Supporting Safer Healthcare

All it takes is one fraudulent or unqualified practitioner on your staff to bring enormous harm to both patients and your organization’s hard-earned reputation.

And sometimes, all it takes to keep them off your staff is one dedicated, qualified medical staff services professional.

November 6-12 is National Medical Staff Services Awareness Week.  If you work in healthcare, take a moment to recognize the work of the individuals who manage your credentialing and privileging process, as well as facilitate the work of the medical staff organization.  The work they do, along with medical and administrative staff leaders, helps keep your patients and your organization safe every day. 

She faced the worst of all enemies; the impending death of someone dearly loved.  She knew that her son would soon leave behind not only loving parents, but a lovely wife and young child.  There was precious little time left.

The enemy proved victorious, although with faith she looks to a time when even those chains will be broken. 

When asked later for advice in dealing with this most heart-rending of futures she replied, “Don’t live your life in anticipation of death.   Grief will come soon enough.  For now, live each day full of love and appreciation for just today.”

Wisdom.

Lisa Venn, JD, MA, author of “Improving Patient Experience:  50 Things Every Advocate Must Know,” a nationally recognized speaker and owner of Advocate Alliance, was interviewed on the popular “Coping with Caregiving” Internet radio program on Saturday, October 15th.  Listen online to the recorded program.  

Lisa shared tips on protecting patient rights and resolving patient concerns.

Based on twenty years’ experience as an attorney and patient advocate, Lisa believes that knowledgeable advocates can empower patients to make informed health care decisions, avoid medical errors, privacy violations, identity theft, billing fraud and property loss.

Findings of the U.S. Department of Health and Human Services Advisory Committee on Blood Safety and Availability, June 8, 2011:

• Blood transfusion carries significant risk that may outweigh its benefits in some settings and add unnecessary costs.
• Wide variability in use of transfusions indicates that there is both excessive and inappropriate use of blood transfusions in the U.S.
• Medical advances and aging of the population are expected to drive demands for transfusions that could exceed supplies in one to two decades.
• Improvements in rational use of blood have lagged behind improvements in the quality and safety of the products.
• Additional data on blood utilization and clinical outcomes are needed to identify gaps in knowledge.
• Programs at some hospitals have demonstrated significant reduction in blood use without increase in patient harm, based on expert decision-making

“On that day in late May, a black-and-green monster swooped in, its shoulders nearly a mile wide, its savagery unimaginable. One of America’s worst tornadoes in half a century took dead aim at St. John’s Regional Medical Center, barreling through halls and ripping open ceilings. Concrete crumbled. Pipes burst. Windows exploded. The building groaned in agony…”

MSNBC reports on the devastation that struck St. John’s in Joplin on May 22, 2011, and reveals what has happened at the 367 bed medical center since.

Read the report:
http://www.msnbc.msn.com/id/44720885/ns/health-health_care/

I recently returned from the annual meeting of the Society for the Advancement of Blood Management (SABM). The focus of the program was education and support for individuals involved in improving patient care and safety while curtailing healthcare costs through effective blood conservation and management.

We in Pittsburgh, PA were quite pleased to hear that next year’s SABM conference will be held in our city, September 20-22, 2012.   

Over half of the attendees, and the majority of presenters at this year’s conference were physicians.  The audience was international and multi-cultural; I personally met individuals from China, Malaysia and Switzerland.

We may think of blood transfusion as a long-held medical practice, but in reality its history is relatively recent. The first successful direct transfusion was performed between two brothers by Dr. George W. Crile (one of the founders of the Cleveland Clinic) in 1906 at St. Alexis Hospital in Cleveland. Transfusion didn’t become a commonly prescribed medical therapy until the Second World War. From the 1940′s until 1982 when researchers determined that the AIDS virus was being transmitted via transfused blood, it was a liberally prescribed treatment, and believed to be almost completely safe.

Transfusion is still a commonly prescribed therapy, and is now relatively safe from blood-borne diseases (such as HIV/AIDS) due to extensive testing. However, as the body of medical research continues to grow, the practice is being viewed with increasing concern for patient safety, both short and long term. In addition, in today’s resource-starved healthcare world, the cost vs. benefit of transfusion is under considerable scrutiny.

If this is an area of interest for you or your staff, and you’d like to visit the lovely city of Pittsburgh, consider saving these dates on your 2012 education calendar.  Watch the SABM web site for more information.

Here is the list of 405 hospitals that the Joint Commission honored as 2010 top performers in the following categories:

Heart Attack
Heart Failure
Pneumonia
Surgical
Children’s Asthma

You may be suprised to see who made the list, and who didn’t.

Lisa Venn, J.D., M.A.

For the first time in the history of health care, patients’ experience, namely what they think about the health care they receive, will affect providers’ bottom line. First, patient experience survey results will affect a provider’s reimbursement rate. Second, patients’ opinions about their health care have the power to influence patients’ choice of provider. Let’s examine each of these reasons.

(a) Patient experience survey results will affect a provider’s reimbursement rate.

In the past, Medicare paid health care providers such as hospitals, nursing homes and home health services, whatever “reasonable” costs they charged to treat Medicare patients. When reimbursing providers, Medicare did not measure or factor in treatment outcome or patients’ satisfaction with the care they received.

When this “You bill it, we pay it” reimbursement plan proved too expensive, Medicare changed the way it reimburses patient care. In 1983, Medicare began paying hospitals under a prospective payment system (PPS), which is a pre-determined, set rate based on the patient’s diagnosis. If the cost of the patient’s treatment is less than the set rate, the provider profits; if the cost is greater, the provider loses money. Medicare adopted the PPS for other services including sub-acute services given in nursing homes and home health service. Despite the switch to PPS reimbursement, health care costs continued to skyrocket.

Not only was Medicare paying more for care, evidence revealed that the quality of care was poor. In 2000, the Institute of Medicine (IOM) published “To Err is Human” (Kohn, Corrigan & Donaldson, 2000) which indicated that as many as 98,000 patients die each year in hospitals from preventable medical errors. In March 2001, the IOM issued another report “Crossing the Quality Chasm: A New Health System for the 21st Century” (2001). The IOM reported that the health care delivery system is not meeting the changing needs of patients. The IOM outlined ten rules for redesigning health care. Among other things, the IOM called for health care to be transparent, providing patients with information to choose their provider and make evidence-based decisions.

Read the rest

Matthew Scheidt, Jr., 17, of Osceola, Fla., is facing felony charges.  He was arrested September 2nd, accused of impersonating a physician’s assistant for five days at a central Florida hospital.

It all started on Aug. 24, when Scheidt allegedly went to the human resources office at the Osceola Regional Medical Center and requested a new hospital badge, according to the police report.

Impersonating a Physician Assistant is particularly dangerous as these professionals manage a high level of patient care.  The American Academy of Physician Assistants describes the role this way:

PAs deliver a broad range of medical and surgical services, including:

• Conduct physical exams
• Diagnose and treat illnesses
• Order and interpret tests
• Counsel on preventive health care
• Assist in surgery
• Prescribe medications

The hospital is reportedly reviewing its human resources policies regarding issuing ID badges.

 More on this story:

ABC News Report

NBC Miami Report

Orlando Sentinel Report

The frail, elderly patient was so pale as to be nearly invisible against the crisp white sheets.  Any ability to give voice to his thoughts had been taken away by the ventilator tubes in his throat.  The soft restraints on his wrists prevented him from dislodging those tubes, either in confusion or by design.  Other tubes silently pumped fluids in or drained them out.  During his lucid moments he wondered how it had come to this…

I sit on the Ethics Committee at my hospital; it is a group that deals with complex, challenging and sometimes heartbreaking dilemmas. Participants need a knowledge of state and federal law, an understanding of the essential workings of the healthcare system, and perhaps most importantly, wisdom and compassion. We are fortunate to be led by a physician who excels in those abilities.

As we reviewed cases during our most recent meeting, an obvious theme began to appear. Many of the ethics consults centered around patients with dimminished capacity for decision making who had no one appointed or available to speak for them.   In those cases, providers often turn to the Ethics Committee for guidance, particularly when dealing with end-of-life decisions.

It was a powerful reminder that each of us needs to document our wishes, particularly those regarding end-of-life care, and appoint a trusted individual as our Healthcare Agent/Power of Attorney. Doing so can ensure that our wishes are met and can also relieve our family members of the stress of having to make difficult decisions for us.

Free forms are available. Caring Connections provides links to download many State documents.

Complete one and carry it with you.  Make sure that your physician and your “healthcare attorney in fact” also have copies.

Don’t leave your future up to a room of well-intentioned strangers. 

Related reading from the Pittsburgh Post Gazette:  Death Panels They Are Not