Of the 773 hospitals who responded to a request to supply data about their delivery rates, numbers varied widely. More than half reported rates higher than 12%, with some having as high as 60%. Some hospitals declined to respond, leading one to wonder if they did not keep statistics, or their performance was poor on this indicator.

This kind of information is pointing to the standard of care being defined as discouraging early delivery without medical indication. Consider the risks to the fetus and to the mother when labor is induced or a cesarean section performed to meet the convenience factor.

A short term convenience for the mother or the obstetrician may result in long term complications when the fetus is between 37-39 weeks. The baby may not developmentally ready. Cesarean sections carry risk of bleeding, perforation of surrounding organs, anesthesia complications, need for repeat cesarean sections, and more. Increasingly, hospitals should be putting pressure on their obstetricians to not participate in early deliveries without medical necessity. And patients should be educated about the risks.

Read more.

Find out what rate a hospital reported- or didn’t.

Personal Injury
All I Wanted Was a Car – Brad Paisley
Carry That Weight – The Beatles
Battle with the Bottle – Various Artists
Drive My Car – The Beatles
Ebony Eyes – The Everly Brothers
Feel It In My Bones- Delores Keane
I’m A Loser – The Beatles
Leader of the Pack- the Shangri-Las
Little Deuce Coupe – The Beach Boys
The Little Old Lady from Pasadena- Jan and Dean
Longneck Bottle – Garth Brooks
Margaritaville – Jimmy Buffet
Must have Had a Ball – Alan Jackson
Painless – Lee Ann Womack
Road Kill Café – John Flynn
Seven Drunken Nights – The Dubliners
Sober Again – Various Artists
Ticket to Ride – The Beatles
Wreck of the John B – The Weavers
Yesterday – Paul McCartney
You Always Hurt the One You Love – Various Artists
Loving You is Killing Me – Alabama

Healthcare Risk Management
I’m in a Hurry and I Don’t Know Why – Alabama
As Long As There’s a Heartbeat – Tanya Tucker
Better Not Tell Her – Carly Simon
Both Sides Now – Judy Collins
A Broken Heart Keeps Breaking – Various Artists
Changes Coming On – Alabama

Plaintiffs want their questions answered

This study demonstrates that major challenges stand in the way of achieving mediation’s full benefits. Absence of physician participation minimizes the chances that mediated discussion of adverse events and medical errors can lead to improved quality of care. Change will require medical leaders, hospital administrators, and malpractice insurers to temper their suspicion of the tort system sufficiently to approach medical errors and adverse events as learning opportunities, and to retain lawyers who embrace mediation as an opportunity to solve problems, show compassion, and improve care.

Comments:
One of the most common reasons why plaintiffs seek attorneys is to get answers. They want to know that the system has been changed to avoid injuring someone else in the same way. They want an apology. They want to see their physician has learned from the experience. They want closure. They want the respect that comes with a physician attending this serious meeting. In this study, in none of the mediations was the physician present. An important element is left out when the defendant physician does not attend the mediation. Adequately prepared and supported, the defendant’s presence may provide the healing that is needed . . . for everyone.

never events

Ken Kizer, a physician and former chief operating officer of the National Quality Forum, coined the term “Never Events”. These are particularly shocking medical errors, like operating on the wrong patient, that should never happen. The NQF defined 27 such events in 2002 and revised and expanded the list in 2006. The list is grouped into six categorical events: surgical, product or device, patient protection, care management, environmental, and criminal. They are also referred to as serious reportable events. Some or all of these events are reportable to state agencies. Organizations accredited by The Joint Commission are expected to report these events to The Joint Commission.

See the list: SRE_FactSheetv2

Beginning October 2008, the Centers for Medicare and Medicaid Services stopped reimbursing hospitals for care that resulted in one of a limited list of never events. Private payors followed suit. The healthcare facility is not permitted to bill the patient for the revenue that was lost as a result of this never event.

Why do these events continue to happen? Health care is incredibly complex and there are multiple opportunities for errors – related to communication, the environment, fatigue, stress, and a host of other factors. Healthcare providers don’t want set out to hurt people – this blog explores some of the reasons why that happens and how that influences the litigation process.

Deaths from medical errors are compared to plane crashes

Did you know those numbers are FALSE? Those numbers are way too low! First, the numbers came from the Harvard Practice Study, which looked at 30,000 New York State hospital records. The study did not include deaths caused by care in nursing homes, doctor’s offices, outpatient surgery centers, and other non-hospital sites.

The study also did not include errors that were not documented in the medical record. Even the physician who led the study said “that if we watched people delivering medical care, we’d see up to 17% of care involved errors”. That same Harvard Practice Group study was done using 1980’s medical records but wasn’t published until 1991. So that report, which is still being cited by the medical profession and media sources, only reported partial information “at best” and is now well over 20 years old. Any information contained in it is severely outdated! Health care is even more complex today which means it provides many more opportunities for medical mistakes and errors.

The original studies are found at the link below: Incidence of Adverse Events and Negligence in Hospitalized Patients — Results of the Harvard Medical Practice Study I
Troyen A. Brennan, M.P.H., M.D., J.D., Lucian L. Leape, M.D., Nan M. Laird, Ph.D., et al, New England Journal of Medicine 1991; 324:370-376
The Nature of Adverse Events in Hospitalized Patients – Results of the Harvard Medical Practice Study I, Lucian Leape MD and others

See the full text articles at February 7, 1991

A new study released in November 2010 by the Office of Inspector General confirmed that about 180,000 Medicare beneficiaries die each year from an adverse event in a hospital. Physician reviewers concluded that 44% of the adverse events were likely or clearly preventable. One in seven medicare patients were harmed by medical errors in hospitals. See the report at www.oig.hhs.gov.

This new study reviewed 2,341 patients’ records from stays at 10 North Carolina hospitals from 2002 to 2007. The reviewers found that 25 harms per 100 admissions had occurred, and that 63% of these harms were preventable. Harms that were detected were a consequence of procedures (186), medications (162), nosocomial infections (87), other therapies (59), diagnostic evaluations (7), and falls (5), among other causes. The large majority of identified harms were classified as category E or temporary harm (144) or category F or an initial or prolonged hospitalization (163) harms. Of the identified preventable harms, 13 caused permanent harm (category G), 35 were life-threatening (category H), and 9 caused or contributed to a patient’s death (category I).

The authors concluded harm to patients resulting from medical care was common in North Carolina, and the rate of harm did not appear to decrease significantly during a 6-year period ending in December 2007, despite substantial national attention and allocation of resources to improve the safety of care. Since North Carolina has been a leader in efforts to improve safety, a lack of improvement in this state suggests that further improvement is also needed at the national level.

What is holding us back from making patient care safer? The authors pinpoint these factors:
Despite substantial resource allocation and efforts to draw attention to the patient-safety epidemic on the part of government agencies, health care regulators, and private organizations, the penetration of evidence-based safety practices has been quite modest. For example, only 1.5% of hospitals in the United States have implemented a comprehensive system of electronic medical records, and only 9.1% have even basic electronic record keeping in place; only 17% have computerized provider order entry. Physicians-in-training and nurses alike routinely work hours in excess of those proven to be safe. Compliance with even simple interventions such as hand washing is poor in many centers.

If North Carolina, which has aggressively pushed patient safety, has not improved in 6 years, what is going on in the rest of the country?

They held her facedown in the chair while a nurse injected a sedative into her hip. Alexis continued to struggle and then went limp. The nurse and the two aides left without checking her pulse or making sure she was breathing. Charge nurse Iris Blanks checked on her minutes later and didn’t think Alexis looked right. An aide helped Blanks roll the girl over. Alexis wasn’t breathing. Her pulse was faint. It was 12 minutes after she stopped moving before anyone tried to revive Alexis. By then it was too late.

Read more

Dr. Wanda Mohr and I did a teleseminar on the topic of death in restraints. She talked about a colleague of hers who did a study of pediatric deaths from restraints. Just simply looking at lawsuits and newspaper articles, within that 10-year period he found that 45 deaths had occurred and those deaths were specifically limited to children. The youngest child who had died was 6-year-old. The most common mechanism of death is restraint asphyxia. A person essentially asphyxiates or chokes to death. Her oxygen is cut off and that, most commonly, occurs in a prone position. This is associated with individuals actually putting pressure on people’s back and their lower back and despite their pleas that they were unable to breathe, the staff would not let the person up.

For a death in another treatment center, read about a 17-year-old boy who was strangled while being restrained.

One child dying of being restrained is far too many. There are safe ways to help agitated or violent people get back under control. Any healthcare provider working in a setting where this type of behavior could occur should know how to protect the patient (as well as the healthcare workers) from injury.

Cheryl James enjoyed her job at Oakwood Hospital, Michigan. She never imagined posting something on Facebook from her own computer on her own time would get her fired. “He died for us, protecting us,” said James. Like so many others, James was emotional following the shooting death of Taylor Police Corporal Matthew Edwards. She worked for the hospital organization that treated the police officer and the shooting suspect, Tyress Mathews.

One night, while at home, she posted on Facebook that she came face-to-face with a cop killer and hoped he rotted in hell. She also posted another remark we can’t repeat.

Tuesday, she got a call. Her bosses wanted to talk.

“They called me in, told me that they got notice and word that I had posted this specific post on Facebook, and that they had to investigate it,” James said.

She says she immediately removed the posting and thought she might get written up or suspended. Instead, she got fired.

Read more

The nurse who posted her remarks offered enough information that readers were able to determine who she was talking about. This violated HIPAA, a federal statute that protects the confidentiality of medical information.

This nurse’s story is a good reminder that anything posted on social media sites can be easily desseminated, can hang around forever, and can come back to haunt a poster.

In the World War II era, the phrase was “loose lips sink ships”. Our parents and grandparents could not have foreseen that loose fingers could destroy a job.

What do you think? Have you seen comments on social media that make you cringe?

Staff worried about patient
Acute change in heart rate
Acute change in systolic blood pressure
Acute change in respiratory rate

a rapid response team could save your life

The composition of RRTs varies from hospital to hospital. A team typically consists of 2-3 people who are assigned to flexible responsibilities within the facility. The team may consist of respiratory therapists, physician assistants, nurse practitioners, critical care nurses, intensivist (critical care doctors), hospitalists (physicians employed within a facility to provide inpatient care) or residents. The team’s role is to assess and stabilize the patient, assist with communication with the attending physician, educate and support the nursing staff and family, and assist with transfer to another level of care, if needed.

The rapid response team serves a vital role, but not all hospitals have them. Does yours? Consider this important patient safety feature when you pick a hospital.