The End

The first post on this blog was added on November 12, 2004 – it’s hard to believe I’ve been writing online about various aspects of healthcare for almost ten years.

When I started this site, originally named MSSPNexus, (Medical Staff Service Professionals) the focus of my writing was current news and standards pertaining to hospital medical staff administration.  Later, as my career took a different path, I added risk management and over the past few years patient blood management into the mix.

In 2004 being a healthcare blogger was a heady experience; there weren’t that many of us and we formed a sort of online friendship, especially through Nick Gene’s Medical Grand Rounds.  We were sometimes interviewed, either by one another or by traditional news media.  KevinMD came along in 2005, and his blog remains one of the best and most active medical sites on the web.  Nurse Kim’s Emergiblog was always a fascinating read.  Of note, she recently posted that she is shutting down her blog.  Dr. Mike Sevilla soon found that it is difficult to remain anonymous on the web, and he continues to write under his real name.  There were a host of others, many of whom contributed to the first grand rounds hosted on this site.

sunset_valleyOver the past couple of years Supporting Safer Healthcare has been sadly neglected.  There are many concerns about protected health information and social media, some justified, and some over-the-top paranoid.   We who write weigh every word and image carefully before posting.  There are also security issues, this blog was hacked by spammers a couple of years ago and had to be rebuilt from the ground up.

My current hospital position in bloodless medicine/patient blood management is fascinating and contributes to patient safety and good quality healthcare, although from a different perspective than medical staff administration and risk management.  I have learned more about the clinical aspects of healthcare, and my interactions with patients are often the most rewarding part of the job.  The down side is that the time and focus it requires can be a bit daunting.  I’ve been left with little creative energy for writing.

If I may offer one parting word of advice to everyone, find out of you are anemic and if you are, get treatment.  It’s often as simple as building up your body’s iron stores through changes in nutrition or iron supplements.  In many cases not being anemic (in other words, having a good blood hemoglobin count) is the single biggest protection against needing a blood transfusion during a hospital stay.  Research continues to mount showing that patients who do not need transfusions recover more quickly and with fewer complications.

Progressive hospitals everywhere are developing patient blood management programs that are designed to conserve a patient’s own blood supply and avoid the need for transfusion whenever possible.  In the hospital where I work the program is growing out of the body of knowledge acquired over the past 15 years of being a center of excellence for bloodless medicine patients, i.e., those who decline blood under all circumstances. Historically, that has been primarily Jehovah’s Witnesses, but others are now requesting our services in increasing numbers. If your hospital doesn’t have such a program encourage leadership to contact one that does.  There is also a professional society devoted to PBM, the Society for the Advancement of Blood Management, which offers professional education and resources.

It’s time to close this chapter of my professional career.  For those of you who have been readers of this blog for all or part of the past ten years, thank you. The older posts will remain online for now.  It has been my pleasure to be of some small service in sharing news and insights that affect both the delivery and safety of healthcare.  Many of you are gatekeepers for patient safety – a worthwhile role to be sure.  Keep up your good work. Patients, and at some point isn’t that all of us, need you.

Rita Schwab
MSSPNexus / Supporting Safer Healthcare


 

The Patient Safety Movement

ZERO Preventable Patient Deaths by 2020

The Patient Safety Movement is connecting People, Ideas and Technology to confront the large scale problem of over 200,000 preventable patient deaths in US hospitals each year by providing actionable ideas and innovations that can transform the process of care, dramatically improve patient safety and help eliminate patient preventable deaths. We are doing this one solution, one commitment, one hospital, one act of kindness and love, and one patient at a time. The movement is breaking down silos between hospitals, medical technology companies, patient advocates, patients, the government and all the stakeholders affected in healthcare—all of us. Together we are pushing toward ZERO preventable deaths by 2020.

Find out more at http://patientsafetymovement.org/

Choosing Wisely – Critical Care Societies Collaborative

Healthcare professionals tend, like everyone else, to make some choices based on habit or training.  The web site Choosing Wisely encourages physicians and patients to question some of those routine choices.

Choosing Wisely® aims to promote conversations between physicians and patients by helping patients choose care that is:

  • Supported by evidence
  • Not duplicative of other tests or procedures already received
  • Free from harm
  • Truly necessary

One of the lists on the site is from the Critical Care Societies Collaborative; five things physicians and patients should question:

1.  Don’t order diagnostic tests at regular intervals (such as every day), but rather in response to specific clinical questions.

2.  Don’t transfuse red blood cells in hemodynamically stable, non-bleeding ICU patients with a hemoglobin concentration greater than 7 g/dL.

3.  Don’t use parenteral nutrition in adequately nourished critically ill patients within the first seven days of an ICU stay.

4.  Don’t deeply sedate mechanically ventilated patients without a specific indication and without daily attempts to lighten sedation.

5.  Don’t continue life support for patients at high risk for death or severely impaired functional recovery without offering patients and their families the alternative of care focused entirely on comfort.

Read the explanations for these five recommendations here:

http://www.choosingwisely.org/doctor-patient-lists/critical-care-societies-collaborative-critical-care/

 

Did You Know?

There are numerous benefits to applying blood conservation principles in patient care, most often referred to as Patient Blood Management. For example:

 

 

 

 

 

 

Have We Lost the Art of Medicine?

Experienced Caregiver Shares 3 Tips for Injecting Humanity into an Often Cold & Arbitrary Heath-Care System

As a well-traveled, well-educated couple who spent most of their lives in New York City, Philip and Ruth Barash had witnessed and experienced much as they approached their golden years. A savvy New York couple, they’d learned to anticipate challenges.

Philip was a U.S. Army veteran who’d served in the Korean War and later became an attorney; Ruth’s education and experience includes philosophy, art, real estate, public relations and executive-level civic work. But one problem they didn’t foresee was navigating their own country’s health-care system. In the most prominent city of the wealthiest nation on the planet, how bad could it be?

“Philip’s health problems began in 1988 and steadily continued until his death in 2012,” says Barash, who shares her health-care experiences in a new book, “For Better or Worse: Lurching from Crisis to Crisis in America’s Medical Morass,” (http://forbetterorworsebook.com/).

“We were in and out of doctors’ offices, hospitals and emergency rooms a lot, and I was shocked by the lack of compassion we frequently encountered, as well as the number of health-care professionals who simply are not good diagnosticians.”

Barash’s cautionary tale traces her husband’s long death through a medical journey fraught with mismanagement and excess, useless interventions and a sometimes complete disregard for pain – even when there was no hope of healing.

“The art of intuitive, compassionate health care is dying as doctors rely more on technology and are guided through an arbitrary template established by insurance company policies,” she says.

Barash discusses some of the lessons she has learned while navigating overcrowded and dingy emergency room lobbies, callous staff and tech-absorbed doctors.

• Have an advocate! Through the years of Philip’s health problems, we encountered extreme kindness, thoughtfulness and high intelligence; we were also confronted with arrogance, indifference and self-serving staff during some of the worst moments. As hard as it was for both of us, we always knew we had each other. If and when you find yourself requiring medical assistance, avoid going it alone; it will be exponentially more difficult, and your chance for survival will exponentially decrease.

• Ask what benefits a proposed treatment will have. We all like to think we have good doctors, and that if we’re hospitalized, we’ll be competently cared for. We also like to think Santa will bring us nice presents if we’ve been good children. Realize that invasive and expensive tests are often not necessary; in fact, they often make things worse. Be as skeptical about a procedure proposed by a doctor as you would by any salesman.

• Don’t get sick! While this may seem like a facetious bit of advice, since we all succumb to illness at some point – it’s actually a sincere sentiment. Do not take your health for granted; do not think “they” will invent a quick fix between now and the time you find yourself in need of serious medical attention. Unnecessary health risks such as smoking; illegal drug use; excessive alcohol intake; and a diet filled with sugar, salt and fat will take you sooner rather than later to the hellish journey known as the U.S. health-care system.

About Ruth Fenner Barash

Ruth Fenner Barash studied philosophy at City College of New York and did graduate work at the University of Chicago. In 1958, she met and married Philip Barash, a private practice attorney. She went on to work in public relations and real estate, served education and civic organizations at the executive level, and taught art in various media. Her long marriage was a “harmonious adventure” despite the couple’s treacherous journey through the health-care system. Her husband died in 2012.

NAMSS and AHLA Approve Partnership

The NAMSS Board of Directors and the Executive Committee of the AHLA, American Health Lawyers Association, have approved an exciting joint initiative allowing NAMSS members access to a network of 11,000 health lawyers.

NAMSS members can now join the AHLA organization and their Medical Staff, Credentialing and Peer Review Practice Group (MS/CPR) at the discounted rate of $110 for annual membership.

Established to help bridge the relationship gap between MSPs and the legal staff who represent their facilities, this partnership will provide a platform for NAMSS members to have open dialogue with legal staff and exchange information about the regulatory issues affecting hospitals and credentialing departments across the country.

New Patient Blood Management Certification Program Proposed by Joint Commission

The Joint Commission is developing a Patient Blood Management certification program for Joint Commission-accredited hospitals. Patient blood management incorporates a patient-centered approach into the blood utilization activities and blood conservation strategies that occur within the hospital. Blood conservation strategies minimize the need for blood transfusions.

Patient blood management applies to all patient populations from pediatrics to geriatrics. It also spans the entire continuum of patient medical care, including the management of anemia, minimization of blood loss, and optimization of coagulation, in addition to evidence-based transfusion.

Living Forever Online May Not Be a Good Thing

Guest Post.  In these days of social media and automatic bill pay, Hillel L. Presser, Esq. offers some worthwhile tips for all of us.

Asset Protection Lawyer Offers 3 Steps to Take Now

Now, you really can live forever, but that’s not necessarily a good thing.

Many of your online accounts – from automatic bill payments to eBay – may remain active after you pass away, unless you take steps to ensure they don’t, says attorney Hillel Presser, author of “Financial Self-Defense (Revised Edition), ”www.assetprotectionattorneys.com.

Automatic bill pay, for example, can theoretically keep tapping your bank account long after you’re gone or, at least, until your money is.

“It’s important to make sure your online bank and shopping accounts, even your social media, can be closed out, or that your loved ones are authorized to access them,” Presser says. “You may ask, ‘Why would I care if I’m gone?’ I can tell you from experience: because it can create real headaches, and more heartache, for your family.”

Bank and shopping accounts will be vulnerable to identity theft, which would affect your estate if someone opens credit cards in your name. You might have valuable intellectual property, like domain names. They may need access to your health records, particularly if you died under questionable circumstances, he says.

There’s the sentimental stuff – photos and emails — that your family may want as a remembrance of you, and the libraries of music and ebooks, which may represent a considerable investment on your part.

“The problem is, even if you provide a family member with all of your accounts, log-ins and passwords, they may not be legally allowed to access them,” Presser says. “In many cases, they may be violating the accounts’ terms of service or violatingfederal privacy and computer fraud laws. Some states have laws governing online materials, but they’re different and which of your accounts are covered depends on where the provider is located.”

What can you do to ensure your family isn’t left with a virtual nightmare after your passing? Presser offers these tips:

• Create a list of all of your accounts, including log-innames, passwords, and answers to any security questions. Obviously, your list will need to be securely stored. Since you’ll need to update it regularly as you add accounts or change passwords,  it will be easiest if you keep the list on your computer in a password-protected folder. Some versions of Windows allow you to create protected folders, but you may need to get third-party software to do this, such as freeAxCrypt. Remember to create a backup of your list, whether it’s on a jump drive or printed out on paper. Store the backup in a secure place such as a safe deposit box. Do not put password information in your will, which is a public document.

• If you have a Google account, set up the new inactive account manager. In May 2013, Google became the first site to give users an option for choosing what becomes of their content if they should become debilitated or die. Under the profile button, click “Account,” scroll down to “Account Management,” and you’ll find instructions for “Control what happens to your account when you stop using Google.” You can select how long the account should be inactive before your plans are set into motion; choose to whom you want to offer content, such as YouTube videos, Gmail, Google+ posts, Blogger and Picasa web albums, or whether it should simply be deleted.

• Appoint a digital executor. Perhaps the simplest way to ensure your online life is taken care of is to appoint a digital executor – a tech-savvy person who will be willing and able to carry out your wishes. Authorize the person to access your inventory of log-in information and spell out what you want done with each account, whether it’s providing access to loved ones or business partners, or deleting it.

The digital world has grown and transformed so rapidly, the law hasn’t kept up, which makes managing your digital afterlife challenging, Presser says.

“Until there are more consistent laws and procedures governing this area, it’s best to plan ahead, leave clear instructions and be sure you have a list of accounts where your estate lawyer or a loved one can find it and access it,” he says. “It will make a world of difference to your survivors.”

About Hillel L. Presser, Esq., MBA

Hillel L. Presser’s firm, The Presser Law Firm, P.A., represents individuals and businesses in establishing comprehensive asset protection plans. He is a graduate of Syracuse University’s School of Management and Nova Southeastern University’s law school, and serves on Nova’s President’s Advisory Council. He is a former adjunct faculty member for law at Lynn University. Complimentary copies of “Financial Self-Defense” are available through www.assetprotectionattorneys.com.

Questions to Ask About Blood Transfusion and Heart Surgery

Conventional wisdom may lead you to believe you’ll fare better (during surgery) if you get a transfusion, but that’s not always the case, said Colleen Koch, MD, vice chair for research and education in cardiothoracic anesthesiology at the Cleveland Clinic in Ohio. In fact, heart surgery patients who receive blood transfusions tend not to do as well as those who don’t receive them, Dr. Koch noted.

During a coronary artery bypass graft (CABG) surgery, for example, a patient at one hospital might be given two units of blood, while doctors at another center may decide not to give a similar patient a blood transfusion.

Before you head to the operating room, it’s smart to ask your medical team about the likelihood of needing a blood transfusion and whether it can be avoided.

Read the rest of Questions to Ask About Blood Transfusion and Heart Surgery to see questions to ask prior to surgery.

Physician Suicide – A Tragedy for Us All

“Physicians have the highest suicide rate of any profession.  In the United States we lose over 400 physicians per year to suicide. That’s the equivalent of an entire medical school. Even that’s an underestimate because many physician suicides are incorrectly identified as accidents.”

So states Pamela Wible, M.D. in her article, What I’ve learned from saving physicians from suicide.

In the article she quotes a Canadian doctor who shares her frustration with the practice of medicine.  “My head is exploding from banging it against the system.”

If you suspect a physician you know is suffering, reach out; there is help available.