medical mistakes

Disruptive doctor behavior causes mistakes, intimidates workers

Anne Zieger — Tue, 02 Dec 2008 09:27:12 -0500

We've told you about the Joint Commission's new rule requiring hospitals to have rules and consequences to prevent disruptive behavior from physicians. And subsequently, the AMA asked for a one year hold on that rule so they could have time to consider how best to prevent disruptive behavior.

How often does it happen? There is anecdotal evidence--stories of nurses and other healthcare workers being yelled at and humiliated after they, say, saved a patient's life by noticing a mistake--but it's hard to tell whether these are unusual situations.

Now, however, we have results from a survey to show how big a problem disruptive behavior really is in hospitals. The number of doctors who appeared to be disruptive seems to be relatively low, perhaps only 3 to 4 percent, but the problems that these doctors can cause belie their low numbers.

Dr. Alan Rosenstein performed a survey of healthcare workers from 102 non-profit hospitals between 2004 and 2007. What he found was that 67 percent of the respondents thought that disruptive behavior contributed to medical mistakes, and 17 percent had actually seen at least one mistake as a result of disruptive behavior.

To learn more about the survey:
- read this New York Times piece

FL puts health facility inspection records online

Anne Zieger — Thu, 14 Aug 2008 09:51:19 -0400

The state of Florida has put inspection reports and the results of complaint investigations for most health facilities online, allowing the public to simply review them at a moment's notice rather than having to file a public-records request to get them. The database will include reports on 32,000 hospitals, nursing homes, clinics, surgery centers, dialysis units and more. Officials are posting all reports written after June 1. Consumers will be able to look at reports from annual inspections, complaint investigations, safety inspections and unannounced visits, which will include information on violations such as lack of cleanliness, medical mistakes and procedural errors. The state's providers, meanwhile, had mixed reactions, with some suggesting that the reports would be misleading since they won't have a chance to respond.

To learn more about the state's plans:
- read this South Florida Sun-Sentinel piece

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TX hospital group issues medical-error billing guidelines

Anne Zieger — Fri, 18 Jul 2008 10:29:40 -0400

Following the lead of individual hospitals and associations around the U.S., the Texas Hospital Association has developed a policy designed to help its member hospitals determine when not to bill for care related to serious medical mistakes. The group's five "guiding principles" include that the error or event must have been preventable, within the control of the hospital, the result of a mistake made within the hospital, result in significant harm, and have been defined clearly and precisely in advance of the incident. The Association also included nine examples of non-payment events, including wrong-body-part surgery, wrong surgical procedure, infant discharged to the wrong patient, or patient death or disability due to a reaction to wrongly-used blood products. In creating this policy, the THA seems to be nudging health plans along, too. For example, Blue Cross and Blue Shield of Texas has already decided to base reimbursement on these principles.

To learn more about the policy:
- read this Modern Healthcare article (reg. req.)

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Boston hospital discloses wrong-side surgery

Anne Zieger — Mon, 07 Jul 2008 08:07:11 -0400

A surgeon at Beth Israel Deaconess Medical Center operated on the wrong side of a patient this week--and in a rare act of transparency, hospital officials disclosed the event promptly in an email to staff members. The surgical mistake happened during an elective orthopedic procedure that didn't involve removal of organs and didn't cause permanent damage to the patient. However, state authorities are still investigating the matter. This is one of five wrong-side surgeries reported to authorities statewide during the first five months of the year, according to the state's Bureau of Health Care Safety and Quality.

The error occurred despite the fact that medical workers had used a marker to label the correct side of the patient for the operation. However, the surgeon failed to notice the mark. Experts note that this problem might have been avoided if the surgical team took a "time out" before the procedure, under which operating teams stop and verbally call out, "Right patient, right procedure, right location."

To learn more about the surgery:
- read this item from The Boston Globe

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