The Centers for Medicare and Medicaid Services (CMS) has developed a checklist for patients when they leave a hospital, nursing home, or other healthcare setting. This 16-step tool provides guidance to patients on what questions to ask and what arrangements should be made before they are discharged, allowing them some control in the discharge process.
Robotic Surgery & Surgeon Training
The Wall Street Journal has published a couple of stories about a community hospital with a rash of patient injuries alleging surgeoninexperience using the DaVinci Robot. The hospital requires surgeons to attend a two day training session, during which they use human or pig cadavers, followed by four live cases. When reviewing robotic surgery cases, it is important to investigate the surgeon's training using the robot including both his/her initial training and subsequent live case training. How many cases did the surgeon complete under supervision of another surgeon? How much training did the supervising surgeon have?
Increased mortality at teaching hospitals
A recent study in this month's Archives of Surgery showed an increased risk of death in those undergoing colon resection for both cancer and non-cancerous conditions at teaching hospitals in 38 states. The study is a retrospective review of over 100,000 patients over a five year period.
State of Health Care Quality Report
The National Committee for Quality Assurance is a private, 501(c)(3) not-for-profit organization dedicated to improving health care quality. Since 1997, NCQA has published an annual analysis of major trends in managed care. Information on performance averages and benchmarks on a wide range of topics are included. The analysis is based on hundreds of health plan submissions through HEIDIS and CAHPS© . The 2009 report is available online at no cost.
Head Injuries and Sports Legislation Moves Forward
As sports related concussions continue to get more media attention, a bill in the Virginia House of Delegates, already passed by the Senate, is making progress towards being passed. Sen. Ralph S. Northam, D-Norfolk, a neurologist, introduced the bill (SB652) which outlines polices concerning education, prevention and treatment of concussions suffered by high school athletes. According the Centers for Disease Control (CDC) brain injuries are the number one cause of death and disability in people under age 25. Source:
http://www.newsleader.com/article/20100314/HSSPORTS/100313002
Jolly Featured at Critical Care Nursing Conference
Dana Jolly, principal of Jolly Consulting, LLC will be the featured speaker at Odyssey of Critical Careconference being held in Richmond, VA on March 16. Ms. Jolly will be presenting "Defensive Nursing" giving the clinical nurse audience information on medical negligence claims and tips on how to practice nursing defensively by thoroughly documenting the care they deliver to their patients.
Pressure Ulcers Unavoidable?
A recent consensus conference of the National Pressure Ulcer Advisory Panel revised the definition of unavoidable pressue ulcers for long term care settings to include all care settings. The revised definition reads is below. The panelists agreed the condition of skin failure exists. “Unavoidable - means that the individual developed a pressure ulcer even though the provider had evaluated the individual's clinical condition and pressure ulcer risk factors; defined and implemented interventions that are consistent with individual needs goals and recognized standards of practice; monitored and evaluated the impact of the interventions; and revised the approaches as appropriate.”
The full report of the consensus conference including a report on the methodology used will be forthcoming.
The National Pressure Ulcer Advisory Panel serves as the authoritative voice for improved patient outcomes in pressure ulcer prevention and treatment through public policy, education and research.
Contact Information: David Saunders, NPUAP Executive Director at dsaunders@npuap.org
Most deviations from guidelines for medical reasons are appropriate
ST LOUIS (MD Consult) - In the vast majority of cases, physicians' deviation from quality measures set forth in guidelines on medical grounds are appropriate, finds a single-institution study reported in the February 16, 2010, issue of the Annals of Internal Medicine. Investigators implemented a system in a large internal medicine practice to allow physicians to document medical exceptions to 16 quality measures pertaining to preventive care and the management of chronic disease, to peer review the exceptions recorded, and to provide feedback to the physicians.
A peer review panel classified each medical exception as appropriate, inappropriate, or of uncertain appropriateness.
During a 7-month period, physicians recorded 614 exceptions to quality measures for medical reasons.
The panel classified 94% of the exceptions as medically appropriate, 3% as inappropriate, and 3% as having uncertain appropriateness.
Of the 19 exceptions found to be inappropriate, 10 pertained to diabetes care, 7 pertained to coronary heart disease care, 2 pertained to preventive services, and none pertained to heart failure care.
After provision of feedback, physicians altered their management in 8 (42%) of the 19 cases.
Less than 5 minutes was required to peer review each case. However, 65 reviews were needed for each case in which clinical care was altered.
The investigators acknowledge that the results may differ if similar systems are implemented at other institutions or in settings having financial incentives.
"Physician-recorded medical exceptions were correct most of the time," they conclude. "Peer review of medical exceptions can identify myths and misconceptions, but the process needs to be more efficient to be sustainable."