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Hospital News Part 2

February 21, 2017        

By Mendy Hecht, Hamaspik Gazette

“Top” surgeons bottom performers: study

Think you’re the only one noticing that some doctors are, well, uppity-up?  (And that the “bigger” and more specialized the specialist, the more, well, off-putting the specialist is?)

You’re not alone.

Researchers at Vanderbilt University Medical Center (VUMC) have not only found that yes, not only is there is such a thing as a rude and disrespectful surgeon—but that the more rude and disrespectful, the more medical errors the surgeon will make.

The researchers compared surgical outcomes with patient reports of unprofessional behavior by their doctors at several U.S. health systems, finding that surgeons with a history of patient complaints regarding their personalities or attitude are also likelier to err in the operating room.

Specifically, Vanderbilt research found nearly 14 percent more complications in the month after surgery among patients treated by the surgeons who also had the most complaints against them.

Complications included surgical-site infections, pneumonia, kidney conditions, stroke, heart problems, blood clots, sepsis and infections, according to the study.

Lead author Dr. William Cooper said surgeons who are rude and disrespectful to patients might also treat other medical professionals poorly, which could affect the quality of care.

“For example, if a surgeon speaks disrespectfully to an anesthesiologist during a procedure, the anesthesiologist may become reluctant to speak up the next time the surgeon and the anesthesiologist work together,” he said in a Vanderbilt news release.

“Similarly, if a nurse’s reminder to perform a safety procedure such as a surgical time-out is repeatedly ignored, the nurse may be less likely to continue to share his or her concerns with the surgeon,” Cooper noted.

“We need to reflect on the impact patients and families experience from these avoidable outcomes,” said study co-author Dr. Gerald Hickson is senior vice president for quality, safety and risk prevention at VUMC.  “From conservative economic estimates, the cost of addressing the excess surgical complications could amount to more than $3 billion annually.”

The findings also suggest that analyzing patient and family reports about unprofessional behavior could help spot surgeons with higher complication rates.

Hospitals could then take steps to improve the doctors' behavior and, possibly, also patient care, the researchers said.

“Even though there was only a 14 percent difference in adverse outcomes between patients cared for by the most respectful and least respectful surgeons, if you take those numbers and distribute them across the United States where 27 million surgical procedures are performed each year, that could represent more than 350,000 surgical-site infections, urinary tract infections, sepsis,” said Hickson, “all kinds of things that we know can be avoided when surgical teams work well together.”

The study was published Feb. 15 in the journal JAMA Surgery.

Hand-powered low-cost paper centrifuge tests blood in undeveloped world regions

So, you’re a medical professional in some Third World backwater and you need to do a blood test on your patient.  But you don’t have a centrifuge.

The centrifuge, which separates blood into various components by density by spinning samples at very high rates, is a staple of modern hospitals.

But what about undeveloped world regions where there is hardly any electricity, paved roads, or high-tech anything—never mind high-tech hospitals?

A Stanford University biomedical engineering team recently won an NIH Director’s New Innovator Award for developing and field-testing a paper centrifuge operated by hand.

The device is based on a kind of dreidel spun by pulling a string wound around its center, accelerating it to a very high rate of spin.

Prototypes of their paper centrifuge were photographed with a high-speed camera as being able to spin at up to 125,000 revolutions per minute (RPM) using only a hand pulling its string.

The team’s “paperfuge,” which weighs two grams and costs 20 cents, consists of disposable sealed drinking straws containing blood samples and two paper disks.  Using the string, the paperfuge spins at a very high rate of centrifugal force to separate various components.

In less than two minutes, the paperfuge separates pure plasma from whole blood—providing provides a reading of hematocrit, which is used to diagnose anemia.

And in 15 minutes of spinning, the paperfuge separates separate a layer known as the buffy coat. The buffy coat is used to diagnose conditions where a parasite is in the blood—such as malaria and African trypanosomiasis (sleeping sickness).

The Stanford team has tested the paperfuge in a community health setting in Madagascar and is now clinically validating the device.

“There are more than a billion people around the world who have no infrastructure, no roads, no electricity,” said team leader Prof. Manu Prakash.  “I realized that if we wanted to solve a critical problem like malaria diagnosis, we needed to design a human-powered centrifuge that costs less than a cup of coffee.”

National hospital study finds safeguards reducing serious catheter infections

A new study by Cedars-Sinai Medical Center (Los Angeles) indicates that improved catheter safety measures in hospitals significantly reduce bloodstream infections and health care costs.

The study analyzed data on catheter-related bloodstream infections at 113 U.S. hospitals over the past decade.

To prevent serious infections, hospitals have introduced new safety procedures in recent years.  These include using sterile gloves, covering catheters with antimicrobial dressings and checking catheters daily for signs of movement or infection.

On average, improved catheter safety measures reduced infections by 57 percent.  They also lowered the cost of treating such infections by $1.85 million at each hospital over three years, according to the study.

Over 60,000 primary bloodstream infections related to central venous catheters occur each year in the U.S., with about 12 percent resulting in fatalities.

The catheters, also known as central lines, are widely used in intensive care units (ICUs).  They’re placed in large veins in the arm, chest or neck to deliver medications, fluids or blood.

The study results were published recently in JAMA Internal Medicine.

Is patient access to personal health records the future?

The still-ongoing introduction of electronic health records (EHRs) to doctors’ offices—one of the many key innovations of the Affordable Care Act (ACA)—is changing the way primary care physicians practice medicine.  The ACA offers several incentives for doctors switching to EHRs.

But will that change eventually put the patient in charge of his or her EHR?

“I have always thought the patient should be the primary user of the EHR,” says David Voran, M.D.,

Commenting on health-industry website Physicians Practice, Dr. Voran opines that patients—not doctors, nurses or other professional staff—having as full and open access as possible to their own medical records, is the wave of the future.

“It did take banking nearly 20 years to figure out customers could conduct transactions as accurately as tellers.  Likewise, the airline industry has dramatically reduced its operational costs but turning over flight and seat reservations to customers,” Dr. Voran puts it.  “I am confident medicine will get there some day.”

Dr. Voran writes that he is currently “experimenting” at his job with letting nurses, administrators and other doctors manage their own EHRs. 

“It’s too early to tell, but the feedback from these patients is quite promising,” Dr. Voran reports. “Errors in the chart are much less; some are even doing the lion's share of a visit notes both before and after the encounter, acting in many respects like a scribe for the physicians… So far there have been no untoward events, and the participants feel empowered.”

So, can non-medical professionals be trusted to manage their computerized medical records—especially when they’re filled with jargon?  Are we headed to a patient-centered medicine future where most technicalities not directly care-related are handled by “customers”?

“On my end, I trust their records more than those patients who have relied on healthcare providers for management of their records,” Dr. Voran says.

Only time will tell.