Great Advice From Consumer Reports

February 18, 2015 6:00 am • From the editors of Consumer Reports

In an ideal world, respectful treatment from health care providers would be the norm. In the real world, you may have to insist on it. Consumer Reports suggests increasing the odds of a good hospital experience with these strategies:
•Choose the right hospital. A study published in the New England Journal of Medicine linked low patient satisfaction with less-than-stellar hospital performance in areas such as pain control, discharge instructions and communicating about medication. And research in the American Journal of Managed Care showed that people who were satisfied with their care after a heart attack, heart failure or pneumonia were less likely to be readmitted to the hospital within 30 days.
•Help providers see you as a person. Once you get to the hospital, chances are you won’t know many of the folks taking care of you. Reminding people that you are more than a diagnosis can change that. Bring in pictures, maybe one showing you playing golf or tennis. Add a personal detail when you describe your medical problems to a doctor.
•Invite your doctor to have a seat. In a recent study, Norwegian researchers created simulations in a hospital setting, using real doctors and actors as patients and comparing electronic devices with paper medical records. The patient actors thought the doctors were so busy with their devices that they shouldn’t interrupt to ask questions. If you experience that dynamic, you can change it and make it easier to communicate by inviting your doctor to sit down and have a conversation.
•Have your people with you. An advocate can help in a number of ways — for instance, making sure you are comfortable, getting information from the doctor or nurse, helping you make decisions about treatment and speaking for you if you aren’t able to speak for yourself.
•Know when errors tend to occur. In a new national Consumer Reports survey of 1,200 recently hospitalized people, patients who thought there weren’t enough nurses available were twice as likely to experience some kind of a medical error and 14 percent less likely to think they were always treated with dignity and respect. Shift changes can also create safety hazards, as can care transitions, such as moving from an intensive care unit to a hospital floor. If you know when and where errors are most likely to occur, you can make a special effort to have your advocate be present then.
•Find a “troubleshooter.” Navigating the hospital is much easier with an “insider” ally. You or a family member should introduce yourself to the head nurse on duty or seek out the nursing supervisor, attending physician or even a physical therapist or aide with whom you feel comfortable. Then, if something goes wrong, you will have already established a personal connection with someone who knows the system and can help.
•Be assertive and prepared, but always be courteous. Think about what you want to ask your doctors when they rush in for that early morning visit, and say it out loud a few times so that you get what you want from the encounter.
•Write things down. With doctors, nurses, technicians, medical students and social workers in and out of your hospital room, it can be very difficult to keep track of what is being done, especially when you are ill. Consumer Reports recommends listening to what they have to say, asking questions and taking notes.
•If you don’t understand something, ask again. Medicine is complicated stuff, and sometimes doctors forget you haven’t studied it. “This is so much a part of their lives and their vocabulary. Sometimes they rush through an explanation without realizing that the person in front of them has no clue how to interpret what they just said,” says communications specialist Carolyn Thomas. “I simply raise a hand in the ‘stop’ position, and politely remind them that I haven’t been to medical school, so please slow down and translate.”

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The Department of Justice Is Investigating LifePoint Hospitals

Modern Healthcare (2/13, Schencker, Subscription Publication, 246K) is reporting that in a Feb. 12 filing with the Securities and Exchange Commission, Tennessee-based LifePoint Hospitals “revealed” that it is “the target of federal investigations, more than twelve individual lawsuits and two class action suits alleging the performance of improper interventional heart procedures.” After conducting “an internal review,” LifePoint “identified two cardiologists who ‘independently elected to place cardiac stents that may not have been clinically appropriate,’ according to a LifePoint statement released” yesterday. LifePoint “then self-reported the matter to the Department of Justice.” The two physicians no longer practice at any facilities affiliated with LifePoint, according to a company statement. Currently, the only LifePoint Hospital in Georgia is Rockdale Medical Center.

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The FDA’s Adverse Reporting System Includes Numerous Incomplete Reports

The New York Times (2/3, B3, Thomas, Subscription Publication, 9.97M) is reporting that “the main system for keeping track of the dangerous side effects of prescription drugs is deeply flawed, primarily because drug makers are submitting incomplete information about the problems to the” FDA, “according to a new study by” the Institute for Safe Medicine Practices (ISMP), “a nonprofit group that tracks drug safety issues.” An FDA spokesman “acknowledged that adverse-event reports were often incomplete, and said improving the system was ‘of great interest’ to the agency.” But, “doing so ‘is challenging because of the voluntary nature of the reporting.’”
Similarly, The Wall Street Journal (2/2, Silverman, 5.67M) “Pharmalot” blog reports that although the ISMP says reports can only be considered reasonably complete when they include patient age, gender and event date, only 49% of reports contained that information. Additionally, the analysis found that 67% of death reports were of limited value due to incomplete information about the cause of death and the possible role of a medicine. Thomas Moore, an ISMP senior scientist, attributes the lack of completeness in reporting in part to the fact that the FDA’s adverse-alert system has not been updated since 2001 despite the fact that the pharmaceutical market has evolved immensely, yielding new interactions between drugmakers, patient, and consumers.

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Large Pharmaceutical Companies Are Outsourcing Drug Safety Monitoring Overseas

According to The Wall Street Journal (2/2, Mclain, Subscription Publication, 5.67M) more and more pharmaceutical companies are outsourcing their drug-monitoring operations to foreign countries like India. Outsourcing companies like Accenture are benefiting as major drug companies like AstraZeneca, Novartis, and Bristol-Myers Squibb contract out safety checks in order to lower costs and focus on R&D and marketing. The Journal goes on to explore in great depth the issues surrounding the practice, observing that some opponents of this type of work say that drug monitoring is hard to do, requiring significant experience, natural talent, and sufficient knowledge of biochemistry and pharmacology, and that the outsourcing trend brings greater risk that harmful side effects of drugs will be overlooked.

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Another Example of VA Neglect

The Los Angeles Times (1/28, Holland, 3.49M) is reporting that the U.S. government “has agreed to settle a lawsuit accusing the Department of Veterans Affairs of misusing its sprawling West Los Angeles health campus while veterans with brain injuries and mental impairment slept in the streets, people familiar with the agreement said Tuesday.” The settlement will require the VA “will develop a master land-use plan for the campus that identifies sites for housing homeless veterans.” The ACLU of Southern California brought the lawsuit contending “that the VA should develop housing for veterans on the 387-acre campus.” The ACLU of Southern California “accused the agency of illegally leasing land to UCLA for its baseball stadium, a television studio for set storage, a hotel laundry and a parking service.” In 2013 a Federal Judge “struck down the leases, saying they were ‘totally divorced from the provision of healthcare.’” More recently, US District Judge S. James Otero “halted construction of an amphitheater on the property.”

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Senator Charles Grassley: Nonprofit Hospitals Who Sue Poor Patients Over Unpaid Bills Could Be Breaking The Law

Fox News (1/25, 8.25M) reports that “Sen. Charles Grassley [R-IA] is calling out nonprofit hospitals who are suing poor patients over unpaid bills and says they could be breaking the law, according to a report by ProPublica and NPR.” Senator Grassley “sent a letter, dated January 16, 2015, to Heartland Regional Medical Center, a nonprofit hospital in St. Joseph, Mo., that has garnished the wages of low-income patients who were unable to pay their medical bills.” Sen. Grassley, “citing the ProPublica (1/26, 7K) and NPR (1/22, 1.58M) report…said the hospital, which recently changed its name to Mosaic Life Care, had stretched the law to the breaking point,” writing that the hospital, “may not be meeting the requirements to be a nonprofit, tax-exempt hospital.”

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NHTSA Investigates Jeep Cherokee Vehicles After Reports Of Fires

Bloomberg News (1/17, Plungis, 2.94M) reports that NHTSA has begun “a defect investigation into the latest model of the Jeep Cherokee sport-utility vehicle after an owner reported 20-foot flames shot out of its engine compartment after being parked,” which spreads across 50,415 vehicles built for the 2015 model year. The article states that NHTSA routinely starts investigations “based on a single complaint” when the agency “believes the alleged defect is especially dangerous.”
Reuters (1/17) reports that Fiat Chrysler spokesperson Eric Mayne stated the company plans to cooperate to the fullest with NHTSA.
The Auto World News (1/16, 1K) reported that NHTSA Deputy Administrator David Friedman told the press back in November that Jeep has “to get their act in gear,” adding that “They’ve got to make sure that they are getting those parts in the hands of consumers.”

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Dietary Supplements Manufacturer Shuts Down After Federal Lawsuit

The Los Angeles Times (1/17, Panzar, 3.49M) reported that a pharmaceuticals manufacturer in Los Angeles “agreed to close its operations and to recall and destroy all the dietary supplements it has sold since 2011 as part of an agreement with” the FDA. According to a lawsuit filed by the DOJ and FDA, the manufacturer “distributed unapproved supplements that claimed to treat diabetes, allergies and cancer. “ The AP (1/16) and Medical Daily (1/18, Olson, 85K) also reported on the story.

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Auto Parts Suppliers Step Up Quality Control

The Wall Street Journal (1/14, Kubota, Subscription Publication, 5.62M) reports that parts suppliers for automakers are working to improve their quality control process following the record recalls in 2014, including the issues with Takata’s exploding air bags and Delphi Automotive’s faulty ignition switches in GM vehicles.

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Liability Claims Reduced by Hospitals in National Program

December 6, 2012 – Claims Journal
Initial results from a national perinatal improvement initiatives suggest hospitals can reduce harm to babies and mothers, and lower associated liability claims and pay-outs, through the use of high-reliability perinatal teams.
Results from Phase 1 (2008-2010) of the Premier Perinatal Safety Initiative (PPSI), a Premier healthcare alliance project, show that the 14 participating hospitals have reduced harm and liability since the program’s baseline period (2006-2007).
In relation to harm, PPSI hospitals have reduced, on average:
• Birth hypoxia and asphyxia, which can cause infant brain damage, by 25 percent.
• Neonatal birth trauma, which can range from minor bruising to nerve or brain damage, by 22 percent. In addition, all hospitals were below the 2008 AHRQ Provider Rate, a national comparative rate measuring perinatal harm.
• Complications from administrating anesthesia during labor/delivery, which include cardiac arrest and other cardiac complications, by 15 percent.
• Postpartum hemorrhage, the most common cause of perinatal maternal death in the developed world, by 5.4 percent.
• The adverse outcome index rate, which measures the number of patients with one or more of the identified adverse events as a proportion of total deliveries, by 7.5 percent.
Because of these improvements, approximately 110 fewer mothers and babies experienced these harms.
Reduced liability claims
In addition, participants decreased the number of annual liability claims filed per delivery by 39 percent vs. 10 percent at non-participating hospitals. PPSI hospitals averaged a total of 18 claims per year and project wide during the baseline period, that number dropped to 10 in 2009 and is trending to be at 8 in 2010.
Findings on liability claims and losses are current through November 2012. Because it typically takes two years or longer for a claim to be filed after an injury, final liability claims and losses will not be closed for some time. These results, however, provide clear insight into the trend in claims and losses.
Launched in 2008 by Premier and affiliate liability insurer American Excess Insurance Exchange, RRG (AEIX), PPSI participants are large and small, teaching and non-teaching, system-based and stand-alone, with employed and non-employed physicians. They represent 12 states, in which approximately 250,000 babies will be delivered over the collaborative’s five years (2008-2012).
“There’s no other area in a hospital where providers routinely treat two distinctly different patients at the same time,” said Susan DeVore, Premier president and CEO. “Even though childbirth is so complex and unique, serious adverse events during labor and delivery are rare. But they do occur – sometimes they’re preventable, but they’re always devastating for babies, mothers, families and care providers.”
“The PPSI seeks to better define preventable perinatal harm and identify care practices that can result in improved outcomes,” continued DeVore. “Our results to date suggest that doing so can lower the incidence of certain infrequent, though serious, birth injuries and their associated liability claims. And the diversity of the participating hospitals also lends well to possible replication of the project and its results nationwide.”
Leveraging knowledge gained from previous initiatives, including an Institute for Healthcare Improvement (IHI)/Ascension Health/Premier collaboration, PPSI hospitals use two powerful methods to create high-reliability healthcare teams: increased adherence to evidence-based care bundles and enhanced communication and teamwork.
Increased adherence to evidence-based care bundles
Research shows that grouping essential processes together in care bundles helps clinical staff remember to take all of the necessary steps to provide optimal care to every patient, every time. Although many hospitals have long followed some or all of these individual care practices to improve perinatal outcomes, the key is consistently using all of them in concert.
Care bundle adherence is scored in an “all-or-none” fashion; the care team must provide all elements of care in the bundle to be given credit for its use. For example, one care bundle is focused on reducing the risks associated with augmenting labor, particularly in using oxytocin, a drug that accelerates a slow labor. This bundle has four elements that must be practiced consistently. If a team neglects to estimate the fetal weight before administering the medication, it would not receive credit for the work, even if team members successfully implemented the three other elements of the bundle.
PPSI hospitals have significantly improved compliance with care bundles over the course of Phase I. These improvements led to 106,000 additional mothers receiving evidence-based care bundles.
“Over the past several years, our team has established a number of quality interventions designed to increase safety for moms and babies and reduce the incidence of already very rare perinatal injuries,” said Tiffany Kenny, RN, MSN, C-EFM, OB informatics administrator at Summa Akron City Hospital in Akron, Ohio. “By following evidence-based care models, we’ve improved the quality of our Elective Inductions, lowered the C-section rate for low-risk first time mothers and improved overall safety.”
Enhanced communications and teamwork
PPSI hospitals have implemented the following proven strategies for certain high-risk protocols:
• TeamSTEPPS: Developed by the U.S. Department of Defense and the Agency for Healthcare Research and Quality (AHRQ), TeamSTEPPS produces highly effective medical teams that optimize the use of information, people and resources to achieve the best clinical outcomes.
• Situation Background Assessment Recommendation (SBAR): An effective situational briefing strategy, used by the U.S. Navy, to communicate relevant case facts in a respectful, focused and effective manner.
• Simulation drills: Exercises featuring actresses and mannequins reacting as real patients during the birthing process.
“These principles and strategies provide a foundation of clear communications tools and close to real life scenarios for use by obstetric, NICU, anesthesia, blood bank and lab teams,” said Becky Gams, RN, MS, APNL, University of Minnesota Medical Center, Fairview, and University of Minnesota Amplatz Children’s Hospital.
The PPSI’s Baseline Phase consisted of the retrospective collection of harm outcome data from 2006 and 2007 to establish a baseline of performance. During Phase I, healthcare teams implemented interventions and actively worked on performance and perinatal safety improvement across approximately 145,000 births.
Phase II began in January 2011 and will be completed in December 2012. In June 2010, AHRQ awarded a three-year demonstration grant to PPSI participant Fairview Health Services to extend the initiative. The grant allowed for the Phase II extension, which is examining hospital bundle compliance and associated outcomes, and the role of hospital culture in perinatal performance improvement to further reduce harm and liability. The University of Minnesota School of Public Health and the National Perinatal Information Center will continue providing specialized data and analytic services during the grant phase. Premier will begin analysis of Phase II results when the PPSI concludes. Results from the entire initiative will be made public in the summer or fall of 2013.

Source: Premier healthcare alliance

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