doctors and nurses

Hospital collective works to reduce birth injuries

Thu, 15 May 2008 06:59:54 -0400

A group of 16 hospitals has come together to create seamless processes to avoid birth injuries to infants in risky situations. Right now, about three infants of every 1,000 are injured during birth, but Premier research suggests that about 80 percent of those injuries could be avoided.

The project, backed by healthcare alliance Premier Inc., is designed to address the major sources of birth injury identified by the Alliance, including failing to recognize when a baby is in distress, failing to perform a timely C-section, failing to properly resuscitate a baby, inducing labor inappropriately with drugs, and using vacuums or forceps inappropriately.

Hospitals participating in this project have committed to following a set of guidelines proven to reduce harm to infants and mothers in each of these situations. Not only that, hospitals are drilling their staff on how to respond, with Harris Methodist Fort Worth Hospital, or example, offering staff the chance to practice with computerized simulators named "Mama Noelle" and "Baby Hal."

Teams are also taking the time to develop clear plans ahead of time for how to deal with dangerous situations. For example, doctors and nurses are creating agreements on how many attempts to make before using a vacuum device to deliver a baby. While developing such strategies is time consuming, hospital leaders and Premier officials believe that the time spent will pay for itself in reduced expenses and fewer lawsuits.

To learn more about the Premier initiative:
- read this USA Today piece

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Case study: TX hospital uses 'lean manufacturing' methods

Wed, 16 Apr 2008 06:59:54 -0400

At St. Luke's Episcopal Hospital, administrators were as likely to get a patient letter saying that their experience was dreadful as they were to get letters praising the hospital experience. Hoping to eliminate such variations, CEO Dr. David Pate decided to apply techniques from "lean manufacturing," an industrial process designed to eliminate waste. In doing so, he joined high-profile players like Beth Israel Deaconess Medical Center, which has also seen significant success with this approach.

The hospital began by standardizing critical processes, then worked on continuous improvements. For example, to save on needless phone calls, the hospital put up screens--much like those used in airports to track flights--that allowed doctors and nurses to know a patient's status at all times. It also worked to improve efficiency in accessing supplies.

The effort is paying off in many ways. For example, the hospital's emergency department has now managed to stay within the recommended 90 minutes for getting patients with chest pain assessed and through the heart cath lab for 10 months. And with the screens in place, phone time for coordination has gone down 80 percent.

To learn more about St. Luke's effort:
- read this Houston Chronicle piece

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PA doctors, lawyers cooperate on med mal project

Tue, 04 Mar 2008 06:59:54 -0500

Here's a case where strange bedfellows seem to be making good law. Doctors in Pennsylvania's Montgomery County have begun working together on a pilot project that they're hoping will keep malpractice cases out of court. Sponsors of the project, which include the county's bar association, medical society and Abington Memorial Hospital, hope mediation will save money for everyone involved.

The pilot, which has been in the works for three years, pulls together teams of lawyers and doctors who will work to mediate conflicts between patients and their providers. The idea is to resolve problems more quickly, and gently, than what happens in malpractice trials. The doctors get special mediation training, which includes play acting, before they get involved with real cases. The process moves patients and families through two steps. First, doctors and nurses meet with patients to explain what happened medically. If that doesn't satisfy the aggrieved party, patients or families can move to mediation, in which the two can pull together a settlement. Patients still can go to court if they can't settle through mediation.

To learn more about the program:
- read this Philadelphia Inquirer article

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NY hospitals reconstructing, rethinking EDs

Wed, 13 Feb 2008 06:59:56 -0500

Even by today's standards, New York City's emergency departments have been in a state of crisis. All told, EDs in the city handled more than 3.6 million visits in 2005, up 6 percent over 2000--with some hospitals seeing 50 percent volume increases or more during that period. The problem has gotten worse since a state commission ordered some city hospitals to close or merge with others, shrinking ED capacity in an already overstressed system. However, the hospitals are fighting back by expanding and remodeling their EDs, while adding new staff members whose job is to streamline the ED experience for patients and improve administration.

One notable example is Montefiore Medical Center, which runs the city's busiest ED. Not only has Montefiore added two new emergency rooms, one of which is just for children, it's also added another 7,000 square feet, brought on more doctors and nurses, and hired customer service reps who visit with patients on "comfort rounds" to offer extra pillows, free snacks and child care. The idea at Montefiore is not just to ease crowding, but also to make the ED experience more attractive to paying patients and boost inpatient revenue who come in through that channel.

Meanwhile, other hospitals in the city, such as St. Vincent's Hospital Manhattan, are creating fast-track options for patients with minor injuries. Others, also fighting for paying patients who come in through the ED, have added flat screen TVs and other amenities to ED rooms.

To learn about more of New York City's ED transformations:
- read this article in The New York Times

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Study: Hand gel not enough to curb infections

Wed, 30 Jan 2008 06:59:55 -0500

A new study suggests that the use of alcohol-based hand gel, while effective, is not enough to cut down on hospital-acquired infections. The study, which looked at 300 hours of hand hygiene observation of doctors and nurses in two Nebraska ICUs over a two-year period, found that while workers nearly doubled their use of alcohol-based gel when it was made readily available, infection rates remained about the same. Researchers concluded that rings, excessively long fingernails, poor handling of catheters and unsanitized treatment areas were major contributors to remaining infections. The results of this study, which appears in this month's issue of Infection Control and Hospital Epidemiology, seems to contradict CDC guidelines suggesting that frequent use of hand gels or frequent hand washing is sufficient to lower rates of hospital-acquired infection.

To learn more about the study:
- read this South Florida Sun-Sentinel piece

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Untreated patient dies of heart attack in CA hospital

Wed, 28 Nov 2007 06:59:56 -0500

It's now official that a 33-year-old man who died in a Los Angeles medical center died because his heart attack wasn't diagnosed, despite his spending three hours in its emergency department. A coroner found that the man, Christopher Jones, died from a blood clot and coronary heart disease.

Though they did take his vitals, it appears that the triage staff at Olive View-UCLA Medical Center didn't give the man an EKG, despite being told that he had arm pain, chest pain and chills. This runs counter to standards created by the American College of Cardiology, which strongly advises hospitals to provide an EKG for patients with such symptoms, then continue to administer EKGs every 15 to 30 minutes if the original test shows no results.

Since the incident, the county Department of Health Services has announced that it's planning to fire the triage nurse involved in screening Jones. Also, the hospital is retraining doctors and nurses on triage policy, and also changing the way it assesses ED patients who complain of chest pain.

To learn more about this incident:
- read this Los Angeles Times item

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Case study:Ala. hospital works to cut ER waits

Tue, 21 Aug 2007 06:59:54 -0400

Doctors and nurses at Huntsville (Ala.) Hospital are getting what many elsewhere can only dream about having. The hospital is building a $27 million development project that will give the hospital one of the country's largest and most up-to-date Emergency Departments. The new ED will have 63,000 square feet, from 25,000 square feet at present. It will be able to accommodate 100 patients at a time, and help the hospital to meet its goal of getting every patient seen by a doctor within 30 minutes.

As part of the changes, Huntsville is going with an emerging national trend by stationing a doctor in the triage area of the ED. His or her job will be to treat non-life-threatening injuries quickly without tying up ED beds. This should help the hospital greatly if it succeeds in reducing ED bed demand. Huntsville's ED is the state's biggest, treating about 93,000 patients last year.

To learn more about the changes:
- read this article from The Huntsville Times

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SPOTLIGHT: Staff, patients at Atlanta hospital want say in its future

Tue, 14 Aug 2007 06:59:52 -0400

Atlanta's Grady Memorial Hospital is in serious financial trouble--so serious that the tax-funded hospital might need to close. Executives are working to handle the problems, of course. However, patients, doctors and nurses are arguing angrily that they, too, should have a voice in how the hospital's issues are resolved. Article

SPOTLIGHT: Community health centers at breaking point

Wed, 18 Jul 2007 06:59:52 -0400

While the nation's 952 federally-approved community health centers are managing to serve millions of poor and uninsured patients, they won't be able to keep it up forever. With patient loads having grown 53 percent since the year 2000 alone, and no slowdown in sight, it's hard to imagine how our current funding system will be able to keep up, much less recruit enough doctors and nurses to staff future centers. Article

SPOTLIGHT: Military faces physician, nurse shortage

Tue, 05 Jun 2007 20:01:32 -0400

With the U.S. at war, and the number of enlisted troops climbing, the volume of military personnel seeking medical care is growing. The problem, however, is that the military is struggling to recruit enough doctors and nurses to meet this demand. Increasingly, military officials are being forced to pay outside providers to care for soldiers and their families. Article