kboreilly.com :: [Kevin B. O'Reilly]

My lede:

When you hurt someone, saying “sorry” may seem like the least you can do. But when the hurt occurs in the medical arena, offering an apology is not so easy.

Thirty-five states have laws offering some kind of legal protection for physicians who express regret or empathy to patients who experience an adverse event. But laws vary in what they protect from admissibility in court. Most insurers discourage doctors from apologizing for fear it could hurt them in court, and lawyers often advise against it.

Hospitals are required to tell patients about serious mistakes. But it is unclear to what extent disclosure policies are followed, and these disclosures may not be accompanied by apologies.

More than a decade since studies first showed that openness and apology might work, “I’m sorry” is still rarely uttered in medicine.

The whole shebang.

My lede:

Physicians in Montana should not fear criminal prosecution when writing lethal prescriptions for mentally competent patients with terminal illnesses, the state’s supreme court said in a 4-2 decision issued Dec. 31, 2009.

Because patients consent to their own deaths and administer the lethal medications themselves, physicians would be shielded from homicide liability under state law, the court said in its decision in the case of Baxter v. Montana. The ruling makes Montana the third state, after Oregon and Washington, where physician-assisted suicide is legal.

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My lede:

Methicillin-resistant Staphylococcus aureus, the hard-to-control superbug, wreaks havoc on the surgical patients who contract it and is a financial burden for hospitals, new research shows.

Compared with patients who go home from surgery uninfected, patients with MRSA infections are 35 times more likely to be readmitted to the hospital and seven times more likely to die within three months, according to a study in the December 2009 PLoS ONE. …

The study also found that patients infected with MRSA after surgery spent an additional three weeks in the hospital and cost $60,000 more to care for.

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My lede:

Training that draws on the lessons from aviation, particularly in interpersonal communication and decision-making, can have a positive effect on patient safety, a study found.

Aviation-based team training at two hospitals was associated with greater use of preoperative safety checklists. Physicians, nurses and other health professionals who took the six-hour training course also reported improved comfort levels on metrics of “empowerment,” such as identifying and eliminating communication barriers and confronting mistakes and incompetence.

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My lede:

American hospitals have dramatically improved their performance in providing timely heart attack care, according to a study published in the Dec. 15/22 Journal of the American College of Cardiology.

Every minute counts when it comes to treating patients with ST-segment elevation acute myocardial infarction, or STEMI.

The sooner the patient’s blocked artery is opened with balloon angioplasty after arriving at the emergency department door, the better the chances of survival.

The “door-to-balloon” time should be 90 minutes or less, according to guidelines adopted in 2004 by the American College of Cardiology and the American Heart Assn. Yet as of mid-2005, only about half of U.S. patients with STEMI were getting angioplasties within that time frame.

By mid-2008, 831 American hospitals with primary percutaneous coronary intervention capabilities achieved a 90-minute door-to-balloon time for 75% of patients with STEMI, according to the new study.

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My lede:

New Jersey physicians would have to refuse lunches from drug reps and publicly disclose any industry payments of more than $200 as conditions of licensure if new recommendations from the state attorney general’s office are adopted.

The proposals were among 22 recommendations included in a Dec. 3 report to Attorney General Anne Milgram.

The report also recommended the state medical board require that 25% of continuing medical education credits should come from “evidence-based educational programs” that refuse industry grants. Also, doctors would be barred from claiming authorship for articles they did not write and from misrepresenting their financial interests on disclosure forms.

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My lede:

November marked a decade since the release of a seminal Institute of Medicine report that cited research estimating as many as 98,000 Americans die annually from preventable medical errors.

The report, “To Err is Human,” attracted a flurry of media attention and political scrutiny — as well as criticism from physicians who said the estimate was too high. It also helped catalyze the modern patient safety movement, but to what end?

A report issued in December in the policy journal Health Affairs, said patient safety efforts since 1999 deserve a B-minus grade, compared with a C-plus for 2004.

The report cited improvements in error reporting and quality initiatives led by the Institute for Healthcare Improvement, the Agency for Healthcare Research and Quality, the Joint Commission and others. But, the report said, safety gains from health information technology have largely failed to materialize due to slow take-up, unintended consequences and implementation problems.

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My lede:

Not every patient in need of a lifesaving bone marrow transplant can find a matching donor. So a handful of cancer patients, a bone marrow transplant physician and an online group are suing the Justice Dept. to try to increase the odds.

The lawsuit, filed in October against U.S. Attorney General Eric Holder in his official capacity, argues that the 1984 National Organ Transplant Act violates the Constitution’s 14th Amendment guarantee of equal protection under the law. The law bans the sale of organs and threatens a prison sentence of up to five years for anyone convicted of breaking it.

The law is wrong, the plaintiffs say, because it treats bone marrow — a renewable bodily resource — the same way it treats solid organs such as lungs and eyes. Patients who donate blood, sperm and ova can be compensated legally. The group argues that financial incentives for bone marrow could help reduce the shortage for transplants.

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My lede:

Communication failures such as poor handoff of critical information between surgical team members are the leading cause of surgeries involving the wrong patient, the wrong side, the wrong body part, the wrong implant or the wrong procedure.

Poor communication was the cause of one in five adverse events reported to the Veterans Health Administration system from 2001 to 2006, according to a study published in November’s Archives of Surgery. Problems during the perioperative timeout process were a root cause of errors more than 15% of the time.

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My lede:

Only 44% of hospital boards say quality is among the top two criteria they use to evaluate their chief executives, according to a survey of 722 board chairs.

The survey results, published online Nov. 6 in Health Affairs, also found a strong link between the importance hospital leaders placed on quality improvement and their hospitals’ performance on Medicare and Joint Commission care metrics.

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My lede:

Doctors in Maryland hospitals soon may find themselves the targets of covert surveillance.

That stranger in the corridor reading Newsweek or texting on his iPhone actually may be taking notes on whether physicians and other health care workers wash their hands after leaving patients’ rooms.

In early November, the state launched a safety initiative using $100,000 in American Recovery and Reinvestment Act — popularly known as the federal stimulus package — funds to help hospitals train “secret shoppers” to monitor health workers’ hand hygiene. Forty-five of the state’s 47 acute care hospitals have joined the voluntary initiative.

The Maryland effort is believed to be the first time that government funds are going to train secret observers to keep an eye on doctors. At the same time, Rhode Island health officials have ordered video monitoring of surgeries at one hospital after a rash of wrong-site surgical errors.

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My lede:

The American Medical Association came out in favor of ending the “don’t ask, don’t tell” law that requires gays in the military to hide their sexual orientation from their physicians and others. Delegates to the AMA Interim Meeting said the policy threatens the physician-patient relationship and compromises the medical care of gay patients in the military.

The military reserves the power to inspect service members’ medical records for combat readiness purposes. So any mention of their sexual orientation could result in discharge under the federal law governing the military’s policy on gays, known as “don’t ask, don’t tell.”

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And here is a round-up of my other stories from the AMA’s Interim Meeting in Houston.

The Association called for a review of marijuana’s schedule I status; said drivers should keep their hands on wheel; rejected ordering medical residents to sleep; took a pass on requiring doctors to get flu shots; and debated physicians’ role in controlling health care costs.

My lede:

Hospitals that disproportionately care for poor patients are less likely than other hospitals to have adopted health information technology, says a new study. The research finds the digital divide is associated with differences in how well hospitals address racial and ethnic disparities in care and highlights the importance of helping hospitals go electronic.

Researchers surveyed 2,368 hospitals about their use of electronic systems for 24 functions such as physician notes, discharge summaries, test results viewing, order entries and decision support. The hospitals that served the most Medicaid, black and Hispanic patients, according to a Medicare measure known as the disproportionate-share hospital index, had lower rates of adoption than hospitals that served the fewest such patients, said the Health Affairs study published online Oct. 26.

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