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.
Palliative care piece launches embedded dispatches
Philadelphia Inquirer staff writer Michael Vitez has been embedded with Abington Memorial Hospital in suburban Montgomery County, Pa. Karl Stark, the Inquirer’s health and science editor, writes that “means he went there for an extended period and reported what he saw with almost no restrictions.”
Here’s how Vitez describes the series, which will be published over the next few months:
My goal is to spend a year at Abington, writing stories that show how one hospital deals with the biggest issues in health care today and also the changes that are coming fast and furious - regardless of what Congress and the President do - to hospitals and health care.
This first story looks at how the palliative care movement is medicine’s response to the dismal way people have died. I try to show, up close, how the team works, the agony that families feel, the immense costs involved.
In future stories, I’m going to look at how a hospital struggles to bring down infection rates, how it handles patients who have nowhere to go, the madness of one Medicare rule, the impact of the uninsured, and more. I hope in the end readers will get a bedside view of how things work, how things are changing, and I hope a great appreciation for our common humanity.
Vitez’s first report is a very readable and nuanced account of palliative care, something he looks at from the perspective of a patient’s family as well as that of the medical professionals.
Joint Commission finds improved hospital quality
Filed under: Conflicts of interest, Health data, Hospitals, Pharmaceuticals, Studies
The latest report from The Joint Commission, a hospital accrediting organization, finds that “overall, hospitals are following evidence-based standards for treatment of myocardial infarction, heart failure, and pneumonia,” as MedPage Today reports.
The report, which looks at 31 evidence-based measures, did find decreases in two areas: measuring oxygen in blood for pneumonia patients and administering antibiotics to pneumonia patients in the intensive care unit within 24 hours.
The report, “Improving America’s Hospitals: The Joint Commission’s Annual Report on Quality and Safety 2009,” (PDF) and those from three previous years are available on the commission’s Web site. Among the key findings:
- Hospitals accredited by The Joint Commission have significantly improved the quality of care provided to heart attack, heart failure and pneumonia patients over a seven-year period.
- Hospitals have steadily improved on individual surgical care performance measures – as well as on additional individual heart attack and pneumonia care measures - over a two-, three- or four-year period.
- Hospital performance on two individual measures of quality relating to inpatient care for childhood asthma is excellent after only one year of measurement.
- Improvement is still needed.
- Where a patient receives care makes a difference.
As ProPublica’s Charles Ornstein explains in his tip sheet, The Joint Commission does routine inspections of participating hospitals to ensure they meet the standards required for accreditation. It compiles public reports on each hospital, which are available on the qualitycheck.org Web site. These reports include the hospital’s accreditation status, as well as some data on hospital outcomes and practices.
It does not release its detailed inspection reports to the public, and many states’ open records laws specifically exempt the reports from public disclosure. In the past, these inspections have not been surprises, and the group has been faulted for being slow to act against hospitals with problems Also, The Joint Commission rarely takes punitive steps against hospitals, preferring to work with them to improve.
Tip Sheets
A road map for covering your local hospital’s quality
Study: Hospital quality comparisons are inconsistent
News: Congress requires Joint Commission to re-apply for accreditation privileges (Sept. 17, 2008)
Residents put dispute with Bronx hospital online
Interns and residents at St. Barnabas Hospital in the Bronx are attempting to formally organize in response to what they believe are poor, unacceptable working conditions.
As part of their effort, they have launched “Examining St. Barnabas,” a site that solicits community input, rounds up (mostly unfavorable) coverage about the hospital and adds a sort of disgruntled-employee spin to St. Barnabas-related issues. It’s an interesting nexus of special interest and community service, as well as a window into the workings of a sometimes troubled hospital. The effort also has a presence on Twitter as @examinebarnabas.
Posting ER wait times online: Gimmick or service?
Writing for HealthLeaders Media, Cheryl Clark looked at the growing number of hospitals that are posting their emergency room wait times online.
Clark describes the practice as a “marketing strategy” that may help hospitals snag market share and improve the patient experience, and quotes physicians calling it a “gimmick” that may actually hurt patients by encouraging them to delay ER visits until the line gets shorter. Clark also spotlights a more disturbing version of the system, one which allows patients to pay online to reserve a spot at the head of the ER waiting line.
Sacred Heart Medical Center in Eugene, Ore., uses a system of infrared tags to monitor ER wait times and post them online.
(Another system) allows patients to buy, for $24.99, the ability to register online for a place at the head of the emergency room wait line at participating hospitals. The concept, called InQuickER—”Skip the ER Waiting Room”—was developed three years ago as a customer service program.
The patient prints out a confirmation number with instructions for what time to be at the hospital so they don’t have to wait.
So far, three hospitals have signed up: Emory-Adventist Hospital in Smyrna, GA, Florida Hospital Waterman in Tavares, FL, and Infirmary West in Mobile, AL.
Getting patients home safely after a hospital stay
New America Media’s Paul Kleyman explores the effects of hospitals cutting corners when it comes to patient transitions from hospital to home, a problem his sources call one of the biggest gaps in the health care system. Citing a widely reported 2009 New England Journal of Medicine article on preventable rehospitalizations, Kleyman explains why the current transition system is both expensive and broken, then chronicles the efforts of advocates and legislators to change the system or, at the very least, fill in the gaps.
Kleyman on the latest legislative attempt to change the system:
These findings led members of Congress to introduce the Medicare Transitional Care Act of 2009. According to the bill, “Insufficient communication among older adults, family caregivers and health care providers contribute to poor continuity of care, inadequate management of complex health care needs and preventable hospital admissions.” The Act would set up demonstration projects to test ways for improving patients’ continuity of care.
Utah tests hybrid bundled payment system
Filed under: Health care reform, Hospitals, Hot Health Headline, Public health
The Salt Lake Tribune’s Lisa Rosetta explains Utah’s new bulk payment pilot program, which aims to drive down costs by paying participating physicians flat rates for delivering babies and managing diabetes. In a departure from previous systems, the Utah hybrid will still include mini-reimbursements on a per-procedure bases, primarily to prevent instances of undertreatment. For another primer on bundling, see this post.
Here’s Rosetta’s explanation of the diabetes management program:
Doctors treating diabetics will be paid a monthly retainer fee, giving them the flexibility to innovate. If a patient would be better served by calling them at home to make sure they are taking their medications, or checking their blood glucose regularly, for example, doctors can do that without worrying about whether the insurance company is going to pay.
If a patient has problems — say a diabetic ends up in the emergency room for a preventable complication — the doctor’s monthly retainer fee goes down.
Additionally, doctors will be paid a “mini” fee for service so they aren’t discouraged from providing care.
The mini fee was instituted because of lessons learned from a similar experiment in the 1990s, in which a simple flat fee encouraged undertreatment of patients by cost-conscious hospitals.
Pregnancy will work a little differently, Rosetta said:
Doctors caring for pregnant women will be paid differently. They’ll continue to receive one large, bundled payment after the patient delivers, as they do now; the difference is they’ll be paid the same whether it’s a vaginal delivery or cesarean section. Doing so removes any incentive a doctor may have to perform a section, which costs more, but doesn’t discourage it if it’s necessary.
A number of hospitals, doctors and insurers have already signed on for the pilot project. Organizers hope it will be up and running by early 2010. In future versions, they hope it evolves to the point that it is “rewarding cost-effective choices by consumers, and recognizing employers that actively engage workers in healthy behaviors and value-based health care choices.”
Rounding up some of the latest health coverage
Filed under: Government, Health care reform, Health journalism, Hot Health Headline, Public health
With good topics for the blog flooding in and a short holiday week to get them all posted, I’m taking a shortcut to point you toward some interesting stories:
ProPublica: What Health Care Reform Means for the underinsured
Rapidly rising premiums have forced them to increase their deductible every year, and now they have a policy with a $5,000 deductible per illness per year.
Steve Lopez in the Los Angeles Times: A doctor is flummoxed by the costs when he becomes the patient
As a physician, he’s well aware that emergency room treatment is very expensive. But knowing the true cost of the limited supplies and labor required to treat such a minor wound, he found the experience more than a little disturbing.
Trevor Butterworth in Forbes.com: Why mall Santas do need the H1N1 vaccine, featuring AHCJ board member Maryn McKenna’s take on how well the media has covered H1N1.
McKenna gives the media a “gentleman’s C” for its coverage of swine flu, but believes it has been getting better in the past few months.
AHCJ member Elaine Schattner, M.D., in the Huffington Post: Mammography: A Not-So-Fatalistic View
I’m a medical oncologist and breast cancer survivor who holds a highly informed and intensely personal perspective on the subject. In my view, the press is getting and giving the wrong message on mammography. There are significant flaws in recent analyses that have escaped most headlines.
When quality matters to boards, hospitals do better
In Health Affairs, Ashish K. Jha and Arnold M. Epstein have released a study in which they found a link between hospital boards that focused on quality of care and hospital quality ratings. They also found that quality isn’t a top priority for most hospital boards. The researchers hope their findings will help those who want to improve hospital quality by demonstrating just how much influence a hospital board can have.
Jha and Epstein surveyed 1,000 board chairs from a wide sample of not-for-profit acute-care hospitals in the United States. For quality ratings, they relied on the Hospital Quality Alliance.
Related
AHCJ President Charles Ornstein, whose hospital quality coverage has earned national recognition, recently updated his comprehensive “Road map for covering your local hospital’s quality” tip sheet.
AHCJ article: Making sense of hospital quality reports
Book: Covering the Quality of Health Care: A Resource Guide for Journalists
Slim guide: Covering Hospitals: Using Tools on the Web
Free online training
On the Beat: Covering Hospitals: An innovative simulation guides you through the sources and resources you need to tackle the beat. You’ll tap into the same tools that you’ll use on the job, and you’ll have a virtual mentor to walk you through the maze of reports, statistics and sources. One story line teaches you about reporting on hospital quality
Data
Investigating hospitals: Find stories with ready-to-use Hospital Compare data: AHCJ has made it easier for journalists to compare hospitals in their regions by generating spreadsheet files from the HHS database, allowing members to compare more than a few hospitals at a time, using spreadsheet or database software. AHCJ provides key documentation and explanatory material to help you understand the data possibilities and limits.
Tip sheets
- How to cover your local hospital - Overview of many organizations that offer hospital quality ratings
- Sorting out hospital rankings
- Intro to investigating health data using spreadsheets
- Computer-assisted reporting basics: Investigating health data using spreadsheets
Reports
- Study: Hospital quality comparisons are inconsistent
- Performance data may not affect patient decisions
- GAO report on reliability of hospital quality data reported to CMS
- 2007 state quality data available
- Hospital quality resources by state
Hot Health Headlines
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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
