Pierce uses medicine to tell a classic sports story
It has all the fixings of a front-page health narrative – the handsome baseball star, the stunning neurological condition, the virtuoso brain surgeon and the arduous, improbable comeback – but Charlie Pierce’s piece in The Boston Globe Magazine is remarkable not for these stuff-of-legend elements, but for the mundane ones.
From how his first symptoms affected top prospect Ryan Westmoreland’s ability to gun down the bad dudes in “Call of Duty” to how he spent a week practicing stair climbing before he could board the Red Sox owner’s private plane, Pierce nails the niggling medical realities that drive this profile home. I could recap the highlights, but this is a case where the value lies in the storytelling as much as in the story.
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
New CME provider eschews industry money
Filed under: Health journalism, Hot Health Headline
Medical Marketing & Media’s Marc Iskowitz profiles a new continuing medical education provider, Lighthouse Learning.
Started by a Harvard neurologist and an executive, both with former ties to CME firm Pri-Med, along with a third partner, Lighthouse Learning receives no funding from pharmaceutical or device companies for the development of its curricula. Instead, the business model relies exclusively on licensing content nationwide, to medical societies, insurers and meetings companies.
Most American physicians are required to earn CME credits to maintain their licenses. These are often industry-sponsored, but while Lighthouse is in the headlines, it’s not alone. Iskowitz again:
Lighthouse’s funding model is not without precedent, though, said Dr. Murray Kopelow, executive director of the Accreditation Council for CME. He told MM&M that 772—or 35% of the 2,225 ACCME-accredited providers submitting data for the 2009 ACCME annual data report—took neither commercial support nor advertising/exhibit income for their educational programs. A total of 943 providers, or 42%, accepted no commercial support. Many of these are providers accredited by state medical societies, and it’s not known whether any of them operate on a national scale, as the council has not analyzed data in this regard.
Notable psychiatry (and COI) blogger Daniel Carlat has taken notice of the new company as well, noting that coverage of its launch shows that conflicts of interest in CME are officially mainstream news.
The Boston Globe broke the story in this article on their front page, which is in itself significant. It means that mainstream journalists understand that the funding of medical education is no longer an arcane topic that is of interest only to a few insiders.
Carlat also provides a little context on one of the company’s founders and his CME past.
Mass. data show how reform could affect access
Filed under: Government, Health data, Health policy, Hot Health Headline
How will the masses of newly insured post-reform patients impact already tight access to primary care? The Boston Globe’s Liz Kowalczyk has found some hints in the latest results from a Massachusetts patient satisfaction survey. The survey involved about 80,000 commercially insured patients and the data is from 2009.
According to new data from the Massachusetts Health Quality Partners, a coalition that includes doctors, hospitals, and health plans, 83 percent of adult patients said when they called their doctor’s office for care they needed right away, they always or almost always got an appointment quickly.
Fewer patients — 78 percent — reported that they always or almost always got an appointment for a routine check-up or after-hours help as soon as they needed it.
To add some context, Kowalczyk compared the results to numbers from the 2007 survey, which was conducted before Massachusetts had fully boarded the expanded coverage train.
Still, said Barbra Rabson, the group’s executive director, the survey showed slight declines in patient access to their doctors, which could be a warning sign of growing strain in the system. “We need to watch this very carefully,” she said.
In addition to the sort of health care access numbers that bear directly upon reform coverage, the survey also included typical consumer satisfaction-oriented questions. By those measures, at least, care in Massachusetts seems to be improving slightly. The one area of decline? Coordination of care.
Recent examples show need for critical evaluation
Using parenting Web sites as examples, the Boston Globe’s Joanna Weiss writes about how many sites, which live or die based on their traffic numbers, seem to forget that “there’s something to be said for headline-writing care, and for editorial judgment.” While she mentions the furor over bisphenol A and other stories, the immediate inspiration for Weiss’ timely rant/reminder was an UrbanBaby.com blog post headlined “If You Went to College, Will Your Daughter Develop an Eating Disorder?“.
She interviewed Ivan Oransky, M.D., AHCJ’s treasurer and executive editor of Reuters Health, who reminds us that epidemiological studies are conducted in the real world, not a carefully controlled lab, so they’re often open to misinterpretation.
Weiss’ piece reminds us to take care in how critically we look at studies and to be careful of oversimplifications.
For some hospitals, tax breaks outstrip charity care
Filed under: Hospitals, Hot Health Headline, Public records
A story by Boston Globe reporters Scott Allen and Marcella Bombardieri questions the provision of nonprofit status for hospitals and the tax breaks that come with it, vestiges of a time when hospitals needed financial incentives to treat the nation’s poor.
They look at Massachusetts hospitals pulling in billions of research dollars and making liberal use of their tax incentives. An intensive review of relevant records revealed that the value of these tax breaks far exceeds the value of the free care the hospitals provide for the poor, the reporters say.
The 10 leading hospital companies benefited from an estimated $638 million in federal, state, and local tax breaks as well as state discounts on borrowing in 2007, the latest year for which complete data are available. More than half of that goes to two large and growing companies, Partners and Children’s Hospital. Overall, the 10 hospital companies’ tax breaks and other benefits were worth $264 million more than the value of the “community benefits” - care for the poor and other charity work - they reported to the state attorney general that year.
The reporters also note that Massachusetts health care reform has helped increase the gap; hospitals now provide half as much free care as they did before reforms were instituted (Today, about 1 percent of patients don’t have to pay). In the midst of a climate of tight budgets and potential reforms, a group of politicians led by Republican Sen. Charles Grassley of Iowa is calling for rules holding nonprofit hospitals to higher standards of charity work than their for-profit peers.
The in-depth story digs deeper into potential reforms and issues and paints a detailed financial picture of the impact the nonprofit status of major hospitals is currently having on the state’s budget.
Reports: Detainees receive sub-par medical care
In the process of investigating the unreported death of Pakistani detainee Ahmad Tanveer, 43, Nina Bernstein of The New York Times discovered just how difficult it can be to keep track of immigrants detained in Immigration and Customs Enforcement’s massive and decentralized system. Bernstein investigated multiple instances in which a suspected detainee death was not included on government lists, and others in which obvious detainee medical problems were misdiagnosed or ignored.
As Congress and the news media brought new scrutiny to the issue, several detention deaths have highlighted problems with medical care and accountability. In one, a Chinese computer engineer’s extensive cancer and fractured spine went undiagnosed at a Rhode Island jail until shortly before he died, despite his pleas for help. In another, records show a Guinean tailor who suffered a skull fracture in a New Jersey jail was left in isolation without treatment for more than 13 hours.
Boston Globe
In the Boston Globe’s Op-Ed section, Homer Venters and Allen S. Keller say the problem’s scope is vast, with 400,000 immigrants being detained in 2008 and projections even higher for 2009:
Over 90 detainees have died in ICE custody since 2004, but because ICE does not track the types and severity of medical problems among detainees, we are unaware of the much larger number of detainees who needed care and did not receive it.
Venters and Keller, professors at NYU’s school of medicine, call for the Obama administration to reform detainee treatment and say have been a few promising signs of progress.
ProPublica
Sheri Fink of ProPublica cited a leaked Red Cross report stating that medical staff provided detainees in secret CIA prisons with excellent medical care, but also sometimes participated in “‘ill treatment’ such as beatings and waterboarding.” Fink used publicly available information and records to answer questions raised by the report.
Responding to questions from the New York Times, CIA spokesman Mark Mansfield said his agency had long ago ended the interrogation program and the agency, as directed by the Obama administration, will only use techniques that fall within the Army Field Manual.
Mont. Democrat leads Senate health charge
Filed under: Health care reform, Hot Health Headline
The Boston Globe’s Lisa Wangsness reports that Montana Democrat and Senate Finance Committee chair Max Baucus has become a leader in the legislative push for health-care reform.
At a time many see as the best opportunity in 15 years for a comprehensive healthcare overhaul, Baucus, 67, has stepped into an unexpected leadership void. Senator Edward M. Kennedy, a leader on the issue for decades, is suffering from brain cancer. Obama’s initial point-person on health reform, Tom Daschle, who boasted both extensive legislative experience and in-depth understanding of the policy, withdrew his nomination for Health and Human Services secretary because of tax problems.
Wangsness reports that, instead of using a weak economy as an excuse to put off reform plans, Baucus has argued that in tough financial times health care costs are a bigger issue than ever. Sen. Baucus has moved quickly to establish health-care street cred, Wangsness said. “Since last June, he has held hearings, hired top policy staff and issued a widely praised 89-page blueprint for reform days after the election.”
Globe section eliminated; Post staff joins team
Call this the case of the disappearing health section. One of the nation’s biggest and best-known dailies - The Boston Globe - has eliminated its stand-alone Monday Health/Science section after 25 years of widely praised coverage that included a 2005 Pulitzer Prize. The move, of course, comes amid ongoing retrenchment at the paper, but health and science editor Gideon Gil is putting on a brave face.
“I don’t see it as a serious retreat,” says Gil, who expects his nine-person staff will remain intact. “The content is all running in the paper, but going in different places … It was nice to have our own sandbox to play in, the freedom to stretch. Science is quirky sometimes, so a bit of serendipity is lost when we have to fit into different niches in the paper.”
However, former Globe science editor Nils Bruzelius, who is now deputy national editor in charge of science at The Washington Post, was more blunt. “It will definitely put a crimp in the amount of science and health coverage in the paper,” he tells the Columbia Journalism Review. ”It will continue to be high-quality, but this can’t help but dim the overall breadth and scope of coverage when you’re fighting for space every day and defining what you do in a more narrowly focused way.”
Meanwhile, The Post is gathering its smattering of health, science and environment reporters into one team. Just the same, the “stories will appear all over the paper and online, just as they do now - on the front page or home page, in National, Metro, Business and the Health sections,” according to a memo written by executive editor Marcus Brauchli and publicized by Politico’s Michael Calderone.
“The aim is two-fold. One, our current structure can sometimes work against strong communication and collaboration, which means reporters only occasionally work in concert with each other and - not surprisingly - often don’t know who’s working on what at any given time. Second, we hope to break down the newsroom silos that can prevent us from using resources in the smartest, highest-impact way.”
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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
