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


 

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.

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.

Hospital Inspections Site Launched

Healthcare transparency took a step forward this week.  The Association of Health Care Journalists (AHCJ) and the Centers for Medicare and Medicaid Services (CMS) have collaborated to bring HospitalInspections.org  online.

The searchable database contains information about serious federal safety rule violations in U.S. hospitals since January, 2011.  It does not contain hospital responses to deficiencies cited during inspections. Those can be obtained by filing a request with a hospital or the U.S. Centers for Medicare and Medicaid Services (CMS).

Searching is free.

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Example:  Greivance

One example documents a lengthy trail of CMS interviews with hospital personnel related to a patient’s complaint regarding a grievance letter to which she had received no response..

“An interview was conducted with S2 Divisional Director, Regulatory Management on 9/19/12 at 9:05 a.m. She reported the hospital was unable to locate what happened to the grievance letter after it was signed for on the loading dock.  Also the hospital has been unable to locate the letter sent by regular mail by the mother of Patient #7.

Review of the policy titled Patient Rights, Complaint, and Grievance Process, policy reference # OrgClin/020, revealed in part,  ” …All expressed concerns regarding care or treatment are entered into the approved complaint tracking software program …”

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Example:  Environment of Care / Fire Safety

“The inspector observed, while accompanied by the Plant Manager during the hours of the inspection from 8:00 am to 9:45 am on 7/24/2012 that the fire doors going into the generator room had the closers removed and the doors were propped open. The doors must be self-closing. If the facility requires the doors to be open, they must be placed on hold opens that will release with activation of the fire alarm.”

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The site also has a list of states that post their hospital inspections online.

Angry Physicians Impact Care

Kaiser Health Plan reports on a long-festering problem that many hospitals have been reluctant to address: disruptive and often angry behavior by doctors. Experts estimate that 3 to 5 percent of physicians engage in such behavior, berating nurses who call them in the middle of the night about a patient, flinging scalpels at trainees who aren’t moving fast enough, demeaning co-workers they consider incompetent or cutting off patients who ask a lot of questions.

Experts say that doctors’ bad behavior is not merely unpleasant; it also has a corrosive effect on morale and poses a significant threat to patient safety.

To be fair to physicians, bad behavior is not limited to them.  Administrators, nurses, and others can also subject co-workers and subordinates to what could only be termed as work-place bullying.  Physicians, however, impact patient care in ways that others do not.  When those caring for a patient hesitate to call a physician about care concerns for fear of being subjected to a wrathful outburst, hospital and medical staff leadership must act.

Read:  Hospitals Crack Down on Tirades by Angry Doctors

 

DHHS Levies First Fine for Small Data Breach

MedLaw.com reports on the first payout for a HIPAA violation involving a small data breach:

“The Hospice of North Idaho (HONI) has agreed to pay the U.S. Department of Health and Human Services’ (HHS) $50,000 to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security Rule.  This is the first settlement involving a breach of unprotected electronic protected health information (ePHI) affecting fewer than 500 individuals.”

The breach stemmed from a stolen laptop.

Read the rest:  http://www.medlaw.com/ocr-issues-first-fine-for-small-data-breach/

 

Routine Blood Transfusion-Not So Routine After All

Variant Creutzfeldt-Jakob disease (vCJD) is a rare, but deadly infection that can be transmitted in transfused blood or blood products.

An article in the UK Telegraph Killed by a needless blood transfusion, notes that Deryck Kenny, who died in 2003, was the first recorded death from vCJD traceable to contaminated blood.  His widow, a retired nurse, later reviewed his medical record and could find no documented reason for the three units of blood Deryck received during surgery for prostate cancer.  She concluded that it was simply the surgeon’s routine to transfuse patients.

Routine is a more common reason for transfusion than most would think.  As a result, hospitals around the globe are beginning to adopt patient blood management as a key safety concept.  The roots of the program lie in alternative treatments developed for patients who decline all blood transfusions in their care, in the past primarily Jehovah’s Witnesses, but now a choice that is being made by an increasing number of others as well.

For those anticipating a planned surgery, consider asking your physician to do a routine blood count in advance, and if anemia (low hemoglobin / hematocrit) is noted, to take steps to correct that anemia prior to surgery.  That simple step alone would eliminate the need for many transfuions during or after surgery.  In cases of mild anemia iron supplements may help, or if the problem is more pronounced, IV iron or medication that stimulates a patient’s own bone marrow to produce red cells, may be needed.

It has been said that “the safest transfusion is the one not given.”

 

NAMSS Conference – HCQIA Hearing Rights

I listened in recently to the National Association Medical Staff Services (NAMSS) Virtual Conference sessions.  Getting into the online program was easy, the sound was good, the slides were easy to see and follow, and no trips through airline security were required.  Overall I’d give the experience an A. 

Speakers for Thursday’s virtual sessions were Carol Cairns, CPMSM, CPCS, Sally Pelletier, CPMSM, CPCS, Linda Haddad, JD, and Todd Sagan, MD, JD., and every session was full of good instruction.  

One particular point worth noting was the reminder Dr. Sagan gave about hearing rights and HCQIA immunity.  We’re all keenly aware of the requirement to report any physician suspension of more than 30 days to the National Practitioner Data Bank (NPDB), but my ears perked up at his mention of the 14 day hearing requirement in order to qualify for protection from the Healthcare Quality Improvement Act (HCQIA).

The Healthcare Lawyers site provides the HCQIA language pertaining to hearings:

Notice of Hearing: If the physician timely requests a hearing, he must be given a notice stating:

1. the place, time and date of the hearing, which shall not be less than 30 days after the date of the notice…

Hearing Requirements: …

 The above notice and hearing procedures are not required in situations where no adverse professional review action was taken or if a physician’s clinical privileges are suspended or restricted for 14 days or less, during which time an investigation must be conducted to determine whether a professional review action is needed.  (see: 42 U.S.C. Section 11112(c)(1)).

At least for me, that was a lesser known requirement, and an excellent reminder.

 

Grief For Those We Cannot Save

I got to know one of our hospitalized patients fairly well during the last months of her life.  Young and battling a deadly disease, she fought with every ounce of strength she possessed.  In one of our conversations she told me she wasn’t ready to sleep; there was so much more to do.  We talked about faith, the future,  and what she wished for those she loved.

In a conversation with her long-time physician shortly after her death, he quietly said, “I’m sorry”.

At first I didn’t understand what he meant; then I realized he was apologizing to me for not being able to save this patient I had grown fond of.  “You did all that you could,” I responded.

“But it wasn’t enough, was it?” he replied, as he walked away.

What a burden to carry – grief for those we cannot save from “the last enemy” death.

When Doctors Grieve, recently published in the New York Times, addresses this seldom discussed issue.  “Do doctors grieve when their patients die? In the medical profession, such grief is seldom discussed — except, perhaps, as an example of the sort of emotion that a skilled doctor avoids feeling.”

It is a discussion worth bringing into the open.

Considering Joint Commission Hospital Surveyor Focus – 2012

If your hospital is up for Joint Commission survey in the coming months, you will find a recent article by Compass Clinical Consulting, A Snapshot of First Quarter TJC Survey Results, worth reviewing. 

The first three months of 2012 TJC surveys are complete, and reports to Compass Clinical Consulting from clients and from the field draw a revealing and somewhat concerning picture…

READ  A Snapshot of First Quarter TJC Survey Results