This Daily Briefing is brought to you from the
Georgia Society of the American College of Surgeons
as a member benefit.
NPR News 10-18-10
As the Hospital Food blog can clearly attest, American hospital menus feature some of the most unappetizing options available in institutional dining.
How to brighten up a dismal plate of boiled carrots and chicken tetrazzini? A glass of wine just might do the trick.
That's the thinking behind a new policy at an Indiana hospital, which is betting than a little booze might help perk up a patient's stay.
Parkview Ortho Hospital in Fort Wayne allows patients or family members to bring alcohol into the hospital if doctors have approved it. As first reported in The Journal Gazette, the hospital also indulges patients' fancies by serving steak dinners as a final meal before being discharged.
Though most hospitals are dry, the Parkview Ortho isn't the only one where patients may be able to wrangle a tipple. Shots learned from the Association for Healthcare Foodservice that the Henry County Medical Center in Paris, TN. and "many other healthcare facilities" stock beer, wine and even liquor to dispense to patients with their physician's blessing.
Aside from making a meal go down easier, sometimes it's even necessary to prescribe alcohol to keep the patient out of delirium tremens, a.k.a. severe alcohol withdrawal syndrome, says Denisa Cate, AHF president and director of food and nutrition services at the medical center. "We keep a 'beer log' detailing what comes in and goes out of our department," Cate says.
The American Hospital Association doesn't track alcohol acquiescence among its members, but spokeswoman Elizabeth Lietz says the AHA defers to physicians' own clinical expertise.
But the new practice strikes some as odd, if not risky and hard to regulate. Susan Levin is the director of nutrition education at the Physicians Committee for Responsible Medicine, a group that has studied hospital food and recommended ways to promote health through hospital foodservice. She calls hospitals' booze-friendly policies "mind-boggling."
"The hospital just isn’t the right environment for a crutch put you at ease," says Levin. "Of all the places, hospitals should be educating patients about healthy dietary habits."
Levin is also concerned that patients approved to drink alcohol could endanger their neighbors who haven't been cleared to raise a glass of bubbly.
"When you consider amount of medications people are on in hospitals — it's a dangerous system to begin with before you even start mixing alcohol into the cocktail," Levis notes.
NPR News 10-18-10
The whole idea behind HHS’ Hospital Compare website is simple:Patients can shop around by putting in their zip codes, and the site churns out a list of nearby hospitals, with detail on available services, care outcomes, patient satisfaction ratings and more.
The aim: to help consumers – and companies that pay for their care - make informed decisions about where to seek medical care; and to pressure hospitals to improve the quality of their services.
But a report that appears today in the Archives of Surgery says the website isn’t helping Medicare beneficiaries in need of certain high-risk surgery find better facilities.
If hospitals are forced to publicly report the measures they’re taking to prevent surgical infection and blood clots, the thinking goes, they’ll have a stronger incentive to comply with recommended safety measures. And that compliance will reduce the number of preventable deaths from surgical complications.
That may not necessarily be the case, according to this report. Researchers analyzed the information on the Hospital Compare site from Medicare inpatient stays for 325,052 patients in over 2,000 hospitals who underwent one of six “high-risk” surgeries – such as some open-heart procedures – in 2005 and 2006. Some hospitals only followed certain safety measures in about half the patients, while others did it more than 90 percent of the time.
But interestingly, the higher compliance rate didn’t correspond to a lower rate of post-operative deaths most of the time.
The “safer” hospitals did make a difference in one significant way – patients had a lower risk of having an “extended stay” in the hospital.
The lack of association may be due to the fact that the CMS only collects data on “low-leverage” safety measures that aren’t good indicators of surgical quality, the report’s authors say. Their bottom line: CMS needs to find better measures and “devote greater attention to profiling hospitals based on outcomes for improved public reporting and pay-for-performance programs.”
Some of this may come as no surprise: Previous studies with the Hospital Compare data have shown wide variations in cost and quality – and found no correlation: if you spend more, it doesn’t necessarily mean you’ll have better care.
'Virtual white board' helps to cut hospital length of stay
Published on FierceHealthIT (http://www.fiercehealthit.com)
By Neil Versel Created Oct 18 2010 - 10:57am
First there was the chalkboard. Then the dry-erase board came along. Now, hospitals are replacing the departmental white board with electronic alternatives.
"Turning this manual board into an electronic white board with large monitors is more consistent, saves time and improves visibility not only on the floor unit but throughout the hospital. It also lets clinicians input other codes and times to help manage patient status and overall length of stay," Robert Watson, who works in strategic process improvement at Inova Health System in Falls Church, Va., writes in Hospitals & Health Networks.
While some software packages can cost upward of $200,000, Inova took a homegrown approach at the health system's Mount Vernon Hospital in Alexandria, Va., setting up Microsoft Excel worksheets with special formatting, numerous macros and customized design for each hospital unit, with the goal of reducing patient length of stay.
The virtual white board tracks length of stay by requiring a time stamp of each patient's arrival on the hospital unit. Mount Vernon's director of case management insisted that the display include a planned discharge date and provide automatic notifications, in the form of color-coded visual cues, on the appointed date. Other color codes indicate special status like a patient's risk of falling, isolation and do-not-resuscitate orders. "The nurse or doctor can view the board at a glance and understand patient status immediately," according to Watson. "Also, color coding when a patient gets discharge orders helps the flow of patients on the floor."
Building the system required input from physicians, nurses and administrators in each unit, and the decision to build in Excel came from the medical-surgical floor, which piloted the virtual white board. The IT department also created a summary board, located on a separate server, for administrators to track patient metrics.
Since the board went live in June 2009, average patient length of stay is down by three-quarters of a day, Watson reports. Time to transport patients from the ED to an inpatient unit has been halved. "We would like to claim that it was all due to the board; however, the board just provided more visibility for LOS data and helped in the reduction."
Barnes, Deal target women voters in final two weeks of campaign
The Atlanta Journal-Constitution October 19, 2010
With just two weeks to go before the election, women voters are increasingly drawing attention in Georgia’s high stakes race for governor.
And for good reason. Women make up most of Georgia’s registered voters at 53 percent, state records show, and more women turn out at the polls here compared men.
Last weekend, Democrat Roy Barnes unleashed a pair of radio and television ads aimed directly at female voters and attacking Deal.. Earlier in the campaign, Barnes’ supporters launched a “Women for Roy” website. And on Monday, the Georgia Democratic Party announced that more than 35 house parties will take place across the state this week in an effort to get more women voters to the polls.
Republican Nathan Deal, who has vigorously defended against Barnes’ attacks, has also targeted women voters. Between July's Republican primary and the August runoff, Deal and a group of high-powered female leaders and elected officials toured the state to fend off attacks from Deal's opponent at the time, former Secretary of State Karen Handel. The move worked and Deal went from a double-digit deficit in the primary to a 2,400-vote win in the runoff. Since then, his campaign has been hosting women-for-Deal events. And it often dispatches Sandra Deal, Nathan's wife, to campaign for votes on her own.
Barnes, however, has a slight edge over Deal with women voters, according to a September poll conducted by Mason-Dixon Polling & Research on behalf of The Atlanta Journal-Constitution and the Georgia Newspaper Partnership. The poll shows Barnes leading Deal among likely female voters, 44 to 40 percent. Libertarian John Monds received support from 4 percent of women and 12 percent were undecided. In contrast, 51 percent of men said they would support Deal, compared to only 37 percent for Barnes, 6 percent for Monds, and 6 percent undecided.
Barnes, a former governor who lost his bid for reelection in 2002, continued the drum beat for women voters Monday when he appeared with his wife, Marie, in front of the DeKalb Rape Crisis Center, touting his record of fighting domestic violence.
“Women are always the difference in elections, I will tell you that, whether they vote or have their husbands to vote,” Barnes told reporters after his news conference.
In the September poll, men and women split on which party they trust to make key decisions. Men, across the board, trusted Republicans in Washington and Atlanta more on issues of the economy, health care, the budget and education. Women, however, were much more split: they were about even on trusting Democrats or Republicans in Washington on the economy and health care, and said they trust Republicans in Atlanta to fix the state budget. But on education, 49 percent of female voters said they trust Democrats, compared to 39 percent who said they trusted Republicans.
Kathy Brown, a Houston County resident and the mother of a public middle school student, attended a rally for Barnes at the Georgia National Fairgrounds in Perry last week. She is troubled that Georgia’s SAT scores rank 48th out of 50 states and the District of Columbia. And she agrees with Barnes’ promises to protect pensions for teachers and oppose furloughs for them.
“To me, he is in the best position as far as education in this state,” said the former Air Force sergeant. “What business really wants to locate to a state that is in the bottom five of the SATs?”
Orit Sklar, a conservative blogger from Fulton County, attended a women-for-Deal rally last weekend. She said women are playing an increasing role in the economy and in business and are therefore trending Republican.
"It's about family, it's about education," Sklar said. "Nathan is the choice for us. Personally, I'm conservative and I'm pro-life and, given my age, I look for a candidate who talks about reducing the size of government."
Barnes' new ads aimed at women attacked Deal’s ethics and his record on crime.
In the radio ad, one woman whispers to another that she is going to vote for Barnes and try to convince her husband to do the same, saying, “Deal is just too risky, too ethically challenged.”
The Barnes TV ad accuses Deal of trying to weaken state laws shielding rape victims.
Deal's campaign immediately responded to the attacks, calling them "a new low." He said his bill in 1991 was designed to align state law with state Supreme Court decisions and federal law to prevent convictions from being thrown out on appeal.
Brian Robinson, Deal's spokesman, said the Republican's campaign does not have a problem with female voters, despite the poll results. The importance women will play in the election is obvious, he said.
"They are a majority of the electorate so they're a critical component of our campaign," Robinson said. Barnes' attacks, Robinson added, won't work. "Roy Barnes has seen that months of nothing but attacks on Nathan Deal hasn't helped his poll standings. Georgians remember why they fired him and now he is spiraling down into desperate lies."
Getting women to turn out for him at the polls on Nov. 2 may be critical for Barnes, who has been trailing Deal in the polls overall, said Charles Bullock, a University of Georgia political scientist.
“That is the fertile field for Barnes to try to make up ground in,” Bullock said. “White males especially have left the Democratic Party in droves and are less likely to come back. Women have stuck with the Democrats longer.”
Charlene Marino, an Atlanta attorney, said she is among the undecided. She described herself as a fiscal conservative who typically votes Republican in national elections. She said in state and local races she casts her ballot for the candidate she believes is the most fiscally responsible. In the race for governor, however, she said she hasn't made up her mind.
"Ultimately, about 50 percent of my decision will come down to who will be most fiscally responsible," Marino said. "Georgia is facing a big crisis in the budget and it's important for whoever becomes governor to be responsible with our taxpayer dollars."
More tort reform needed to combat $8.5B in medical incidence claims
CMIO.net 10-19-10
U.S. hospitals will be faced with more than 44,000 incident claims this year, and according to a study conducted by Aon Risk Solutions, hospitals and physicians should plan for lofty liability costs associated with these claims that could exceed $8.6 billion. According to the report, loss rates, which measure the total cost of medical malpractice claims per hospital bed, are expected to increase 5 percent annually. Additionally, Aon noted that hospitals could experience a loss rate of $3,290, a $150 increase from the expected rate in 2010, which was $3,130. The rate is an almost $300 rise from the $2,980 in 2009. The report also found that the frequency of hospital professional liability claims is continuing to grow at a rate of 1 percent annually. Claim severity is increasing at a steady rate of 4 percent per year. The researchers said that tort reforms and patient safety initiatives had facilitated the reduction of medical malpractice costs between 2000 and 2006. “Today, there is less momentum associated with establishing new tort reforms and existing tort reforms face serious legal challenges in several states,” the report stated. Additionally, Aon Risk Solutions found that the obstetrics unit and emergency department of hospitals made up more than a quarter of the $8.6 billion in expected claims costs for hospitals and physicians this year. According to the report, hospitals could incur $204 per birth for liability associated with obstetrics claims and $6.30 per visit for ED claims. "The uncertainties of healthcare reform and difficult economic times represent significant sources of risk for many hospital systems," said the report's lead author Erik Johnson, healthcare practice leader for Aon Risk Solutions' Actuarial and Analytics Practice. "While many hospitals have grown accustomed to declining professional liability costs, the underlying claim frequency and severity cost drivers have entered a period of growth. Whether commercially insured or self-insured, hospitals and physicians should prepare for increases to their professional liability costs in the coming years." The 2010 Hospital Professional Liability and Physician Liability Benchmark Analysis report, conducted by the global risk management company in conjunction with the American Society for Healthcare Risk Management, examines the trends in frequency, severity and loss of rates for hospital and physician liability. |
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