Although the majority of babies in the United States are born without complications, those who experience problems during the birthing process owing to substandard care -- which can broadly include unqualified members of a delivery team, insufficient staff members on hand, a lack of necessary equipment, the failure to properly recognize or respond to dangerous developments, improper monitoring and unnecessary delays -- can sustain serious and sometimes fatal injuries. Those include cerebral palsy, facility-acquired infections, shoulder dystocia and fetal distress. Injuries to the mother can also arise during delivery.
]]> Two medical groups -- the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP), respectively -- say that, notwithstanding such risks, the safest place for a child to be born is always in a hospital or birthing center and not at home. Owing to that, both groups have issued written policies regarding home deliveries that they say are prompted by a concern that all babies receive the same type and level of care during the birthing process and following it, regardless of where they are born.The AAP statement is the more recent announcement, with its policy being stated earlier this month. The document contains a number of recommendations concerning home deliveries and counsels that home births be limited to the low-risk pregnancies of healthy mothers.
Analysis conducted in one medical study concludes that a baby is up to three times more likely to die in a planned home birth than if delivered in a hospital or birthing center.
Source: American Medical News, "Pediatricians offer newborn care standards for home births," Kevin B. O'Reilly, May 13, 2013
]]>And it's wrong, says a Johns Hopkins research team that has examined a voluminous amount of data relating to malpractice payments over a number of years.
]]> What tort reform advocates consistently argue is a predominant catalyst in driving up health costs to unsustainable levels is frivolous claim litigation pursued by injured plaintiffs' attorneys. The argument: Limits are needed to counter emotional juries and unwarranted awards that are so high that they frighten doctors and nearly bankrupt the system.That simply couldn't be further from the truth, says the Hopkins team, led by associate professor of surgery and health policy Marty Makary.
What Dr. Makary and his team uncovered through scrutiny of years' worth of data on so-called "catastrophic awards" (payouts over $1 million) is that such payments comprise substantially less than one percent of medical outlays each year in the United States.
That conclusion materially undercuts the argument for reforms stressing limits on patient payouts. Indeed, diverse critics of that argument from across a wide spectrum say that curbing jury awards actually rewards deficient doctors and increases patient harm.
Makary and fellow researchers say that the main culprit in driving up industry costs is, rather, the array of diagnostic tests and procedures routinely ordered up by doctors. Many of those are flatly unnecessary and, in fact, often lead to false-positive conclusions (i.e., diagnostic errors). That in turn often results in further and unnecessary surgeries and increased patient harm.
Those who truly favor reining in costs, say Makary, will focus on curbing the widespread use of diagnostic tests and not claims that patients are fleecing the system by collecting unwarranted damage awards. That is pure fallacy.
Source: Claims Journal, "Catastrophic malpractice payouts add little to health care's rising costs," May 2, 2013
]]>A team of Johns Hopkins researchers has scrutinized NPDB data from the tool's inception, looking at the details relating to more than 350,000 malpractice payments. A central conclusion of that inquiry is that diagnostic error is persistently at the apex of health care concerns.
]]> "Diagnostic error and its associated harm is a major public health problem," states the report, which appears online in BMJ's Quality and Safety in Health Care medical journal.As to the magnitude of that problem, the Hopkins researchers say that it is both highly significant and underreported. In fact, they note, errors in diagnosis -- defined in the study as missed, delayed or flatly wrong diagnoses -- are the leading cause of malpractice deaths, taking the lives of more patients each year than do treatment mistakes and surgical errors.
The study team counted more than 100,000 diagnostic errors in the NPDB, noting that they resulted in as many as 80,000 patient deaths. The authors state that about one in every 20 autopsies conducted in American hospitals discloses a mistake in diagnosis leading to death that could have been prevented in the absence of medical negligence.
The NPDB data reveal that death occurs about 41 percent of the time as a result of diagnostic error, with materially significant injuries occurring about 17 percent of the time.
Source: MedPage Today, "Diagnosis error is costliest medical mistake," Kathleen Struck, April 22, 2013
]]>And reward them with more money than is the case for delivering a better product.
That sounds illogical in any business field, but it seems especially incongruous in the field of medicine, where mistakes often have very serious consequences. Patients in New Jersey and across the country die from medical malpractice acts such as surgical error and medication mistakes, and medical administrators and doctors strongly tout their ongoing efforts to curb preventable medical errors and thereby promote patient safety.
]]> Given that, a recent study published last week in The Journal of the American Medical Association seems more than just a bit jarring for its central finding, which is precisely that hospitals earn more money the higher their rate of preventable medical mistakes.If that sounds flatly contradictory, it might make a bit more sense when it is considered that health insurers usually and quite readily pay hospitals for the extra costs of taking care of patients suffering from surgical and other complications. Where preventable medical error occurs, it often necessitates a longer hospital stay for a patient, which naturally drives up the cost. The researchers in the study -- which included participants from the Boston Consulting Group and Harvard Medical School -- say that the added days of in-house care typically tack on about $30,500 more for patients on the receiving end of preventable mistakes as opposed to those who are adequately treated and released as originally scheduled.
One study commentator notes that Medicare and some other payers are trying to bring about enhanced care by refusing to pay for preventable errors. He admits, though, that the study "shows that we still have miles to go."
Source: New York Times, "Hospitals profit from surgical errors, study finds," Denise Grady, April 16, 2013
]]>The transformation, advocates routinely state, is marked by game-changing technology that is reducing costs, streamlining the information stream and, most importantly, improving patient care and outcomes.
]]> And now for the critics.One of those -- among many -- is the ECRI Institute, a national and independently run group of researchers focused on optimizing all aspects of patient care, from cost to quality.
One of ECRI's many efforts is working with hospitals that, pursuant to federal legislation, voluntarily report medical errors at their facilities that stem from information technology glitches. The inclination of those hospitals to do so flows from their immunity to legal discovery and lawsuits. The idea is to promote honesty about problems and errors, with legislators and safety regulators believing that identification of problem areas must precede fixes.
ECRI scrutinizes the data, looking for acute problems and trends and making recommendations for improvements.
What the institute's researchers say they are noting with increased concern is that, regarding EHRs, there is a lot of improving to do.
Karen Zimmer, the ECRI medical director, says that the high number of EHR-related errors voluntarily reported to the institute, and their diverse nature, renders researchers certain that "this is just the tip of the iceberg" and that underreported adverse incidents are rampant.
Problems owe to a number of causes, including these: software that incorrectly reads dosing and patient data; different vendors supplying services within the same EHR systems; upgrades that are not uniformly and consistently undertaken; lab tests that are not properly identified and forwarded; and human data-entering errors.
Results of those disconnects have led to fatal medication errors, failure to diagnose serious conditions, surgical mistakes and many other adverse outcomes.
Zimmer says the type and scope of errors seen through voluntary hospital reporting underscores how important that reporting is, even if error disclosure is far from comprehensive.
"[It] affords us the chance to focus health systems' attention on these issues," she says, "and suggest some strategies."
Source: HealthLeaders Media, "HIT errors 'tip of the iceberg,' says ECRI," Cheryl Clark, April 15, 2013
That unfamiliarity does not extend to hospital administrators, virtually all of whom know exactly what the Leapfrog Group is and does. Some of them are doubtless elated by the attention they receive from Leapfrog, while others rue the day that the group ever cast its organizational eye upon their facilities.
]]> The Leapfrog Group is a nonprofit that exists to gauge hospital quality based on a number of national standards. It recently paired up with AARP, the advocacy group for the elderly, to put a spotlight on the sheer amount of doctor errors and medical malpractice that routinely occurs across the country and to acknowledge what it deems as the safest and most innovative hospitals in the United States.The need to address the problem is urgent, according to safety experts. A federal government report indicates that about 6,000 "never events" -- surgical errors such as operating on the wrong patient or body part -- occur every month in the country. An Institute of Medicine study concludes that approximately 400,000 medication errors resulting in patient injuries occur annually in the nation's hospitals.
"Preventable hospital errors are a terrible danger to American families, says Leah Binder, Leapfrog CEO.
Binder and many medical commentators believe that highlighting what the best hospitals nationally are doing to combat surgical and drug errors, hospital-acquired infections and other problems -- publicly naming those hospitals -- will motivate other facilities to perform better, as well as put important information in the hands of patients.
Source: AARP, "Lessons from America's safest hospitals," Beth Howard, April/May 2013 issue
Such is the case with a study on medication error published recently in the Journal of the American Medical Informatics Association (JAMIA). Because the research was based on work done by multiple medical bodies and also scrutiny of myriad other studies, there is a bit of time disconnect between its February 2013 publishing date and its focus on medication mistakes occurring in American hospitals in 2008.
Nonetheless, the study is revealing for its snapshot view of drug errors in medical facilities across the country as well as for its discussion of the now advanced trend of computerized provider order entry (CPOE) systems introduced to reduce medication problems. Further, the statistics it supplies can be extrapolated to the present and considered in light of the steadily increasing employment of CPOE processes in hospitals across the country.
What researchers noted foremost is the need to reduce in-house prescribing errors, which many diverse sources, including the Institute of Medicine (IOM), say is rampant. In fact, the IOM estimates that a typical hospital patient is on the receiving end of at least one medication mistake every day while hospitalized.
CPOE systems have been shown to greatly reduce such error, with JAMIA researchers saying that about 17 million fewer medication mistakes -- in ordering, transcribing, dispensing and monitoring -- occurred in 2008 compared to previous years owing to the increased adoption of computerized ordering.
There is a flip side to that, though, as has been acknowledged by many medical commentators and also, sadly, by a number of dire outcomes associated with the CPOE technology.
Specifically, and as noted in a recent media story on CPOE systems, computerized entry itself "can introduce new opportunities for medication errors." Those include doctors and staff members entering the wrong drug from drop-down menus, linking medication with the wrong patient, entering duplicate orders, providing incorrect dosing information, and failing to update patient status.
Those errors have had fatal consequences and point to a central fact about CPOE systems: They are of tremendous utility, but must be carefully managed.
Source: Pharmacy Times, "Computerized drug order systems lead to millions fewer hospital medication errors," Daniel Weiss, March 20, 2013
]]>That is how an executive with a well-known doctors organization terms the marketing tactics promoting robotic surgical systems over traditional surgeries in hysterectomy operations and other procedures involving soft tissue.
According to the American Congress of Obstetricians and Gynecologists (ACOG), a leading industry group of medical professionals, robotic surgery both oversells and underperforms. Fundamentally, and despite its self-avowed merits, ACOG notes that robotic surgery might actually be related to an uptick in surgical errors in procedures such as uterus removal and prostate operations.
]]> Federally compiled data on medical harm and adverse patient outcomes readily seems to support ACOG's assessment. Bloomberg News has reviewed adverse incident reports sent to the FDA over a several-year period, and they reveal that personal injury reports noted in surgeries involving robots have increased nearly 500 percent since 2009. More than 70 patient deaths have also been linked to robot-assisted surgery over that same period.Denigration of robotic surgery performance flatly equates to criticism of the California company Intuitive Surgical Inc., which is the only company in the United States to have received regulatory approval to market and sell robot systems for soft-tissue surgeries. ACOG officials say that comparatively higher rates of complication can occur in such surgeries as compared with traditional operations, because many doctors are simply not adequately trained on how to use the robots.
Moreover, surgeons surveyed by the FDA relate that surgery costs are higher when robots are used.
Intuitive staunchly defends its robotic systems, which were used in nearly 370,000 surgeries in the United States last year.
Source: Bloomberg, "Robot surgery isn't first choice for uterus removals," Robert Langreth, March 15, 2013
]]>Even without elaboration on such medical errors, many readers can likely make an educated guess as to the types of things they include. Often cited, for example, are the obviously horrific consequences suffered through wrong-site and wrong-patient surgery.
Less commonly mentioned, yet occurring many thousands of times each year and leading to many medical malpractice claims and settlements, are retained surgical items -- operation-related artifacts left inside patients' bodies through surgical error. Research studies show those as most often being lost sponges that are simply forgotten about as other tasks are being attended to while wrapping up an operation.
]]> That occurs more often than most people might suspect. In fact, three major studies in recent years are in decided agreement that sponges and other surgery-related items are left inside patients as many as 6,000 times or more each year. It is estimates that between one and two percent of retained-items cases result in patient fatalities.What is truly tragic is that most medical experts think that the problem is actually easily and cheaply solved, and they can readily point to medical institutions that have impeccable records in avoiding such never events. Following problems in past years with surgical teams manually counting sponges, researchers came up with the idea of introducing sponges with bar codes into surgeries. These have proved highly effective for hospitals and operating teams using them.
And they are cheap, adding only a few dollars to the cost of a surgery.
That seems a wise investment, given an average estimated malpractice cost of about $150,000 for a lost sponge.
Source: USA TODAY, "What surgeons leave behind costs some patients dearly," Peter Eisler, March 8, 2013
]]>The comparative rarity of men having the disease unfortunately means that many doctors are not looking for or seeing its symptoms, which in turn can lead to a failure to diagnose in a timely and effective fashion.
]]> The results of a delayed diagnosis can be dire, since, as one oncologist says, "right off the bat, the lump or mass is going to be a later-stage tumor."In other words, the diagnosis of male breast cancer is often accurately made at a much later time than it commonly is for women, which means that the disease is more advanced and less susceptible of treatment in many cases.
The rarity of male breast cancer makes most men not even consider the possibility and flatly ignore symptoms such as a lump or bleeding. Many men view the disease as being exclusively a female ailment.
"Both the patient and the doctor often don't have a high level of suspicion it is breast cancer," notes another oncologist, adding that, as a result, some physicians don't follow through with biopsies that can reveal the disease and enable the cancer to be appropriately and timely treated.
And thus its diagnosis is delayed, sometimes tragically so. The American Cancer Society states that the average age at which breast cancer is discovered in men is 68.
Source: Washington Post, "Because male breast cancer is rare, many cases aren't caught till later stages," Laura Hambleton, Feb. 25, 2013
]]>That is, patients frequently view that things weren't as thoroughly communicated or explored as they optimally might have been. The pace at medical clinics is typically fast, with physicians going back and forth to see patients in different rooms. Moreover, there is often a lack of continuity between patient visits; for example, multiple visits for what a patient feels might be a connected illness or condition can result in new doctors and nurses each time that are unfamiliar with the patient and his or her medical record.
]]> That atmosphere -- marked for some patients by communication breakdowns, proper tests not being conducted, lack of follow through on ordering and evaluating diagnostic screenings, overworked and time-stressed doctors, and a compromised continuity of care -- leads to medical errors, and they frequently occur as misdiagnosis of a problem at the initial exam.That is the pronounced finding of a recent study appearing in the journal JAMA Internal Medicine, which reports that primary care doctors make diagnostic mistakes often and spanning a wide range of matters. Researchers say that those diagnostic errors are missed or delayed diagnoses in nearly70 percent of all cases.
The study indicates that pneumonia is the most frequently missed diagnosis, followed by heart failure, kidney failure and various infections.
The main culprit leading to a failure to diagnose is lack of clear communication between the doctor and patient, for the reasons described above.
There is no easy fix for alleviating that problem, given the fast -- even frenzied -- pace of many clinics.
For improved outcomes in many instances, study researchers stress that doctors and patients simply need to focus on clear two-way communication.
"Getting the story right is important," says lead study author Dr/ Hardeep Singh. "Following through with instructions is important."
Source: WebMD, "Primary care doctors can make the wrong call," Amanda Gardner, Feb. 25, 2013
•· In clinics and hospitals across the United States, failure to properly diagnose a serious medical condition often leads to dire patient outcomes, including disability and death. Our firm advocate diligently and with proven effectiveness on behalf of persons who have sustained injuries through negligence or medical malpractice. We invite readers to visit our Bergen County, New Jersey, Medical Malpractice page for relevant information.
]]>Obviously, though, and tragically owing sometimes to acts of medical malpractice or hospital negligence, a good many other defects and lasting disabilities can also result from deliveries and during an infant's early newborn period.
]]> One of those is stroke, a condition that, while more than infrequently occurring in infants, is often misdiagnosed initially, with the result being that precious time is lost that could have been spent on vital treatment and medications.In fact, it is estimated that stroke occurs in about one of every 3,000 live births. Although that number might at first glance appear to be small and less than immediately alarming, its implications are clear when it is extrapolated out to the number of births that occur daily in hospitals across the country.
Research indicates that pediatric stroke is not accurately diagnosed on average until about 28 hours after it has occurred. Some medical experts stress that this is far too long a period to note and treat the condition, and that physicians should be performing better, given that the risk of pediatric stroke is highest during late pregnancy and right after birth.
"The first week of life is the highest risk in a child's whole life," says Dr. Neil Friedman, a pediatric neurologist at the highly regarded Cleveland Clinic's Center for Pediatric Neurology.
Friedman adds that many pediatricians miss the diagnosis entirely until developmental lags are seen in a child when he or she is older.
Obviously, the earlier an accurate diagnosis is made, the better are the chances for an optimal recovery.
Source: ABC News, "Pediatric stroke often misdiagnosed, treatment delayed," Susan Donaldson James, Feb. 11, 2013
]]>Researchers at the Mayo Clinic disagree with that perspective, though, at least as it relates to spine surgeries. They state that in those instances, there is no increase in surgical errors or other health complications in July as compared to other months throughout the year. Although there is a slight increase in the number of infections experienced after a surgery, study findings indicate that the uptick is not significant enough to suggest a relation to the July Effect.
]]> The study focuses on nearly one million hospitalizations for spine surgeries that occurred between 2001 and 2008 in facilities across the country. Researchers hope that their findings will ease patient fears that having s surgical procedure done at a particular time of the year could put them at a comparatively higher risk of complications.It is worth noting, though, that the Mayo Clinic study contradicts an earlier review suggesting that patient deaths can increase up to 34 percent in July. Yet another study from 2010 found that hospital fatalities peaked in July, with death rates being more pronounced in teaching hospitals. That study's sample size was much smaller than the most recent research, though.
Source: Huffington Post, "'July Effect in hospitals is a myth, Mayo Clinic study finds -- at least when it comes to spine surgery," Jan. 30, 2013
]]>The description also applies, though, to a practice in the medical field that many commentators are drawing attention to and voicing concerns with, namely, the frequent copying and pasting of notes in a person's electronic health record (EHR) without regard to proper scrutiny or updating to reflect that patient's real-time condition.
The implications of that for medical malpractice and hospital negligence can be staggering and, indeed, concern is growing in the industry that careless copying and pasting is leading to doctor errors and patient harm to an ever-escalating degree.
]]> "It's an epidemic," says a doctor and critic at Northwestern University who has studied and written about the practice. "And it's among people who should know better," he adds.The advent of EHRs in medical facilities across the country has been touted for many reasons, including the greater ease it affords for interaction among various medical actors -- doctors, pharmacists, lab technicians, medical teams at different locations -- and for its expected savings over historically maintained paper records.
A down side has emerged, too, though, and a major component of it relates to the confusion and compromised medical care that has been seen to result from careless carry-over pasting of medical information. That data -- which is often outdated -- is subsequently seen and relied on by new doctors and medical teams that misinterpret it.
"It's especially problematic when you have multiple teams taking care of the patient and we're communicating through the same chart," says a professor of medicine at Yale University.
Researchers at Weill Cornell Medical College counsel "extreme care" for doctors copying and pasting patient data in EHRs, and the college has issued guidelines concerning its limited-use recommendations.
The bottom line: Text that is being carried forward should always be updated to reflect a patient's current medical reality.
Source: American Medical News, "EHRs: 'Sloppy and paste' endures despite patient safety risk," Kevin B. O'Reilly, Feb. 4, 2013
]]>Rother and many other health care critics believe that national health policy and budget discussions and initiatives should acknowledge this front and center, and make misdiagnosis and the failure to diagnose an illness or disease main talking points whenever patient harm and medical error are agenda topics.
]]> The NHCC teamed up recently with the group Best Doctors, Inc., to conduct a survey of 400 of the country's leading cancer specialists. The coalition's just-released report focuses centrally on doctors' perceptions, underlying catalysts contributing to misdiagnosis and recommendations for reform. Some of the findings are quite noteworthy, and include the following:An executive with Best Doctors says that, regardless of how impassioned and competent a physician might be, performance-reducing factors challenge him or her on a daily basis that increase the likelihood of cancer misdiagnosis. Those include an inordinately high patient load, insufficient time available to spend on individual cases, and incomplete medical records.
Source: Health News Digest, "Landmark nationwide survey on cancer misdiagnosis released," Jan. 29, 2013