Idea #309 for December 24th, 2009: Ensuring A Safe Landing or What Aviation Can Teach Us About Safety in Medicine

In aviation, the advent of pre-flight checklists have been credited with boosting airplane safety and saving lives. A similar approach may prove effective in the world of medicine as well. A study in the New England Journal of Medicine indicated that patient mortality rates were cut in half and complications dropped by a third after surgical teams adopted checklists.

The study involved over 7,000 patients in eight hospitals located around the world. The checklist was only 19 steps long, and covered aspects of patient safety like correct patient identification. It’s a simple idea that can have real benefits at almost no extra cost.

Read more about the story in Time Magazine.

Idea #303 for December 18th, 2009: A Large Chunk Of Change or The Costs Associated With MRSA

Infections resulting from surgery are a major concern in healthcare, and it’s been addressed here several times already. The economic aspect of these infections has been difficult to pin down, though. A new study sought to estimate the per-patient cost of the infections, and the amount is staggering.

The study, which was conducted by researchers at Duke, followed hundreds of patients in the 9o days following surgery. Patients who contracted MRSA infections accrued additional costs of around $60,000 for the three additional weeks of hospitalization they required, on average, to clear the infection. In that same 90 day period, the MRSA infected patients were seven times likelier to die than other patients, the study says. At just the seven hospitals that the study investigated, the MRSA infections accounted for more than $19 million in additional costs. These stats remind us once again that preventing MRSA-related infections in hospitals can save us not only unnecessary deaths, but also significant amounts of money.

Read more about the study here.

Idea #302 for December 17th, 2009: A Clearer Message or Using Video To Better Communicate End-of-Life Care Options

Patients with terminal illnesses face many difficult choices when it comes to coordinating end-of-life care. Usually those options are spelled out on paper, but the majority of patients do not complete all the necessary documentation. Researchers have found that using video rather than documentation to convey the message resulted in better understanding on the part of the patients.

Terminal cancer patients in the study were shown either a video that illustrated the options for end-of-life care, or were given the traditional documentation for that purpose. Patients who viewed the video were much more likely to choose less aggressive care, and also scored better on assessments that gauged their understanding of the different options. This seems like a pretty simple fix for a problem that plagues patients with terminal illness, and hospitals should pay close attention to further studies on the matter.

Read more about this study here.

Idea #299 for December 14th, 2009: Glowing In The Dark or The Alarming Variability in CT Scan Radiation

The potentially harmful levels of radiation exposure associated with undergoing CT scans have been well-documented. What’s surprising, though, is how widely the amount of radiation emitted by CT scans varies. The amount of radiation can vary by a factor of ten for a given scan, new research suggests.

The study involved 1,000 patients who received scans at four hospitals, and there was significant variability in radiation exposure from patient-to-patient receiving the same scans. While some variation is expected, the amount of variation in these cases was considered unacceptable. Researchers estimate that 1 in 270 women who receive a coronary CT angiography at age 40 will develop cancer as a result of the scan, and that number is 1 in 600 for men.

Patients should expect some slight risk of potential cancer as a result of CT scans, and that is normally outweighed by the diagnostic benefit of the scan itself. However, high levels of variation in levels of radiation are unacceptable when they provide no additional diagnostic benefits. Hospitals must monitor and address the problem, as they are unnecessarily exposing patients to unknown levels of radiation for no reason.

Read more about this issue in the Wall St Journal.

Idea #295 for December 10th, 2009: Know Your Meds or Hospital Patients Unaware of Drugs They Are Taking

Many hospital patients are often unaware of the medicines they are taking, a new study suggests. In fact, 96% of patients surveyed were unable to accurately recall every medication they received during their hospital stay. And 44% of them believed they were taking a medication that, in reality, they were not given. Lack of communication is thought to be the underlying cause of the problem.

Of those surveyed, less than 30% claimed they had seen their medication list. If patients are made better aware of the drugs they are prescribed in a hospital, it could help them identify possible allergies or other oversights. Even if hospitals do not change the current culture of medication communication, there are some steps patients can take to become better informed. For one, patients should ask about what drugs they are being given and what side-effects they should expect. Also, if patients could bring a list of their current prescriptions to the hospital, it would assist hospital staff in avoiding interactions or allergies.

Read more about this here:

Idea #280 for November 25th, 2009: Looking Over Your Shoulder or A Simple Way to Boost Hand-Washing Compliance in Hospitals

Proper hand-washing compliance remains a problem across many medical facilities. Not thoroughly washing hands can lead to the spread of pathogens including MRSA. A program recently instituted at UCLA Medical Center, however, has led to dramatic changes in the compliance rate of hand-washing there. It could serve as model for other hospitals in the future.

UCLA has achieved their success with using a simple method: enlisting undergrads to observe hand-washing in the hospital and report on the results. They have seen their compliance with hand-washing guidelines rise from 50% to 93% since the program began. Apparently, simply having people watch over medical staff during washing can make them more careful. It’s something for other medical facilities to keep in mind, especially if they are looking for a low-cost way raising compliance.

Read more about this program in the Wall St Journal.

Idea #279 for November 24th, 2009: Unwelcome Visitors or Fighting The Rise in Community-Acquired MRSA

MRSA, the antibiotic resistant pathogen we often hear about in the news, is usually thought of as a problem that only occurs in hospitals. New data suggests that a growing number of patients are picking up MRSA in the community and then bringing the pathogen into hospitals, rather than the other way around. The incidence of MRSA in outpatient units has grown rapidly. This is dangerous because doctors often travel between outpatient and inpatient units, potentially spreading the bacteria that’s carried into the hospital during outpatient visits.

Strains of MRSA that originate outside of hospitals are considered less dangerous than the deadly ones often cited in the media. That doesn’t mean the threat should be ignored, though. Hospitals now have to concentrate not only on containing and eliminating MRSA from their inpatient units, but also must contend with battling strains that are introduced by new patients. Healthcare facilities will probably require more resources to fight the outside waves of MRSA now. They will also need to increase surveillance and find better diagnostic tools to ensure that their response can be rapid.

Read more about this story in the LA Times.

Idea #277 for November 22nd, 2009: The Long Wait or The Problem With Emergency Care Wait Times

Our emergency rooms need fixing. New data show that patients that need care the quickest are least likely to receive it. Less than half of patients who needed emergency care within 15 minutes actually received it within that time frame. More troublesome is that those numbers have been getting worse in recent years.

The researchers studied data from 540 million emergency department visits spanning from 1997 to 2006. In 1997, 59% of the patients requiring care within 15 minutes received it, yet in 2006, that number was down to 48%. Whether patients were insured did not seem to matter in this case. However, Hispanic and African American patients faced even longer wait times on average than whites. There’s no simple fix for this mess, but effective healthcare reform legislation must address this before the trend worsens.

Read about this study here.

Idea #273 for November 18th, 2009: Progress Report or Rethinking Hospital Report Cards

Evaluating hospitals with report cards has been seen as a way to prod under-performing facilities into making improvements. However, the conventional thinking on this subject may be incorrect, says new research from Canada. The study looked specifically at heart patients in Ontario, and found that quality of treatment did not improve after the report cards were released.

It should be pointed out that this study is not all-encompassing by any means: a few dozen hospitals in one Canadian province were evaluated only on treatment for heart patients. That said, it does indicate a certain trend that we should be aware of. If hospital report cards in this country are as ineffective at improving care as they seem to be in Ontario, then we should rethink their value going forward. Still, report cards can be an important tool for the public when they weigh which hospitals to go to, even if they have limited value in terms of improving care. For that reason, the report cards should continue to serve a meaningful role in healthcare, even if they cannot convince hospitals to improve.

Read more about this research here.

Idea #271 for November 16th, 2009: Who’s Really In Charge? or Adverse Event Legislation That Doesn’t Work

In 2002, Connecticut enacted “adverse event” legislation requiring hospitals to report to their health department when adverse events were harming their patients. The impetus for that law was a report from the Institute of Medicine that claimed nearly 100,000 patients in the US were dying yearly due to human error in hospitals. However, that Connecticut law has not proven effective at all, as most adverse events are not reported publicly today.

The breakdown in the process started in 2004 when the law was changed (following complaints from hospitals and their lobbyists). Those changes included limiting the scope of adverse events that needed to be reported as well as keeping reports secret unless an investigation was necessary. Since then, public access to the reports has fallen by 90%. This mess has become an example of how not to make adverse event legislation. The original intent of the law was more openness in the face of staggering numbers of adverse events caused by human error. The current state of the law is anything but open. Other states that are considering adopting similar legislation should look to Connecticut to see how not to do it. The influence of lobbying groups and hospitals has taken the teeth out of the law entirely.

Read more about this in the Hartford Courant.