts of the nation die, unable to sustain themselves economically. She says 80 rural hospitals have closed since 2010, costing small communities not only medical services but also important, higher paying jobs and critical, fundamental institutions that help make or break a town.

When local hospitals disappear, emergency care becomes a nightmare. So, too, does treatment for patients with chronic conditions. The disabled, young, and old face daunting transportation woes to get to medical facilities, long treks that can force them to cross vast spaces, especially in some fearsome weather.

Government health programs, including Medicaid, Medicare, and the Affordable Care Act, aka Obamacare, have helped rural residents some. But not enough. And the already bleak prospects aren’t looking any better with the GOP hoping to make radical changes in the American health care system, with many of these shifts slashing government money and assistance.

To its credit, the online site Politico offers a sunnier counterpoint to the grim picture in rural health care. Anna Gorman, a seasoned health reporter and a member of a Pulitzer Prize-winning team at the Los Angeles Times, travels to Idaho to see how investment, technology, and a leadership commitment can make a rural hospital successful—even in a spot so distant that “bears outnumber people.”

She reports that it is critical for distant hospitals to dive fully into partnerships, especially with colleges and universities, and into innovations if they are to not just survive but thrive. Gorman notes that even after rural hospitals’ see successes, say by attracting talented caregivers, or with telemedicine programs or by offering desperately needed trauma care, their work never ends. They could die as easily as so many others have, especially because the patient-consumers they serve tend to be older, poorer, sicker, and more distant.

Those worrisome demographics also underpin what Stat, the online health news service says, are efforts in North Dakota that may prove crucial for how the rest of the country cares for graying citizens afflicted with dementia.  When young people fled the farms, they left behind older Dakotans whose health and mental health is declining, sometimes sharply. Can the frontier community spirit and a rural willingness to collectively care for neighbors provide models for Alzheimer’s and dementia care? Again, with dwindling outside resources, including government aid, North Dakotans may not have options, and how they deal with one of the nation’s major health concerns of the day may be telling.

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