Intensive care units following a package of evidence-based interventions helped cut the national rate of catheter-related bloodstream infections by 58% between 2001 and 2009. Now more hospitals are looking to high-tech solutions to help when checklists are not enough.

Among the high-tech tools that have been well studied and recommended by the Centers for Disease Control and Prevention are sponge dressings impregnated with the disinfectant chlorhexidine and catheters impregnated with antibacterials or antibiotics.

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Computed tomography use in U.S. emergency departments more than quadrupled between 1996 and 2007, but newly published data from more than 350,000 patient visits show that hospital admissions after a scan in the ED fell by more than half.

In light of concerns about potential cumulative radiation dose due to the skyrocketing use of medical imaging, the information sheds light on how CT scans may benefit patients, said Keith E. Kocher, MD, MPH, lead author of the study published online Aug. 12 in Annals of Emergency Medicine.

“There are a lot of questions to ask about the exploding use of CT scans in the ED, and one of the things you want to know is whether this is changing patient outcomes,” said Dr. Kocher, clinical instructor of emergency medicine at the University of Michigan Medical School. “It appears there’s an association between the rate of CT scans going up and physicians being more likely to discharge patients home than [there] used to be.”

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In September 2010, Kimberly Hiatt made a medical error. The critical care nurse at Seattle Children’s Hospital miscalculated and gave a fragile 8-month-old baby 1.4 grams of calcium chloride, 10 times the correct dose of 140 milligrams.

The mistake contributed to the death of the child and led to Hiatt’s firing and an investigation by the state’s nursing commission. In April 2011, devastated by the loss of her job and an infant patient, Hiatt committed suicide.

Hiatt, who had worked as a nurse for more than two decades, was another in a long line of “second victims” of medical error, the term used in medical literature to describe physicians and other health professionals who often feel guilty and depressed after adverse events. Many physicians and other health professionals hold themselves to a standard of perfection, and when things go wrong, they feel alone.

Physician health experts estimate that 250 doctors commit suicide annually — a rate about double that of the general population. When doctors believe they have made a major medical error, they are three times likelier than other physicians to contemplate suicide, said a January Archives of Surgery study.

If the first instinct after an adverse event is to retreat from scrutiny into a spiral of shame and fear, sharing the ordeal publicly is probably the last thing to cross a physician’s mind. But a small group of doctors has done just that. Here are three physicians who shared their stories with the world in an effort to tell their colleagues and their patients that to err is human.

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Wide-reaching changes announced by the Dept. of Health and Human Services would speed up the process of approving and monitoring federally funded clinical trials.

The plans, which represent the first substantive revisions to the country’s human-research subjects regulations since they were adopted three decades ago, could help ease the regulatory burden faced by the estimated 30,000 U.S. physicians who act as clinical investigators.

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The drugmaker spent $3.8 million on business meals and travel for doctors and health care organizations.

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The number of Americans who act as caregivers for infirm loved ones continues to grow, as do the emotional, financial and medical burdens these family caregivers carry as a result. But experts said the health care system — physicians, nurses, hospitals and manufacturers of medical equipment used at home — can help make family caregivers’ unpaid work a little easier to bear.

The newest figures, released in July by AARP, show that about 42.1 million Americans in 2009 regularly helped an adult loved one with tasks such as cooking, bathing, paying bills, visiting physicians and managing medications. That number, which equals about one in seven Americans, rose 24% from 2007.

“Being a caregiver is becoming a fact of life — we call it the new normal,” said Susan C. Reinhard, PhD, co-author of the AARP report. “If we were to try to hire people to do all the things that all the family caregivers do, it would equal $450 billion a year.”

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The proportion of inpatient care provided by hospitalists has more than quadrupled since 1995, and many studies have found that patients cared for by hospitalists go home sooner than those who receive hospital care from their primary care physicians.

Shorter lengths of stay save hospitals money and could be a sign of higher-quality care, but a new study of nearly 60,000 Medicare patients over five years sheds light on how hospitalist-treated patients fare after they are discharged.

The patients cared for by hospitalists were discharged more than half a day earlier than patients treated by their primary care physicians, and their hospital charges were $282 lower on average. But the hospitalists’ patients were 18% more likely to visit the emergency department within 30 days of leaving the hospital and 8% likelier to be rehospitalized within a month.

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Despite years of guidelines urging simpler and easier-to-understand informed-consent documents, the forms given to clinical trial participants remain too long and use language that is too complex.

A review of 124 informed-consent documents used in 21 HIV clinical trials sponsored by the National Institutes of Health’s Division of AIDS found that the forms were typically written above the ninth-grade level and ran longer than 22 pages. The findings were published online July 6 in the Journal of General Internal Medicine.

“Very few people are going to sit down and read a document that’s that long, and the goal is to have people understand,” said Nancy Kass, ScD, lead author of the study. “The whole reason for putting [informed consent] in writing is with the belief that someone will read it. The longer it is, the less likely people are to read it all the way through, and then you have defeated your own purpose.”

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One step to safer surgeries may be potluck lunches.

Arranging social occasions where members of the surgical team can get to know one another as individuals is part of the patient safety approach that Andrew S. Klein, MD, is pursuing as chair of surgery and transplant medicine at Cedars-Sinai Medical Center in Los Angeles.

“In the operating room, we’re all camouflaged in our gowns and masks and gloves,” Dr. Klein said. “If I ask for one instrument and I get the wrong one, my options could be to swear and yell or throw that instrument on the floor. But if I know the person, if I know something about them, there is a well of good will, and you don’t react that way.”

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My lede:

Chicago — A photograph captures an Afghan girl’s tears as her wrist injury is examined. A painting bursting with color shows the explosive effect of a roadside bomb. A mixed-media piece portrays the emotional turmoil some physicians experience after treating traumatic war injuries.

These pieces — created by orthopedic surgeons who have cared for those wounded in wartime — are just a few of the striking artworks on display through Aug. 31 as part of a free exhibit at the Chicago Cultural Center.

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The new editor-in-chief says medical journals must explore every avenue for communicating with doctors and the public.

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My lede:

Checklists have been used successfully to improve surgical safety and cut infection rates in the intensive care unit, but a study suggests that checklists are even more effective when physicians are prompted by a colleague to take action on information gathered using the quality improvement tool.

A study of 265 critical care patients at Northwestern Memorial Hospital in Chicago found that intensivists who relied on checklists alone did not reduce mortality rates. However, the death rate was cut in half when the checklist was accompanied by residents who asked the attending physicians how to act on information related to matters such as antibiotic prescribing, ventilator use and central-line placement.

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My lede:

The Joint Commission in June cited early progress on a pilot project designed to identify and prevent the problems that can lead to wrong-site and wrong-patient surgeries.

The organizations participating in the project, including La Veta Surgical Center in Orange, Calif., and Thomas Jefferson University Hospitals in Philadelphia, were able to reduce the proportion of surgical cases in which there was a process-related defect that could result in a wrong procedure. That proportion was reduced from a baseline of 52% to 19%.

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