Reports reveal problems in England’s NHS
England’s Care Quality Commission, a regulatory agency, has found that a quarter of the National Health Services hospital trusts fail to meet basic standards of hygiene, according to The Telegraph’s Andrew Hough.
Some of the failures included 36 trusts not providing areas to decontaminate instruments, three trusts failing to regularly flush unused water outlets while more than a dozen trusts failed to keep clinical areas clean.
As Hough reports, the revelations come just days after a BBC investigation found that hospital trusts have given incorrect information on their performance and quality of care.
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Conflicting demands on their job and being rushed or understaffed were common problems revealed by a recent survey of employees of England’s National Health System, as The Telegraph’s Rebecca Smith reports.
The NHS, according to its Web site is “the world’s largest publicly funded health service” with more than 1.7 million employees. The survey was done by the Care Quality Commission.
The CQC reports some improvements in job satisfaction, however:
Approximately half of all staff would recommend their trust as a place to work, and just under two thirds are happy with the standard of care provided by their trust. There has also been a substantial rise in the % of staff saying that they have had training in infection control.
Express-News investigates Texas nursing homes
Filed under: Hospitals, Hot Health Headline, Public records
San Antonio Express-News reporters Karisa King, John Tedesco and Melissa Fletcher Stoeltje took advantage of a number of tools to assemble a broad investigation into the city’s nursing homes.
Slow action on nursing home problems
In the package’s centerpiece, the reporters plowed through 2,200 claims filed against the town’s 55 licensed nursing homes from 2006 to 2009 and found that investigators arrived long after the incidents in question and marked so many claims “unsubstantiated” that the state attorney general posted a notice advising residents that they should take even unsubstantiated claims into account when evaluating nursing homes. They also consulted ratings and visited 10 local nursing homes.
With the ratings as a guide, the newspaper examined more than 3,000 pages of abuse and neglect investigations and annual inspections of 10 nursing homes with the lowest scores. It also reviewed dozens of wrongful-death lawsuits filed against local nursing homes to examine how Texas watches over its elderly.
In addition to a few dangerous homes and some disquieting anecdotes, the reporters found an unenforced reporting law:
(Department of Aging and Disability Services) also is failing to enforce a state law that requires nursing homes to report details about every resident who dies. State officials are supposed to analyze the fatality reports to publicize problems and trends, but that research isn’t being done.
To top off this tale of dysfunction, they also unearthed at least five cases in which would-be nursing home whistle blowers were fired.
Stoeltje added a sidebar on nursing home rating systems, their utility and their shortcomings. She addresses both the local Texas system and the federal Nursing Home Compare database. She talks to both nursing home operators and patient advocates; the operators tend to dwell on ratings’ weaknesses while advocates spoke on their strengths.
LIST: Examples of problems found at nursing homes
Six more examples culled from complaints and often backed with interviews.
MAP: Quality of nursing homesA Yahoo! map linking nursing home location, size and rating.
Texas Public Radio
Terry Gildea, host of a news discussion program called “The Source,” interviewed all three Express-News reporters about their investigation.
Slim guide:
Covering the Health of Local Nursing Homes
This reporting guide gives a head start to journalists who want to pursue stories about one of the most vulnerable populations – nursing home residents. It offers advice about Web sites, datasets, research and other resources. After reading this book, journalists can have more confidence in deciphering nursing home inspection reports, interviewing advocacy groups on all sides of an issue, locating key data, and more. The book includes story examples and ideas.
AHCJ publishes these reporting guides, with the support of the Robert Wood Johnson Foundation, to help journalists understand and accurately report on specific subjects.
• More investigations of nursing homes
• Aging Nation: Troublesome Health Care Issues
• Headlines an advocate for seniors would like to see
• The impact of aging upon health care
• Covering nursing homes and other issues of aging
• How will retiring boomers affect the national health agenda?
• You Can Run, but You Can’t Hide: Policy and Problems in Long-Term Care
• Biology of Aging: Sources and Resources
Some Mass. hospital quality measures online
Elizabeth Cooney, writing on White Coat Notes, alerts us to a change in data provided by the Massachusetts Hospital Association and the Massachusetts Organization of Nurse Executives.
PatientCareLink, the new site, adds examples of hospitals improving their performance and, for patients, gives advice on choosing a doctor or hospital, according to Cooney.
The site allows you to view hospital staffing plans and performance measures, such as prevalence of bedsores, patient falls, heart attack care, pneumonia care and surgical care.
Some of the data comes from Hospital Compare (also participating hospitals. And there’s no apparent way to download the data for analysis, as you can from the Hospital Compare site (and AHCJ).
Of course, ratings of Massachusett’s hospitals also are available from the Massachusetts Health Care Quality and Cost Council.
Kidney swap connects six in small Mo. town
Filed under: Health journalism, Hospitals, Hot Health Headline
Joy Robertson of KOLR-Springfield, Mo., tells the story of the coincidences and generosity that led to six residents of Licking, Mo., (population 1,471) swapping kidneys in a St. Louis hospital. Here’s a quick timeline, to give you an idea of how it all came together.
- Licking resident Stephanie Hood needed a kidney.
- Friends Randy and Melissa Lewis wanted to donate one for her, but neither was a match.
- Randy decided to donate his kidney anyway.
- Carrie Goforth, a 29-year-old Licking mother on dialysis, was a match for Randy.
- Meanwhile, Melissa Lewis decided to donate her kidney as well.
- Hers went to Gern Beasley, another Licking resident.
- Finally, Stephanie Hood, the patient who started it all, also got the kidney she needed. Her donor? Her cousin Diane. From Licking.
Reporting on kidney donation
Josephine Marcotty of the Minneapolis Star Tribune recently wrote a series addressing the increasing demand for kidneys, a need spurred by an aging population, increases in diabetes, obesity and high-blood pressure. In a recent AHCJ article, she explained how the story came together and how other reporters can follow in her footsteps and expand upon her work.
Nurses face dangers of workplace violence
Marlene A. Prost, writing for Human Resource Executive Online, reports that workplace violence is a growing problem for nurses.
She cites reports from Australia and the United States showing that about half of nurses in two surveys had been punched or otherwise assaulted in the past year. It appears the assaults are coming from patients and their families and friends.
However, Prost reports, nursing and hospital associations are taking notice and action, such as “improving security, encouraging incident reports and fighting to strengthen state laws to prevent violence and punish offenders.”
Hospitals are using guidelines from The Joint Commission, the Occupational Safety and Health Administration and the National Institute for Occupational Safety and Health to make nurses safer. They also are training nurses to defuse volatile situations and encouraging them to report incidents, according to the article.
Reporters may be able to find more information through the Bureau of Labor Statistics and the American Nurses Association also has information about workplace violence. The Joint Commission issued a Sentinel Event Alert in 2008 about intimidating and disruptive behaviors in the health care environment.
AHCJ: Joint Commission site obscures information
In a letter to Mark R. Chassin , M.D., the Joint Commission’s president and CEO, the Association of Health Care Journalists has suggested improvements to the commission’s Quality Check Web site, where many people go to find out whether to trust their local hospital.
The Web site also is a potentially useful tool for health-care journalists. “In a time of change in health care, the ability to do comprehensive research on local hospitals is more important than ever before,” the association’s letter said.
Among the problems identified:
- Hospitals with any level of accreditation are given “The Gold Seal of Approval” – even those whose accreditation is conditional or at risk of being denied.
- It’s difficult to find out which hospitals in a given region have less-than-full accreditation. To check on a hospital’s accreditation status, one has to open each individual profile. The Joint Commission once had a mechanism to sort hospitals by accreditation status, but that is no longer available.
- After a hospital loses accreditation, its past Accreditation Quality Reports are eventually removed from the site, leaving only the facility’s name with no historical record.
- There is no easy way to do a side-by-side comparison of more than six facilities simultaneously.
“The organization that accredits hospitals around the country, and voices support for transparency about hospital quality, has a Web site that obscures the reality of many hospitals’ performance,” said Charles Ornstein, AHCJ president.
Read more about AHCJ’s letter to the Joint Commission.
Doctors turn to ‘speed dating’ to find patients
American Medical News‘ Victoria Stagg Elliott outlines a Texas program called “Doc Swap,” which is a sort of speed dating for medical professionals and patients. A doctor and potential patient have five minutes to find out if they’re a good fit for each other before the rotation bell rings and they start the five-minute discussion over again with another partner. 
For Texas Health, it’s a “low-cost way to drive patients to affiliated physicians.” For physicians, even representatives say it’s “good marketing,” as they can net three or four new patients for just an hour’s worth of unpaid effort.
Elliot writes that it appears to be the first such event in the country, though less formal doctor-patient meet-and-greets are common. Physicians say it’s a good way to filter out patients who wouldn’t be a good fit for their practice and expertise, and to help direct patients to the right specialist from the start.
Firing patients
“Doc Swap” and its take on the doctor-patient relationship fit with a recent column on doctors “firing” their patients. Beck says it’s a common topic of discussion among doctors, and lays out the basic criteria for showing a patient the door.
The list of reasons is relatively short, according to medical associations: Patients who are chronically abusive, disruptive or drug-seeking may be asked to leave a practice. So might those who habitually miss appointments or refuse to pay reasonable bills. Failing to heed medical advice isn’t necessarily grounds for a split, but some doctors suggest that patients who won’t quit smoking, use illicit drugs or have potentially harmful habits (daily enemas, say) might be more comfortable in another practice.
The comments on a related blog post provide a few more physician perspectives.
Patient 2.0 empowers patients, worries doctors
Filed under: Health data, Hospitals, Hot Health Headline
Writing for Time, Bonnie Rochman digs into the ramifications of patients sharing information and tips online, an “empowerment movement” she calls “Patient 2.0.” In the piece, she profiles the newly created Society for Participatory Medicine, which “encourages patients to learn as much as they can about their health and also helps doctors support patients on this data-intensive quest,” as well as PatientsLikeMe.com, a free service which makes its money by selling anonymized patient information.
One private-sector initiative already has about 50,000 patients inputting their symptoms and treatment regimens and updating details of their disease progression. Wonder how others are coping with your particular ailment? PatientsLikeMe.com spells it out via color-coded charts and graphs. “When you need help, privacy is a terrible thing,” says Jamie Heywood, who co-founded PatientsLikeMe in 2004 before his brother died of Lou Gehrig’s disease, or ALS.
Rochman demonstrated the strength of PatientsLikeMe in an anecdote in which data from the site’s users allowed administrators to reach clear conclusions about the effectiveness of lithium in the treatment of ALS six months ahead the formal clinical trials that were testing the same thing.
While medical professionals like those at the Society for Participatory Medicine have embraced the patient power movement, “plenty of doctors are worried about the quality of the information that is being assessed as well as patients’ ability to understand it,” Rochman wrote. A few have taken it upon themselves to fill the gaps, banding together to weigh in on the effectiveness of certain off-label treatments via Twitter, and to produce patient seminars on the reasons for clinical trials and the efficacy of various treatments.
NCHS: Patient 2.0 most popular use of health tech by far
The National Center for Health Statistics recently (Feb. 2) released statistics for the first half of 2009 on “Health Information Technology Use Among Men and Women Aged 18-64.” The stats show that “searching for health information online” is still the only use of health information technology embraced by a majority of American adults.
The numbers:
- From January through June 2009, 51% of adults aged 18-64 had used the Internet to look up health information during the past 12 months.
- Over 3% of adults aged 18-64 had used an online chat group to learn about health topics in the past 12 months.
- Among adults aged 18-64, women were more likely than men to look up health information on the Internet (58.0% versus 43.4%) and were also more likely to use online chat groups to learn about health topics (4.1% versus 2.5%).
- From January through June 2009, almost 5% of adults aged 18-64 had communicated with a health care provider by e-mail in the past 12 months.
- During the first 6 months of 2009, 6% of adults aged 18-64 requested a refill of a prescription on the Internet, and almost 3% had made an appointment with a health care provider in the past 12 months using the Internet.
- Among adults aged 18¬64, women were more likely than men to request a prescription refill on the Internet (6.6% versus 5.3%), make an appointment using the Internet (3.5% versus 1.8%), and communicate with a health care provider over e-mail (5.6% versus 4.2%).
Transmitter tracks health-care workers’ washing
Despite constant reminders and a high-level of industrywide awareness, studies indicate that less than half of American health care workers wash their hands as frequently as they ought to. This contributes to the health-care-associated infections that kill tens of thousands annually. Now, NPR’s Gigi Douban reports, one Alabama hospital has resorted to high-tech monitoring devices to keep tabs on the handwashing practices of its employees.
Workers wear a special wireless transmitter, from which, Douban writes, “the hospital can tell when she entered a patient’s room, whether she washed her hands and whether she washed again on the way out. The information is sent to hospital officials, including the CEO.”
“If they’re habitually not complying, we can send them an e-mail or send them a text message, something that goes to them personally,” says Harvey Nix, CEO of Proventix, the company that developed the monitoring system at Baptist Princeton.
According to Douban, the CDC is currently investigating the effects of the technology upon the behavior of health workers.
Is U.S. ready for Haiti-style mass casualty event?
Filed under: Government, Hospitals, Hot Health Headline
The GAO’s latest release, “State Efforts to Plan for Medical Surge Could Benefit from Shared Guidance for Allocating Scarce Medical Resources (20-page PDF),” is the result of an evaluation of the nation’s medical capacity to deal with “mass casualty events,” a response they refer to as a “medical surge.” Read the one-page summary here. The release is a summary of a similarly titled 2008 report, but it has gained extra relevance in the light of the U.S. response to the similar circumstances of the 2010 Haiti earthquake.
The report found that states were making good progress in developing bed reporting systems and coordinating with military and veterans hospitals, as well as in selecting alternate care sites and registering medical volunteers. It also noticed that they were lagging when it came to planning for altered standards of care.
Related
IoM: We need clear guidelines for disaster triage
What really happened at Memorial after Katrina?
AHCJ presentation: How prepared is your city for a health disaster? (Audio)
Protecting the Public’s Health from Disease, Disasters, and Bioterrorism
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Health Journalism 2010, AHCJ's annual conference, features a world-class program with story ideas, sources, stronger reporting skills, chances to meet newsmakers and network with other journalists.
- Health and education: Covering these intersecting beats
- Reporting on the business of health care
- Health reporting resources for journalists on state and local government beats
- Shortened Lives: How location, lifestyle affect health
- Covering a complex story for the long haul
- Aging in the 21st Century: Presentations and tip sheets
- AHCJ calls for better information from Joint Commission Web site
