My lede:

When things go wrong and patients are harmed, doctors and risk managers have reasons to fear telling patients what happened and offering an apology.

For a physician, the result could be the turmoil of a years-long medical liability lawsuit. For a risk manager, the hospital’s bottom line could be hurt.

So how do these two groups compare when it comes to disclosure?

A new study, apparently the first to pose that question, found that physicians are more hesitant than risk managers to tell patients when an error occurs. But doctors are likelier than risk managers to use the word “error” in describing the mistakes and are quicker to say, “I’m sorry.”

The whole shebang.

My lede:

A new study is the latest to document the high costs and deadly consequences of preventable nosocomial infections.

Researchers examined 69 million hospital discharges in 40 states from 1998 to 2006, looking at two conditions, sepsis and pneumonia, often caused by drug-resistant infections. Nosocomial sepsis and pneumonia kill 48,000 patients annually and cost $8.1 billion to treat, said the study, published in the Feb. 22 Archives of Internal Medicine.

The whole shebang.

My lede:

About half the time, the doctors and nurses on popular fictional TV medical shows give improper seizure first aid that, in reality, could lead to broken teeth, bruises or dislocations, according to a study to be presented in April at the American Academy of Neurology’s annual meeting.

Epileptologists noticed a trend of “people doing very inappropriate things on television and seeing some of the same sorts of things happening to our patients in real life,” said Dr. Jeremy Moeller, who co-authored the study. “It’s impossible to definitively prove the connection, but one of the potential sources of misinformation is TV.”

The whole shebang.

My lede:

For years, catheter-related bloodstream infections seemed to be a sometimes unavoidable complication of caring for the sickest patients in intensive care units. The infections kill 17,000 patients annually, and the average cost of caring for an infected patient is $45,000, studies show.

But then a stunning thing happened: A group of Michigan hospitals implemented a relatively simple set of interventions, including a checklist of infection-control practices, and their average infection rate dropped 66% after one year. The median central-line infection rate fell to zero per 1,000 catheter days, compared with a national average of 5.2. The achievement was due to hand washing, using full-barrier precautions when inserting central venous catheters, cleaning the skin with chlorhexidine, avoiding the femoral site for insertion and removing unnecessary catheters.

Three years after the project began, 85 Michigan ICUs have improved their success. The average infection rate has dropped 86%, while the median rate remains at zero, according to a Feb. 4 study published in the British medical journal BMJ.

“Most of the time these things go a different way,” said Peter J. Pronovost, MD, PhD, lead author of the study and a consultant on the Michigan project. “The history is that quality improvement is like an accordion. You push on it, it goes in, and then you stop pushing on it and it comes back out.”

The whole shebang.

My lede:

No U.S. medical board has disciplined a doctor for taking part in an execution, and that is unlikely to change, according to a new legal study.

The study, published in January in the Federation of State Medical Boards’ Journal of Medical Licensure and Discipline, is believed to be the first to comprehensively review all state laws and regulations on doctors, medical boards and executions. The study found that only seven death-penalty states incorporate the American Medical Association’s ethics code, which, among other things, bars physician participation in executions.

Nearly all capital punishment states specifically call for doctors to be involved in some way, the study said.

The whole shebang.

My lede:

Dr. Andrew Wakefield, the investigator whose research sparked fears of a link between autism and the measles, mumps and rubella vaccine, was rebuked on ethical grounds in a British medical regulator’s report released in late January.

The General Medical Council said Dr. Wakefield acted “with callous disregard for the distress and pain” that children would experience after being subjected to blood draws, lumbar punctures and other tests that were clinically unnecessary and not approved by his hospital’s ethics committee.

The whole shebang.

My lede:

It was about 7 p.m. when the ground began to shake — again.

Family physician Douglas McKeag, MD, saw panicked patients hobble on fresh casts and fractured bones, some dragging IV poles, as they rushed to flee the converted schoolhouse where he was working in a Dominican Republic city near the Haitian border.

Some patients on the second floor jumped from a balcony; one patient broke his back doing so. The building was still standing when the aftershock ended, but no one wanted to go back inside.

“We were out in the field taking care of patients, trying to restore order all night long by flashlight,” Dr. McKeag said. “We continued to get aftershocks or other quakes, ones that were even longer than that first one. We were delivering care between earthquakes, outside in the middle of nowhere. It was surreal.”

Dr. McKeag, from Indiana, was among scores of U.S. physicians who took leave from their everyday duties to respond to the aftermath of the 7.0-magnitude earthquake that struck Haiti Jan. 12, killing an estimated 230,000 people and injuring another 300,000.

The whole shebang.

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.

The whole shebang.

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.

The whole shebang.

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.

The whole shebang.

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.

The whole shebang.

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.

The whole shebang.