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.

The whole shebang.

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.

The whole shebang.

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.

The whole shebang.

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.

The whole shebang.

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.

The whole shebang.

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.”

The whole shebang.

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.

The whole shebang.

My lede:

Concerned about the diversion of controlled substances in nursing homes, hospice care organizations and long-term-care facilities, the U.S. Drug Enforcement Administration no longer is allowing pharmacies to dispense schedule II drugs based on chart orders.

The DEA has taken actions against long-term-care pharmacies in Ohio, Virginia and Wisconsin for violating the Controlled Substances Act. The agency says the federal law requires that, except in emergencies, doctors provide written orders directly to pharmacists. Following an emergency, a written order authorizing the prescription is required within seven days. Pharmacists who fill schedule II orders without a written prescription could face fines or criminal prosecution from the DEA.

The whole shebang.

My lede:

America’s hospital chaplains just got a big nod of approval from the nation’s physicians.

Nine in 10 doctors said they were satisfied or very satisfied with their experiences with chaplains, according to a survey of 1,144 U.S. physicians published in the Oct. 26 Archives of Internal Medicine.

Because of physicians’ leadership roles, their views of chaplains are critical, said George Fitchett, PhD, the study’s lead author and a chaplain at Rush University Medical Center in Chicago.

The whole shebang.

My lede:

After heated controversy last winter over the birth of octuplets conceived through in vitro fertilization, the American Society for Reproductive Medicine in October announced tightened practice guidelines and a willingness to work with policymakers to put teeth into its recommendations.

ASRM did not change its guidance on the number of embryos to transfer based on different patient prognoses. But it asked that doctors who exceed the recommendation transfer only one additional embryo, note the decision in the medical record and caution patients about the risks of multifetal pregnancies. The society said it is rare that patient circumstances will warrant exceeding its guidelines.

The whole shebang.

My lede:

An influential group of medical journal editors in October announced a new, more probing conflict-of-interest disclosure form that it hopes will become the industry standard. The effort comes in response to criticism that medical journals have failed to properly inform their readers about authors’ financial relationships with industry.

The uniform disclosure form, adopted by the International Committee of Medical Journal Editors, asks authors submitting for publication to disclose any payment for the research that generated the article as well as other kinds of industry relationships such as consultancies, honoraria or stock options from the last three years.

The whole shebang.

My lede:

The American Academy of Family Physicians announced in October that it was partnering with Coca-Cola Co., the world’s No.1 soft-drink maker, “to develop consumer education content on beverages and sweeteners.”

The one-year deal is the first in the academy’s new “consumer alliance program” and is in the “strong six figures,” according to AAFP Executive Vice President Douglas E. Henley, MD. Coca-Cola is listed as a partner at the academy’s familydoctor.org Web site. The AAFP said it plans to use the funding from Coke and other consumer-goods companies to beef up the site’s educational offerings.

In the fight against childhood obesity, many medical experts have tabbed sugar-sweetened sodas as a principal culprit, and for that reason some have criticized the AAFP deal.

The whole shebang.

My lede:

The Centers for Medicare & Medicaid Services has estimated that rules that took effect in October 2008 and denied payment for “reasonably preventable” hospital-associated conditions would save the government $21 million and encourage patient safety improvement.

But the savings probably will be much lower, according to a study in the September/October Health Affairs.

The nonpayment rules are likely to cost hospitals about $2.7 million — $368 per facility — raising the question of whether the no-pay policy will achieve Medicare’s cost and safety objectives. Hospitals and physician organizations, including the American Medical Association, have objected to some of the conditions included in the no-pay list, saying prevention is not always possible.

The whole shebang.