Quest for profit behind patient safety problems in Las Vegas hospitals
Marshall Allen, of the Las Vegas Sun, continues his look at patient safety in Las Vegas hospitals and has been able to boil down the problems to several themes that explain the 3,689 preventable infections, injuries and surgical accidents that happened to Las Vegas hospital patients in 2008-09.
Allen notes that Nevada and the Las Vegas area have more for-profit hospitals than any other state or urban county in the nation. He found that “the corporate push for profits sometimes trumps patient care and can create an environment where best practices give way to risky shortcuts.” Additionally, Las Vegas does not have any academic medical centers, which normally “elevate a city’s health care because of their focus on excellence, innovation and research.” Other problems include staffing, poor oversight and hospitals that cover up harmful incidents.
In this installment, part four of the paper’s “Do No Harm” series, Allen tells of patients who suffered serious wounds, infections and injuries, as well as the story of one man who died after receiving painkillers.
Beyond the data, documents and anecdotes about patients who suffered harm in Las Vegas hospitals, there is evidence from the nurses who work in those hospitals that points to the problem. The Sun published information from a 2005 study about why new nurses quit their jobs in Nevada. The study, published in the Journal of Nursing Administration, found that patient safety issues were the most frequent reasons for leaving among 325 newly hired nurses.
In addition to lives, checklists save money
Filed under: Health data, Health policy, Hot Health Headline, Studies
Last year, Atul Gawande and company made a splash by showing what a profound clinical impact checklists made on patient outcomes. Now they’re back, but this time the checklist evangelists are aiming for the pocket book. In the latest Health Affairs, Gawande and seven others contributed a paper with the descriptive title “Adopting A Surgical Safety Checklist Could Save Money And Improve The Quality Of Care In U.S. Hospitals.”
Photo by cybrjoe via FlickrHere’s their arithmetic, courtesy of The Boston Globe’s Elizabeth Cooney
Time was the biggest cost in setting up the checklist, Gawande and his co-authors write in the journal Health Affairs. They estimated that a hospital with at least a 3 percent rate of complications per year would begin to see savings after five major complications were prevented. That means a hospital where 4,000 noncardiac operations were done each year could save about $25 on each procedure, or about $100,000 annually, they concluded.
As always, free access to Health Affairs studies is one of many perks enjoyed by AHCJ members.
Identical tubing demonstrates FDA’s inaction
In The New York Times, Gardiner Harris outlines the problem of medical tubing that looks very similar – leading to medical errors – then deftly works his way up the chain in an attempt to find the source of device regulator’s failure to solve a problem that seems entirely solvable.
Many medical device tubing looks the same, which leads to horrific mix-ups like the delivery of food straight into the bloodstream. In 2007, The Wisconsin State Journal’s David Wahlberg earned first place in the medium newspapers category of AHCJ’s Awards for Excellence in Health Care Journalism for his Medical Misconnections series, which detailed the same problems. He even wrote an AHCJ article teaching journalists how to investigate patient safety problems.
Photo by bennylin0724 via FlickrSince then, not much has changed. Which is not all that surprising, when you consider that not much had changed in the decades before Wahlberg’s story either. Harris’ mission is to dig past the finger-pointing and figure out why. In the end, it all seems to point to some remarkable systemic flaws in the FDA’s device approval system, as well as an unwillingness on the industry to change without the threat of brute regulatory force. In addition to compelling analysis, Harris punctuates each argument with a few spicy quotes.
You’ll have to read Harris’ story to truly understand the perversity of the FDA system and how its lent such inertia to the status quo, but here’s a sample:
Dr. Robert Smith, an F.D.A. device reviewer who left the agency on July 31 and was among nine agency employees who in 2009 decried the agency’s device approval process as illegal and dangerous, said that the tubing problem, which has gone on for decades, was another example of how the agency failed to protect the public. “F.D.A. could fix this tubing problem tomorrow, but because the agency is so worried about making industry happy, people continue to die,” Dr. Smith said.
And, from Nancy Pratt, a senior vice president at Sharp HealthCare in San Diego who believes that “Nurses should not have to work in an environment where it is even possible to make that kind of [tubing] mistake.”
“The regulators have been waiting for the manufacturers to come up with a solution,” Ms. Pratt said, “and the manufacturers won’t spend the money to design and produce something different until the regulators force them to. And now the international standards organization is taking forever to get the whole world onto the same page.”
Higher health care costs, lack of safety innovations traced to group purchasing organizations
Filed under: Health policy, Hospitals, Hot Health Headline
The Washington Monthly’s Mariah Blake writes about the ins and outs of group purchasing organizations (GPOs) and their effect on the development of newer, potentially safer, medical equipment. She reports the system has kept potentially lifesaving innovations off the market and may be contributing to the rising costs of health care.
Among the products she cites as having been created but largely kept out of the supply chain as a result of the GPO system are a syringe with a retractable needle, a syringe designed to reduce bloodstream infections and a surgical towel that can be spotted on X-rays to keep towels from being left in the body after surgery. Those products were developed by small suppliers who seem to be squeezed out of the market by the system.
Blake’s combination of narrative about the small suppliers who have been stymied by the system and her investigation into how GPOs became such a game changer will be of great interest to anyone who writes about health care costs and innovations in patient safety.
Blake explains the evolution of GPOs, “a system built on a seemingly minor provision in Medicare law that few people even know about.”
It’s a system that has stifled innovation and kept lifesaving medical devices off the market. And while it’s supposed to curb prices, it may actually be driving up the cost of medical supplies, the second largest expenditure for our nation’s hospitals and clinics and a major contributor to the ballooning cost of health care, which consumes nearly a fifth of our gross domestic product.
Through a series of court cases, one of which granted GPOs protection from antitrust actions, and their subsequent consolidation, GPOs revenues became “tied to the profits of the suppliers they were supposed to be pressing for lower prices.”
A former GPO employee explains, “But GPOs make their money by charging vendors fees. And if you get a percentage of sales, going with a lower bid from a little company just loses you money and pisses off the big vendors with multiple contracts.”
Blake reports that most small suppliers are wary of speaking out about GPOs. “Several talked to me off the record. At least a half dozen more agreed to speak, only to back out at the last minute or retract their statements after we had spoken.”
Blake points out that this incentive system has an effect on health care costs. GPOs contend that they keep costs down by pooling hospitals’ buying power, but Blake reports one company has kept data on hospital purchases and found that “bids hospitals got through their GPO contracts were substantially higher” than what could be had by negotiating directly with vendors for the same equipment.
More about GPOs
- Modern Healthcare surveys GPOs annually and a list of about 11 of them and their addresses is available.
- The Health Industry Group Purchasing Association represents 16 GPOs.
Analysis of billing record data reveals hospital quality issues in Las Vegas
Using data from hospital billing records, Marshall Allen and Alex Richards of the Las Vegas Sun have been able to identify “hospital-acquired patient harm,” that is, events in which patients are harmed while in the hospital.
Medicare does not pay for these “never events” and so they are reflected in hospital billing codes. Such events include things like leaving foreign objects in a patient, bed sores, falls, infections related to catheters or surgical sites, blood clots and poor glycemic control.
Nevada – and 40 other states – collect such data for analysis, Allen and Richards report. In Nevada, the state had not yet analyzed the data so the reporters requested it and did the analysis.
The pair requested and received records for “every Nevada hospital inpatient visit going back a decade — 2.9 million in all. The information, coupled with interviews with more than 150 patients and health care insiders, has yielded a sweeping and detailed portrait of hospital care in Las Vegas.”
The project includes stories about patients who were harmed while hospitalized, the documents behind the reporting, data tables, interactive graphics and more.
CDC report includes state data on infections
Filed under: Government, Hospitals, Member news, Studies
The CDC has released a report detailing health-care-associated infections, specifically central line-associated bloodstream infections.
This is the first such report to include any state-specific information, according to the CDC, though it only includes states that require reporting of CLABSIs to the National Healthcare Safety Network. The CDC expects this to serve as a baseline report to help guide prevention plans and activities.
Peter Pronovost, M.D., who spoke about patient safety and health care associated infections at Health Journalism 2010, was among the participants in a telebriefing about the report. A transcript of that briefing should be available later today.
Quaid releases documentary about medical errors
Filed under: Health journalism, Hot Health Headline
Those of you who attended Health Journalism 2008 may remember actor Dennis Quaid’s appearance at the event, telling the harrowing tale of the heparin overdoses that almost killed his infant twins.
Dennis Quaid spoke about medical errors at Health Journalism 2008. (Photo: Pia Christensen)
Quaid continues his crusade against medical errors with a documentary that will debut April 22 (and airs on the Discovery Channel on April 24) and co-authoring an article in the Journal of Patient Safety.
The article, which focuses on the use of anecdotes and storytelling to improve patient safety, is not typical journal fare. It’s equal parts how-to manual, anecdotes and sermon, and Quaid’s commitment comes across forcefully.
As you finish reading this narrative and return to your life in health care, we challenge you to think about your own story. If every story has a hero, a victim, a villain, a crisis, and a resolution, we want you to see yourself as a hero. It is time to write your own story. Turn that light into heat and focus it on your villain: the villain that protects the status quo, the way we have always done things. A best friend of this villain is survival-centered, blind cost-cutting that drives enormous safety risk and harm to patients.
Quaid spoke about the topic yesterday at a National Press Club luncheon (video), where he also announced that his nonprofit Quaid Foundation has merged with the Texas Medical Institute of Technology.
Patient safety expert Pronovost is keynote speaker
Peter Pronovost, M.D., Ph.D., a professor at Johns Hopkins University and founder of the Quality and Safety Research Group, will be the keynote speaker at Health Journalism 2010. He will appear at the awards luncheon on Saturday, April 24.
Peter Pronovost, M.D., Ph.D.
Pronovost specializes in improving patient safety through methods that are scientifically rigorous but feasible at the bedside. In his new book, “Safe Patients, Smart Hospitals: How One Doctor’s Checklist Can Help Us Change Health Care from the Inside Out,” Pronovost tells of losing his father as the result of a medical error and his own journey from a researcher to an international leader in patient safety.
Pronovost joins a number of high-profile speakers. Conference participants will have the chance to attend newsmaker briefings featuring leaders from the Department of Health and Human Services, the Centers for Disease Control, the Food and Drug Administration:
- Thomas Frieden, M.D., M.P.H., director, Centers for Disease Control and Prevention
- Kathleen Sebelius, M.P.A., secretary, U.S. Department of Health and Human Services
- Jeffrey Shuren, director, Center for Devices and Radiological Health, Food and Drug Administration
A special track on assessing health reform is intended to help reporters understand the changes coming and better explain what’s ahead to their readers, viewers and listeners:
- Does comparative effectiveness research work?
- Outlook for the nation’s hospitals
- Is there a looming doctor shortage?
- What’s ahead for state and local governments
- The reporting challenge going forward
“Influenza! Lessons learned from a year of H1N1″ will feature experts on public health, infectious diseases, preparedness and vaccines:
- Jeffrey Levi, Ph.D., executive director, Trust for America’s Health
- Anne Schuchat, M.D., director, CDC’s National Center for Immunization and Respiratory Diseases
- Litjen Tan, Ph.D., director of medicine and public health, American Medical Association; co-chair, National Influenza Vaccine Summit
- Moderator: Maryn McKenna, independent journalist, Minneapolis
See the complete conference schedule.
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.
Related
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.
Report looks at disclosure of adverse events
Filed under: Government, Health data, Pharmaceuticals, Public records
Adverse events that harm patients are publicly reported unevenly, according to a report from the inspector general for the Department of Health and Human Services.
The report reviewed the public disclosure of the information by state adverse reporting systems, patient safety organizations and the Centers for Medicare & Medicaid Services. As the report points out, reporting such events can help educate health care providers about why such events happen and how to prevent them.
The report (Adverse Events in Hospitals: Public Disclosure of Information about Events OEI-06-09-00360) does highlight seven state systems that are disclosing more information than others: Maryland, Massachusetts (both the Board of Registration in Medicine and the Department of Public Health), Minnesota, New Jersey, Oregon and Pennsylvania.
The inspector general points to those systems as models:
The disclosure practices of the seven State systems with more extensive disclosure can serve as models for other entities. These systems disclose analysis of the causes of events, evidence-based guidance for reducing occurrences, and information about demonstrated improvements by hospitals. This type of information, if disseminated by other State systems and entities that receive adverse event information, could help to improve patient safety.
The report provides some useful information for journalists about what information is publicly reported and AHCJ is, of course, gratified to see a government report that advocates public disclosure of patient safety information.
Cheryl Clark of HealthLeaders Media wrote about the report.
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