Reporters spend 10 weeks immersed in end-of-life care
Filed under: Health journalism, Hospitals, Hot Health Headline, Nursing
Toronto Globe and Mail reporter Lisa Priest and photographer Moe Doiron spent two-and-a-half months embedded in a 20-bed critical care unit at a Toronto
Photo by quinn.anya via Flickr
hospital, following four patients and their families and chronicling life in an environment where, Priest writes, “death is a constant, almost routine event, claiming one in five patients who enter.”
Their assignment was to find out “How does one prepare for the end of life?” and explore the medical, ethical and economic challenges of that stage of life.
The result is a sprawling, intensive report on the state of end-of-life care in Canada, heavy on anecdotes. Priest’s centerpiece is subtitled “Spending 10 weeks with patients facing death“) but remains cognizant of big picture issues like cost and quality of life.
Behind Oklahoma’s nation-leading access-to-care problems
Filed under: Government, Health care reform, Health data, Health journalism, Hot Health Headline, Nursing, Public health, Public records
In February, the New England Journal of Medicine ranked Oklahoma as the worst when it came to access to medical care. With help from a California Endowment Health Journalism Fellowship, Tulsa World reporter Shannon Muchmore sifted through reams of data to emerge with a three-part series helping readers better understand the state’s unique health care delivery challenges.
Fans of data analysis and numbers will want to dive straight into the first installment. According to Muchmore, 66 of Oklahoma’s 77 counties contain “Health Professional Shortage Areas, which means “they don’t meet the national standard of one physician for every 3,500 people.” And those doctor-patient ratios aren’t improving.
The state is facing a severe shortage of doctors as the population ages. Adding to that, as many as 180,000 people are poised to receive insurance when provisions of federal health-care reform kick in 2 1/2 years from now.
What’s behind that shortage? Muchmore enumerates the key drivers.
Medical schools are not increasing their class sizes, residency slots are hard to come by, and doctors are choosing to locate in other states.
The last two factors go hand-in-hand, as doctors often practice where they have their residencies. Without a connection, they have little reason to locate in a rural area.
The state is not well-positioned to handle a further deterioration in its health-care system. Oklahoma consistently ranks among the worst states for obesity, diabetes, smoking, heart disease and overall health. It has the least improvement in the country in age-adjusted death rate since 1990.
In the second installment, she examines the link between disparities in access to medical care and disparities in life expectancy and other indicators throughout the state, with a special focus on Oklahoma’s most rural counties.
In the final piece, Muchmore looks at the future of health care provision in Oklahoma and the key role that physician extenders, such as nurse practitioners and physician assistants, are poised to play.
Keep an eye on the AHCJ website for an upcoming “How I did it” article from Muchmore in which she shares how she did the reporting on this project.
Navigators work to keep patients from falling through cracks
Filed under: Hot Health Headline, Nursing, Public health
Patient navigators - “like the air traffic controllers in health care” - captured the attention of Pamela Fayerman of the Vancouver Sun.
Fayerman explains that patient navigators are specially trained health care providers who help patients get access to care and services they need, serve as liaisons between patients and doctors and generally ensure patients don’t fall through the cracks of a complex health care system.
Fayerman’s five-day, multiplatform series on patient navigators was published last week and is a comprehensive look at this relatively new practice being applied to Canadian patients. She explores the roots of patient navigation in Harlem and goes on to document the evolution in Canada over the past decade.
In a story about one patient, Fayerman shows how the role of a navigator in getting efficient treatment, follow up and having a point of contact got the patient into the hospital for triple bypass surgery before she had a heart attack and sustained damage to her heart.
Other stories look at how navigators bring a culturally sensitive approach to treating members of the aboriginal community, as well as the unwillingness of Canadians to pay out of pocket for navigators, but:
In the U.S., where people are used to paying for health care, navigators are becoming more and more common - in both insured and non-insured settings and at for-profit and non-profit hospitals.
Fayerman, who used a $20,000 grant from the Canadian Institutes of Health Research, visited five provinces and 12 cities over eight months, interviewing nurse and other navigators, their patients and health system leaders. She explains why the series is important and how patients can be their own navigators.
Members’ investigations prompt bills in Wash.
Filed under: Government, Health journalism, Health policy, Member news, Nursing, Pharmaceuticals
Three health-related bills moving through the Washington legislature came about as a result of articles reported by AHCJ members at The Seattle Times and InvestigateWest.
One bill is part of a “proposed overhaul of laws on long-term care of elderly adults” that was prompted by “Seniors for Sale,” a series by Seattle Times reporter and AHCJ member Mike Berens that detailed problems in the state’s adult family homes.
Another bill, unanimously approved by the state senate, will push a state agency to create standards on how to handle chemotherapy drugs. It was prompted by reporting from AHCJ member Carol Smith of InvestigateWest, a nonprofit journalism organization, that revealed that nurses who handle those drugs are exposed to health problems.
A related bill, intended to identify potential links between occupational exposures and cancer outcomes, also was unanimously approved by the senate. It would “require that a cancer patient’s occupation be reported to the registry, and that if the patient is retired, the patient’s primary occupation before retirement be reported,” InvestigateWest reports.
Alarm fatigue hurts patient care, overwhelms nurses
Filed under: Health data, Hospitals, Hot Health Headline, Nursing
In the wake of several high-profile incidents, The Boston Globe’s Liz Kowalczyk has assembled a thorough investigation of alarm fatigue in hospitals. Alarm fatigue, for the record, is the idea that the huge arsenal of patient monitors in any given hospital floor are going off so often that nurses become slower in their responses to the alarms. For example, in one 15-bed unit at Johns Hopkins, staff found that, on average, one critical alarm went off every 90 seconds throughout the day.
With the help of ECRI, Kowalczyk has managed to attach some numbers to the issue.
The Globe enlisted the ECRI Institute, a nonprofit health care research and consulting organization based in Pennsylvania, to help it analyze the Food and Drug Administration’s database of adverse events involving medical devices. The institute listed monitor alarms as the number-one health technology hazard for 2009. Its review found 216 deaths nationwide from 2005 to the middle of 2010 in which problems with monitor alarms occurred.
But ECRI, based on its work with hospitals, believes that the health care industry underreports these cases and that the number of deaths is far higher. It found 13 more cases in its own database, which it compiles from incident investigations on behalf of hospital clients and from its own voluntary reporting system.
Kowalczyk also looks at potential solutions to the problem and how some institutions are trying to make changes to eliminate alarm fatigue, including cutting back on unnecessary monitors and having monitor warnings appear on nurses’ pagers or cell phones.
To back up the numbers, Kowalcyzk got some telling quotes from frustrated nurses.
“Yes, this is real, and, yes, it’s getting worse,’’ said Carol Conley, chief nursing officer for Southcoast Health System, which includes Tobey Hospital. “We want to keep our patients safe and take advantage of all the technology. The unintended consequence is that we have a very over-stimulated environment.’’
“Everyone who walks in the door gets a monitor,’’ said Lisa Sawtelle, a nurse at Boston Medical Center. “We have 17 [types of] alarms that can go off at any time. They all have different pitches and different sounds. You hear alarms all the time. It becomes . . . background.’’
Kowalcyzk’s investigation points out that, while alarms do tend to go off when there’s a real problem, it appears that they do so at the expense of also going off when there isn’t.
Monitors can be so sensitive that alarms go off when patients sit up, turn over, or cough. Some studies have found more than 85 percent of alarms are false, meaning that the patient is not in any danger. Over time this can make nurses less and less likely to respond urgently to the sound.
For more specifics on device design issues, see the final subheading, titled “Looking for solutions.”
For a one year, the Joint Commission made routine alarm testing and training part of their accreditation requirements, but dropped the stipulation in 2004 when it felt the problem had been solved.
Other parts of the series:
- Graphic: Hospital Alarms
- Ask a nurse how they deal with all the noise in hospitals
- Video: Watch an FDA Patient Safety News video on alarms
- ECRI Institute’s 2011 Top 10 Health Technology Hazards
NPR explores the right to at-home care for disabled patients
When it comes to summarizing the NPR news investigation “Home or Nursing Home,” you really can’t do much better than its tagline: “America’s empty promise to give the elderly and disabled a choice.”
The package is anchored by Joseph Shapiro’s wonderfully written profile of the family of a young woman who lives at home, despite the need for 24-hour intensive care. She’s 20, and Illinois Medicaid will stop covering her care as soon as she hits 21. Why?
It’s expensive to care for Olivia at home: nurses cost about $220,000 a year. Still, that’s less than half the cost of what the state counts as the alternative — having her live in a hospital. The Welters figure they’ve saved the state millions of dollars by keeping her at home.
But when she turns 21, the state changes how it measures cost. For an adult, the state says the alternative is no longer a hospital — it’s a less expensive nursing home.
At 21, Olivia and thousands like her around the country enter an uncomfortable gray area rife with lawsuits, acts of government and supreme court decisions. In fact, families like hers have lately been suing states – and winning. Shapiro explains how.
In 1999, the U.S. Supreme Court ruled, in Olmstead v. L.C., that under the ADA, people with disabilities often have the right to live in the community rather than in institutions. Since then, other federal laws and policies have said that states have an obligation to provide more home-based care. The new health reform law is filled with incentives for the states to spend more.
But federal law is contradictory. An older federal law, the 1965 law that created Medicaid and Medicare, says states have an obligation to provide nursing home care. Home care programs are still optional.
Also not to be missed: Shapiro’s profile of a patient advocate that doubles as a seamless history of how the system reached this point. A timeline and interactive graphic round out the package.
Heisel’s ‘Doctors Behaving Badly’ goes viral
Filed under: Health data, Health journalism, Hot Health Headline, Member news, Nursing
As anybody who follows the Reporting on Health blog knows, William Heisel’s virtual roadshow of physician background research has been gaining ridiculous amounts of steam lately. His Doctors Behaving Badly brand has taken on a life of its own, propelled by a Google Map he put together to place his findings into geographic context.
View Doctors Behaving Badly in a larger map
That geographic context has become the focus of his investigation, as Heisel has turned what was once a quirky little recurring item into a systematic, state-by-state way into how the public can check up on disciplined (or otherwise problematic) doctors. He’s almost reached the halfway point, and he’s reached some interesting conclusions. My favorite is that he doesn’t think states that have terrible sites with which to check up on doctors are being malicious, they’re just bad at making websites.
I think the problem lies in poor website design. A board starts with a simple site that allows people to see if a doctor has a valid license. Then that same board adds scanned documents from its disciplinary files, but instead of linking these two things together, it puts them in completely different parts of its site. When the board gets around to adding malpractice information or criminal histories, it layers those on top, too, instead of fully integrating them.
The effect is a stratified system of information that lets patients think their physicians have a clean history when, in fact, their records are simply too hard to find.
Heisel recently appeared on Fox News to explain what he’d found thus far.
On the whole, Heisel’s effort helps illuminate the power of my favorite online reporting tool: The progressively investigated database.
Agreement lets disciplined nurses work in 24 states
Filed under: Health data, Health journalism, Nursing, Public records
ProPublica’s Tracy Weber and Charles Ornstein are back on the disciplined caregivers beat, this time cooperating with USA Today to expose a licensing gap that makes it easier for disciplined nurses to find work in other states. The licensing agreement in question was signed a decade ago as 24 states agreed to recognize each other’s licenses in an attempt to alleviate care shortages by allowing nurses to work where they are needed most.
In some cases, nurses have retained clean multistate licenses after at least one compact state had banned them. They have ignored their patients’ needs, stolen their pain medication, forgotten crucial tests or missed changes in their condition, records show.
Critics say the compact may actually multiply the risk to patients. There is no central licensing for the compact, so policing nurses is left to the vigilance of member states.
Outside the compact, each state licenses and disciplines its own nurses. But within it, states effectively agree to allow in nurses they have never reviewed.
Ornstein and Weber found numerous instances in which a caregiver disciplined in one state was able to work for an extended period in another without being red-flagged, and are helping spark a debate over the costs, benefits and implementations of such agreements.
Calif. finds 3,500 nurses were disciplined elsewhere
Filed under: Health data, Health journalism, Hospitals, Hot Health Headline, Nursing
California’s nursing board has confirmed what fans of Charles Ornstein and Tracy Weber’s disciplined caregivers series for ProPublica and the Los Angeles Times already suspected, that about 3,500 California nurses had clean records there despite being disciplined in other states. You can find Ornstein and Weber’s report on these developments at ProPublica or the LA Times.
After last year’s report by ProPublica and The Times, California ran its list of 376,000 active and inactive nurses against a database maintained by the National Council of State Boards of Nursing, to which nearly all states voluntarily report their disciplinary actions. Among the matches were nurses who had been disciplined by multiple states, sometimes for the same incident.
California officials said they couldn’t disclose the names of any nurses who turned up in the search until a formal disciplinary charge is filed. While those cases are pending, the nurses remain free to practice in California.
Of the 3,500 nurses whose records matched, “as many as 2,000 … will face discipline in California, officials estimate,” Ornstein and Weber write. “That’s more registered nurses than the state has sanctioned in the last four years combined.”
What we’re reading: OSHA, reform and a new site
Filed under: Government, Health care reform, Health journalism, Member news, Nursing
These are busy times for AHCJ (getting ready for Health Journalism 2010!) but we want to take a moment to share some of what we’re reading:
OMBWatch: OSHA Proposal Cuts Workers’ Right to Know about Chemical Risks
PLoS ONE: The Unbearable Lightness of Health Science Reporting: A Week Examining Italian Print Media
FairWarning.org launches: New site to investigate health, safety and corporate conduct issues was founded by former Los Angeles Times reporters.
Poynter’s Al Tompkins has an interview with ProPublica’s Charles Ornstein (also president of AHCJ’s board of directors) about investigating nurses and regulatory boards.
Health care reform: What’s next? Reporters Jim Landers, Washington correspondent for The Dallas Morning News, and Noam Levey, health policy reporter for the Los Angeles Times/Tribune Washington Bureau, have advice on how to cover the local angles of health reform. Suggestions from other reporters will be added soon.
-
Join us in Atlanta
for Health Journalism 2012
Fellowship applications
due Feb. 27
New at HealthJournalism.org
- Data gives depth to investigation of patient safety
- What reporters should know about Alzheimer’s and related dementias
- Apply for fellowships to attend Health Journalism 2012
- AHCJ asks Supreme Court to permit broadcast of arguments in health reform case
- Tips for print, online journalists to embrace broadcast opportunities
- Numbers reveal how often, or how rarely, states check doctors’ disciplinary records
- How I did it: Falsified charts in nursing homes linked to patient care
- Access Denied: Looking at a lack of health care availability
- Transparency & medical errors: Public reporting of patient harm is a potent force
