Showing posts with label hospitalizations. Show all posts
Showing posts with label hospitalizations. Show all posts

Monday, April 4, 2011

Hospital Acquired Infections Becomes A Leading Cause In Patient Deaths | OneMedPlace

Patients today are between a rock and a hard place because when they get sick a hospital may be the last place they want to go. Hospital Acquired Infections, also known as Healthcare-associated infections (HAI) are the 4th leading cause of patient deaths, killing 270 people per day in the USA. Recently the Federal Government and Payers are implementing incentives and penalties on hospitals that are not doing all they can to reduce HAIs.

HAIs are defined as infections not present and without evidence of incubation at the time of admission to a health care setting. Within hours after admission, a patient’s flora begins to acquire characteristics of the surrounding bacterial pool. Most infections that become clinically evident after 48 hours of hospitalization are considered hospital-acquired. Infections that occur after the patient is discharged from the hospital can be considered healthcare-associated if the organisms were acquired during the hospital stay.  There have been several cases of patients going into the hospital for minor surgeries and coming out in coffins, yet limited media coverage has been devoted to this area of concern.

Healthcare-associated infections can be localized or systemic, can involve any system of the body, be associated with medical devices or blood product transfusions. Three major sites of healthcare-associated infections are bloodstream infection, pneumonia, and urinary tract infection. HAIs result in excess length of stay, mortality and healthcare costs. In 2002, an estimated 1.7 million healthcare-associated infections occurred in the United States, resulting in 99,000 deaths.  In March 2009, the CDC released a report estimating overall annual direct medical costs of healthcare-associated infections that ranged from $28-45 billion.

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Friday, February 4, 2011

New babies and heart attacks don't stop in a blizzard - themorningsun.com

Snowstorms don’t stop babies from being born, people from being hospitalized, and they don’t stop heart attacks.

That means that the maternity staff, hospital physicians, cardiologists and other doctors and nurses at MidMichigan Medical Center-Midland needed to plow through snow drifts or even put on skis to get to work.

Dr. Otto Leiti, an internal medicine special with MidMichigan Physicians Group, needed to get to the medical center in Midland to see his patients who were hospitalized, so he strapped on his skis and made a 40-minute ski trip to get in.

“It was fun. I had to be careful with cars, but cross country skis were designed for survival,” Leiti said. “I should do this every day.”

When maternity manager and registered nurse Tonia Van Wieren learned that the storm was coming, she decided that it would be better just to sleep over in the medical center. And when some staff could not get out to come to work, starting at 3 a.m., VanWieren was there to fill in with newly scheduled staff.

“There have been four babies delivered in the snowstorm, and eight (mothers) were in labor yesterday,” she said. “The medical center’s obstetric unit is full and overflowing on to another floor. We’re making it work.”

For some, even a snow day could not postpone the inevitable. Dr. Richard Bartling, an ral and maxillofacial surgeon who is on the Medical Center’s medical staff, was performing oral surgery at his practice in Mt. Pleasant as usual. No surgeries were cancelled and Bartling extracted teeth as usual.

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Saturday, January 1, 2011

Hospital meals make it difficult to control blood sugars, KevinMD.com

My mom doesn’t take any diabetes medicine.  She keeps her blood sugars normal through a combination of common sense and careful carbohydrate consumption.

A few months ago, she had to be hospitalized for what she calls a “minor procedure.”  The procedure went fine, but not the food.  The first meal they brought her consisted of breaded fish (frozen), mashed potatoes (instant), corn (canned), a dinner roll (frozen), and tea (2 sugar packets on tray).  “If I ate that, my blood sugars would have gone through the roof!” she told me.  She drank the tea, and called my dad, who arrived shortly with chopped salad, roasted peppers, and meat loaf.  This week’s post is about hospital food, if you can call it that.  You are not going to believe what it’s like to order meals for hospitalized patients.

Let’s imagine, for example, a diabetic guy in the intensive care unit.  His blood sugars have been completely out of control, up and down, up and down.  He is recovering slowly from a very serious pneumonia, and is only now beginning to eat again.  The nurse asks if I’d like to order an 1800 kcal ADA diet, which I do not.

An “1800 kcal ADA” diet means 1800 calories total each day, in accordance with the recommendations of the American Diabetic Association.  Their recommended diet is loaded (and I am not exaggerating here) with processed carbohydrate items guaranteed to make it nearly impossible to control one’s blood sugar.  No thanks.

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Wednesday, November 17, 2010

Children's Hospital launches 'zero errors' initiative

Reeling from the deaths of two children due to medication errors, the staff of Seattle Children's Hospital devoted Saturday to special training designed to prevent a recurrence of the tragedies.

"It's so very important that we never forget that we harmed these children," said Pat Hagan, president of Children's Hospital. "We were all devastated by this when it happened. It struck us at our core."

Hagan said the patient deaths have been a "great, great tragedy for these families," and "a profound tragedy" for the hospital staff.

"We never want to forget how this feels. That feeling is going to be what drives us to continue to find ways to improve what we do here," he said.

Over 550 doctors, nurses, pharmacists and other staff members gathered at Children's for a special Patient Safety Day to address the medication errors that caused two deaths over the past 18 months.

More than 28 patient safety sessions were held, including 11 devoted to medication safety.

But first, participants gathered together in the morning to remember the two small patients who died.

"How we emerge from this situation today and over the coming months will be the real test of us as an organization," said Thomas Hansen, the hospital's CEO. "As I look around this room, I'm confident that we have the best and brightest people to rise to this challenge."

He told the staff "we must strive for zero errors, this must be our promise."

The day's sessions included topics such as decreasing verbal orders and increasing the safety of verbal orders when they are necessary, standardizing medications located on care units, ordering, dispensing and administration of high-risk medications, interruptions, provider-to-provider hand-offs and communication, ambulance transport and patient safety training using simulation.

Hospital spokesperson Louise Maxwell said Children's also is fully cooperating with state investigations of the recent medication errors and has made a number of improvements to decrease the chance of errors.

The hospital has also initiated a re-evaluation of the entire medication delivery system and launched a detailed analysis to determine why usual safety processes failed in each of the medication error cases.

Hospital officals said Saturday's special training did not affect care for patients or others needing urgent or emergency services.

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Monday, November 15, 2010

JAMA -- Abstract: Fall Prevention in Acute Care Hospitals: A Randomized Trial, November 3, 2010, Dykes et al. 304 (17): 1912

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Fall Prevention in Acute Care Hospitals

A Randomized Trial

Patricia C. Dykes, RN, DNSc; Diane L. Carroll, RN, PhD, BC; Ann Hurley, RN, DNSc; Stuart Lipsitz, ScD; Angela Benoit, BComm; Frank Chang, MSE; Seth Meltzer; Ruslana Tsurikova, MSc, MA; Lyubov Zuyov, MA; Blackford Middleton, MD, MPH, MSc

JAMA. 2010;304(17):1912-1918. doi:10.1001/jama.2010.1567

Context  Falls cause injury and death for persons of all ages, but risk of falls increases markedly with age. Hospitalization further increases risk, yet no evidence exists to support short-stay hospital-based fall prevention strategies to reduce patient falls.

Objective  To investigate whether a fall prevention tool kit (FPTK) using health information technology (HIT) decreases patient falls in hospitals.

Design, Setting, and Patients  Cluster randomized study conducted January 1, 2009, through June 30, 2009, comparing patient fall rates in 4 urban US hospitals in units that received usual care (4 units and 5104 patients) or the intervention (4 units and 5160 patients).

Intervention  The FPTK integrated existing communication and workflow patterns into the HIT application. Based on a valid fall risk assessment scale completed by a nurse, the FPTK software tailored fall prevention interventions to address patients' specific determinants of fall risk. The FPTK produced bed posters composed of brief text with an accompanying icon, patient education handouts, and plans of care, all communicating patient-specific alerts to key stakeholders.

Main Outcome Measures  The primary outcome was patient falls per 1000 patient-days adjusted for site and patient care unit. A secondary outcome was fall-related injuries.

Results  During the 6-month intervention period, the number of patients with falls differed between control (n = 87) and intervention (n = 67) units (P=.02). Site-adjusted fall rates were significantly higher in control units (4.18 [95% confidence interval {CI}, 3.45-5.06] per 1000 patient-days) than in intervention units (3.15 [95% CI, 2.54-3.90] per 1000 patient-days; P = .04). The FPTK was found to be particularly effective with patients aged 65 years or older (adjusted rate difference, 2.08 [95% CI, 0.61-3.56] per 1000 patient-days; P = .003). No significant effect was noted in fall-related injuries.

Conclusion  The use of a fall prevention tool kit in hospital units compared with usual care significantly reduced rate of falls.

Trial Registration  clinicaltrials.gov Identifier: NCT00675935


Author Affiliations: Partners HealthCare System (Drs Dykes and Middleton, Ms Benoit, and Messrs Chang and Meltzer), Brigham and Women's Hospital (Drs Dykes, Hurley, Lipsitz, and Middleton, and Ms Tsurikova), Harvard Medical School (Drs Dykes, Lipsitz, and Middleton), and Massachusetts General Hospital (Dr Carroll and Ms Zuyov), Boston.

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THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Themes of Aging: Preserving Function, Improving Care
Winker
JAMA 2010;304:1954-1955.
FULL TEXT  


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Sunday, November 14, 2010

Consult-A-Nurse - HCA Hospitals, Florida

Consult-a-Nurse is a FREE community service from the HCA hospitals in your area, designed to help you find a physician, obtain health information, or register for an HCA hospital sponsored event in your community.

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Friday, November 12, 2010

Hospitals try high-tech to better inform patients - San Jose Mercury News

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In this photo taken Oct. 29, 2010, Kristen Miller, a colonoscopy... ((AP Photo/Brian Kersey))
CHICAGO—Learning he had prostate cancer floored John Noble. Then came the prospect of surgery and his overpowering fear of being "put under" with anesthesia.

Remarkably, he found comfort in a computer. A soothing woman's voice explained the operation step-by-step, its risks and benefits, and even answered his questions. Noble's phobia vanished. The operation to remove his tumor was uneventful and Noble is doing fine.

The 54-year-old Pennsylvania lawyer was aided by an interactive computer program that is part of a growing trend in health care, helping patients better understand what they are consenting for the doctor to do.

Proponents say this way of getting informed consent makes patients partners in decision-making.

Such a system "sends a message that the decisions are truly owned by the patients," said Dr. Harlan Krumholz, a Yale University heart specialist and advocate of changing informed consent procedures.

Computer-based informed consent programs are also part of a broader push for electronic record-keeping that President Barack Obama's administration has advocated to improve patient safety and curb medical errors.

The Emmi Solutions program that John Noble watched about prostate cancer surgery can be viewed at home, and that's where Noble watched it.

Shortly after his diagnosis last December, while he was still grappling with shock and denial, his doctor e-mailed him the program.

"I put off watching it for a

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while," he said. "Who wants to be filled in on the facts of the surgery? Ultimately I forced myself to review it when I was all alone."

By the time he watched it, he felt better prepared mentally than when his doctor first told him he had cancer.

Noble said his biggest fear "was being knocked out. I was terribly afraid of it."

As the interactive explained the operation, Noble could pause it and ask questions or review the information to make sure he understood it.

"It changed my perspective. It removed my fear," he said.

Traditionally, informed consent has involved a conversation with the doctor and signing medical forms written in tough-to-decipher legalese.

It has a dual purpose: to make sure patients understand risks and benefits, and to protect hospitals from lawsuits in case something goes wrong.

Even for someone with a law degree, like Noble, that process can be dizzying in the emotional aftermath of a scary diagnosis.

Research shows patients often have no clue about what they just signed and may end up totally uninformed about why a procedure is being recommended or how it might help or hurt them.

Chicago-based Emmi Solutions has developed programs used in more than 100 hospitals, including the University of Pittsburgh Medical Center, where Noble had his surgery.

Dialog Medical in Atlanta makes another popular informed consent program, iMedConsent, used by more than 190 U.S. hospitals. It's designed for doctors and patients to go over together. Versions written for patients with a sixth-grade reading level are available.

The Department of Veterans Affairs now requires its doctors to use iMedConsent programs for all procedures needing informed consent. The VA estimates it will receive 2.6 million consent forms this year from patients who used the program.

Dr. Ellen Fox, the VA's chief health care ethics officer, recalls a patient who watched the program with his doctor before having a repeat test to see if his bladder cancer was back. Afterward, the man told his doctor he thought he would be having the same test he had four times before.

It was the same test. "But for the first time, the patient really understood what was going to be done to him," Fox said.

"In order to make informed choices about health care, patients need complete and accurate information," Fox said.

"It is ultimately the patient's choice" whether to have a procedure. It's just that patients may not realize they have a choice. The program helps make that clear, she said.

The University of Chicago Medical Center recently began requiring new patients referred for colonoscopies to watch an Emmi program, with hopes that it will reduce the no-show rate.

Kristen Miller, 29, an online marketer with an intestinal condition called Crohn's disease, watched the Emmi program before she had a recent colonoscopy.

Miller has had previous colon exams and wasn't nervous about the procedure. But for the inexperienced, she believes it would take away "the intimidation factor."

Knowing more about the procedure may make it seem less unpleasant, and better informed patients are more prepared for their treatment, said Dr. Stephen Hanauer, the hospital's gastroenterology chief.

Research has shown that better informing patients about their care also can make them less likely to sue if something goes wrong. Still, it's no guarantee, and computer-based informed consent programs provide an electronic record that gives hospitals extra ammunition against malpractice lawsuits.

When patients watch Emmi programs, stopping and starting them to review information, they create an electronic trail. Hospitals have used that data in court to argue that patients were informed about specific risks because they watched portions of the program where risks were detailed.

Sara Juster, a vice president at Nebraska Methodist Health System, says that feature may have played a role in a patient's recent decision to drop a lawsuit against Methodist Hospital in Omaha.

The patient had sued over a shoulder injury her baby suffered during childbirth, a problem her first child also had encountered. The woman had watched an Emmi program detailing risks for the injury, but claimed she had not been informed, Juster said.

The hospital had electronic documentation, so the woman dropped her suit.

Juster said most of the system's obstetricians give pregnant patients "prescriptions" to watch Emmi programs about labor and delivery. Within the past eight years, obstetrics-related suits against the system's hospitals have dropped by half, from about 12 a year to six.

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Online:

Emmi Solutions: http://www.emmisolutions.com

Dialog Medical: http://www.dialogmedical.com

Foundation for Informed Medical Decision Making: http://www.informedmedicaldecisions.org/

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Friday, October 29, 2010

Taking Charge of Your Hospital Stay

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Taking Charge of Your Hospital Stay

Experts explain four steps that empower patients to manage their health needs from a hospital bed.
By Colette Bouchez
WebMD Feature
Reviewed by Louise Chang, MD

If you're chronically or seriously ill, tending to self-care needs is never easy.

Putting on that hospital gown and wristband and other seemingly easy tasks can become daunting. Getting a second opinion, figuring out what your insurance covers, and researching your treatment options can be a struggle when attempted from a hospital bed.

One reason, say experts, is that patients are frequently unprepared for the change in routine and the lack of resources available in their new environment.

"Once you're admitted, a lot of the options you relied on to help you make health care decisions -- like the Internet, or even your personal computer files or your address book -- are suddenly not there. And that can leave you more than a bit disoriented," says Sandy Burke, the director of patient representatives at NYU Medical Center in New York.

Complicating matters further, she says, is the state of high anxiety that usually accompanies most hospital stays.

"The emotional state is so high on the part of the patient and oftentimes the family that even if the procedure or treatment is elective, most people don't even think beyond getting through the operation," says Burke.

Although no one knows when an acute problem will strike, or when a chronic disease or condition will suddenly worsen, experts say that taking a few simple steps to prepare and organize at least some of your health care needs can help keep you in the driver's seat, if and when the time for hospitalization arrives.

What follows are four steps that experts tell WebMD will make a difference.

Step 1: Get to Know Yourself

Whether you have a chronic condition -- or you're simply getting on in years -- experts say one of the best things you can do for yourself is become familiar with what your future health care needs may be and how your personal needs may change as a result. The best source for this information: your doctor.

"About 10 years ago, my mother sat down with her doctor and had a meaningful conversation about not only her health, but the whole idea of growing old -- what to expect and how to prepare for that," says Lyla Correoso, MD, medical director of the Visiting Nurse Service of New York's Bronx Hospice Program.

As a result, she says her mother not only knows what to expect from herself and her body as the years pass, but is also better prepared to make health care decisions when the time arrives. She is also better able to discuss her needs with family members.

"In the event my mother finds herself in the hospital not only will she be better prepared for the experience, but our whole family will be better prepared to help her, because we have some sense of what will happen and what she wants and needs," says Correoso.