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6-27-06 - LIABILITY UPDATE - Overcrowded ER's, doctor shortages, fewer errors... by Donna Baver Rovito, Editor, "Liability Update" This LIABILITY UPDATE "newsletter" is a free service which I provide, as a volunteer, to help supply medical liability reform and crisis information to physicians, patients, and liability reform advocates. I am not employed by any physician advocacy or liability reform organization, political party or candidate. PLEASE FORWARD THIS IMPORTANT INFORMATION TO EVERY HEALTH CARE PROFESSIONAL YOU KNOW, AND SEND ME MORE EMAIL ADDRESSES SO WE CAN GET THIS INFORMATION TO MORE OF THE PEOPLE WHO NEED IT. If you would like to be added to or removed from the Liability Update Information Network, or if you have information about yourself or a colleague relocating, retiring early, giving up medicine, private practice or curtailing services due to the medical liability crisis please email ROVSPA@aol.com. 1...Commentary 2....Washington Post Crisis Seen in Nation's ER Care - Capacity, Expertise Are Found Lacking 3....Philadelphia Inquirer Report: ER situation critical 4....MedPage Today U.S. Emergency Rooms Unprepared for Major Trouble 5.....Protect Patients Now June Newsletter 6.....National Center for Policy Analysis (NCPA) PHYSICIAN SHORTAGE LOOMS, RISKING A CRISIS, AS DEMAND FOR CARE EXPLODES 7....Reading Eagle We must change use of emergency system 8....The Evening Bulletin Physician Shortage 9.....Washington Post In U.S., Medical Visits Rose 31 Percent From 1994 to 2004 10.....Idaho Statesman Campaign helps reduce hospital deaths Valley hospitals participated in program that saved 122,300 lives nationally 11....Wilkes-Barre Times Tribune Hospitals campaign to save lives successful 12.....Accreditation Association for Ambulatory Health Care 13.....Daily Journal (Northeast Mississippi) Hill's agenda still full as AMA presidency ends 14.....Wall Street Journal Where Would You Rather Be Sick? 15.....Joint Commission on Accreditation of Healthcare Organizations Joint Commission Announces 2007 National Patient Safety Goals 16.....Channel 49 - ABC News Wristband prevents doctors from erring in the OR 17....Harrisburg Patriot News Reform ideas emerge from health care summit 18....Allentown Morning Call Letters Legal caps criticism is unfair to Santorum 19...Healthcare Professionals for Santorum SIGN UP TODAY 20....Favorite Websites 1....Commentary First, the bad news - America's Emergency Departments are seriously overburdened and on the verge of collapse AND there's an impending physician shortage at the time when the highest numbers of Americans ever will be entering their "golden years." Now, for the GOOD news - despite all of that and the many other ills which plague our health care system, physicians and hospitals in America are working together to improve the quality of care and reduce medical errors. AND, even though a recent report suggests that the Canadian health care system is superior to ours, the truth is that no health care system in the WORLD treats seriously ill people more successfully than the one we have right here in America. A couple of weeks ago, it was announced that death rates were down and that cancer survival rates were UP.... What the juxtaposition of these disparate pieces of information says to me is that America's doctors and nurses are STILL the best in the world and that they're STILL doing what they do better than anyone else no matter how many slings and arrows are aimed in their direction. (And there are PLENTY of slings and arrows....) Kind of makes me proud to be on their side, fighting for their ability to keep doing what they do so well....to take care of patients better than any other health care professionals in the world.... DBR 2....Washington Post Crisis Seen in Nation's ER Care Capacity, Expertise Are Found Lacking By David Brown http://www.washingtonpost.com/wp-dyn/content/article/2006/06/14/AR2006061402166.html Emergency medical care in the United States is on the verge of collapse, with the nation's declining number of emergency rooms dangerously overcrowded and often unable to provide the expertise needed to treat seriously ill people in a safe and efficient manner. That's the grim conclusion of three reports released yesterday by the Institute of Medicine, the product of an extensive two-year look at emergency care. Long waits for treatment are epidemic, the reports said, with ambulances sometimes idling for hours to unload patients. Once in the ER, patients sometimes wait up to two days to be admitted to a hospital bed. As a system, U.S. emergency care lacks stability and the capacity to respond to large disasters or epidemics, according to the 25 experts who conducted the study. It provides care of variable and often unknown quality and depends on the willingness of doctors and hospitals to lose large amounts of money. Fixing the problems is likely to cost billions of dollars and will require the leadership of a new federal agency, which Congress should create in the next two years, they wrote. "This is a crisis that could jeopardize everyone in this room, and all their loved ones," A. Brent Eastman, a surgeon and chief medical officer of the ScrippsHealth hospitals in San Diego, said at a daylong conference on the reports, which were prepared by the National Academy of Sciences' Institute of Medicine. "There is just such a gap between what the public knows, or thinks it knows, and the reality. And it is getting worse," said Robert B. Giffin, the Institute of Medicine staffer who headed the study. The reports -- on hospital ERs, on pediatric emergency care and on pre-hospital care given by ambulance services -- were embraced by the 24,000-member American College of Emergency Physicians, and its president said that the endorsement was telling. "What other industry says, 'Hey, look at us, our whole system is broken'?" said the group's president, Frederick C. Blum, a physician in Morgantown, W.Va. Two key steps for improving emergency care are regional planning and creating a standard way to measure outcomes, so that low-quality ERs and ambulance services can be identified and fixed, the committee wrote. Emergency medical care is a legal right for all Americans. Under a law enacted in 1986, emergency rooms must evaluate and stabilize anyone who shows up. That requirement -- bolstered by physicians' ethical duty to treat the ill -- has made hospital emergency departments subject to unique pressures. From 1993 to 2003, the U.S. population grew by 12 percent but emergency room visits grew by 27 percent, from 90 million to 114 million. In that same period, however, 425 emergency departments closed, along with about 700 hospitals and nearly 200,000 beds. ERs are notorious money losers. About 14 percent of ER patients are uninsured. About 16 percent are covered by Medicaid, the federal-state insurance program for the poor, and 21 percent by Medicare, the program for the elderly. More than half of hospitals report losing money on emergency care of both groups of government-insured patients. All of this has led to extreme bottlenecks in ERs, manifested by delays in every step of treatment, according to the reports. In 2003, 501,000 ambulances were diverted from the hospital where they normally would have delivered a patient because the ER was full. In 2004, 70 percent of urban hospitals reported that their emergency departments had been "on diversion" at least once. Nationwide, about 14 percent of ER patients end up admitted to the hospital. A study by the Government Accountability Office in 2003 found that 20 percent of emergency departments had to "board" patients in hallways or other temporary space, for an average of eight hours, before a bed opened. The American College of Emergency Physicians several years ago surveyed 90 emergency departments on a single Monday evening. Seventy-three percent reported that they had two or more patients boarding. A 2004 study found that ERs at university-based hospitals were classified as crowded 35 percent of the time, meaning all emergency beds were occupied, patients were in the hallways, the waiting room was full, and the waiting time for treatment was more than one hour. Another hazard largely unrecognized by Americans is that hospitals, especially in rural areas, often cannot find specialists such as orthopedic surgeons and neurosurgeons willing to cover the ER. In some cases, this is because doctors are unwilling to treat high-risk patients with complicated ailments, many of them uninsured, at inconvenient times. Sometimes it is simply a function of shortages. In 2002, there were fewer practicing neurosurgeons in the United States (about 3,000) than a decade earlier. Largely unknown is the human cost of these problems. Many studies have shown that high-stress, chaotic environments contribute to errors. One from 1991 showed that though relatively few "adverse outcomes" occur in the ER, it was the site of 70 percent of those attributable to negligence. The number of deaths caused by a delay in treatment or lack of expertise is especially uncertain, though it may not be small. San Diego established a trauma system in 1984 after autopsies of accident victims who died after reaching the ER suggested that 22 percent of the deaths were preventable, said Eastman, one of the Institute of Medicine committee members. Trauma care in many ways is the model on which the committee hopes the emergency care system will be rebuilt. Some states and urban areas have systems in which the level of trauma care every hospital is capable of providing is known and a centralized dispatching agency directs patients based on real-time information about each hospital's capacity and staffing. Although the vast majority of ER patients have not suffered trauma, about half need attention within an hour of arrival at the hospital, according to a study in 2003. Because not every hospital or even every city can provide all services, "the committee supports further regionalization of emergency care services," the authors wrote. Even without systemwide reform, hospitals can do many things to make the flow of patients more efficient and to be ready for predictable spikes in demand, said Benjamin K. Chu, an ER physician and regional president of a Kaiser Health Plan in California who was also on the expert panel. The report on ambulance service called for standardizing the training of paramedics and creating guidelines for pre-hospital care based on research. The report on pediatric care emphasized that 27 percent of ER patients are children and that many hospitals lack the expertise or the equipment to meet the needs of those who are critically ill. The District's emergency and trauma services measure up well. A report this year gave the city an A-plus in "its support of an emergency care system." Though the assessment was somewhat skewed by the District's compact geography and urban makeup, population-adjusted numbers showed more emergency departments, board-certified emergency doctors, hospital-staffed beds and trauma centers than in any state, and probably more than in many local jurisdictions, although the report did not look so narrowly. Still, the American College of Emergency Physicians noted, emergency services in the city "are regularly reaching their capacity, and patients are frequently and increasingly diverted to other facilities." In 2004, for example, Washington Hospital Center's ER was "on diversion" for nearly 2,100 hours. Howard University Hospital's ER turned away patients for the same reasons for almost 1,200 hours. Staff writer Susan Levine contributed to this report. 3....Philadelphia Inquirer Report: ER situation critical By Dawn Fallik http://www.philly.com/mld/inquirer/news/local/14820326.htm Overcrowded and underfunded, the nation's emergency medical-care system is broken, with patients waiting hours to see a doctor and days for a hospital bed, according to a national report released yesterday. In the first comprehensive national review in 40 years, the Institute of Medicine study found that 114 million people visited emergency rooms in 2003, up 26 percent from just a decade before. About 30 million of those were children. At the same time, 703 hospitals closed, including 14 in the Philadelphia region. Emergency-room admissions in the area are up about 15 percent, according to the Delaware Valley Healthcare Council. One ER, at Hahnemann University Hospital, reported an increase of almost 50 percent in patient visits since 2000. "If you're waiting four, eight, nine hours on a gurney, that's not the best way to take care of a patient who is ill," said Gail Warden, former head of the Henry Ford Health System and chair of the Institute of Medicine committee that conducted the study. The report looked at three main aspects of emergency care: emergency rooms, the emergency medical system, and pediatric emergency care. The institute, part of the National Academies of Science in Washington, said money would solve part of the problem. The panel suggested Congress allocate $50 million to reimburse hospitals for uncompensated services, and $88 million over five years to build a more efficient network to provide regional emergency care. An additional $37.5 million would go to pediatric emergency services for more equipment and training. But that would not solve the three main problems contributing to cramped emergency rooms: the aging of the baby boomers, the growing number of uninsured patients, and lack of access to primary doctors, Warden said. Hospitals have tried to play catch-up to the demand. Douglas McGee, an emergency-room physician at Albert Einstein Medical Center, said the hospital doubled its ER two years ago from 10,800 square feet to accommodate the patient load. "I distinctly remember about six years ago we were absolutely full, the waiting room was full and we were on EMS diversion and they brought us a cardiac arrest and we had to unload him and resuscitate him on the floor," said McGee, who is also past president of the Pennsylvania chapter of the American College of Emergency Physicians. The Einstein ER sees about 70,000 patients a year, and while the current space is sufficient, he said, the numbers have grown as much as 10 percent a year for the last decade, he said. On average, patients wait about seven hours for a hospital bed and about 30 minutes to see a doctor, he said. Across the region, the numbers are similarly bulging. At Hahnemann University Hospital, there were 33,903 emergency-room visits in 2005, an increase of 50 percent from just five years ago. At Temple University Hospital, 97,856 people went to the ER last year, up 31 percent from 2001. C. William Schwab, chief of trauma at the Hospital of the University of Pennsylvania, was on the Institute of Medicine committee and said hospital-based emergency care was "at the breaking point." Too many people see the emergency room as their main point of care, he said. Some are without insurance, but Schwab also blamed the primary-care system's lack of access. "We have the workday, and then we have all the other hours," he said. "There are three choices: Either wait and see them, evaluate them over the phone and call in a prescription, or send them to the emergency room." Daniel Duffy, the executive vice president for the American Board of Internal Medicine, said that patients definitely had more difficulty getting appointments to see primary-care doctors. But he added that emergency rooms can handle things that primary-care doctors cannot. About half of the people who come through emergency-room doors are considered "urgent," meaning they require lifesaving intervention, the report says. And many whose needs are not urgent wait. Nancy Bonalumi, head of the Emergency Nurses Association and director of emergency and trauma nursing at the Children's Hospital of Philadelphia, said it was not unheard of to wait five hours for an earache. The hospital saw 75,000 pediatric patients in its emergency room last year, an increase of 3 percent from last year. "If we're filled with true emergencies, with children who have been hit by cars and who are critically ill, they're going to get care before the child with the earache," she said. ONLINE EXTRA See more from the Institute of Medicine, from child health to the elderly, via http://go.philly.com/medi 4....MedPage Today U.S. Emergency Rooms Unprepared for Major Trouble By Jeff Minerd, Staff Writer Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine June 15, 2006 Also covered by: Boston Globe, MSNBC, USA Today http://www.medpagetoday.com/EmergencyMedicine/EmergencyMedicine/tb/3558 WASHINGTON, June 15 — The nation's emergency care system is woefully ill-prepared to handle a natural disaster, disease outbreak, or terrorist attack, according to three reports released by the Institute of Medicine today. "With hospitals in many large cities operating at or near full capacity, even a multiple-car highway crash can create havoc in an emergency department," warned the authors of the reports, led by Gail Warden, M.H.A., president emeritus of the Henry Ford Health System in Detroit. "A major disaster with many casualties is something that many hospitals have limited capacity to handle." One report focused on hospital-based emergency care, another on pediatric emergency care, and the third on challenges to the nation's emergency service system overall. Collectively, the reports are titled The Future of Emergency Care. Key problems discussed in the reports include the following: Overcrowding Demand for emergency care grew by 26% between 1993 and 2003, but at the same time the nation lost 425 emergency departments and 198,000 hospital beds, according to the report Hospital-Based Emergency Care: At the Breaking Point. "The result has been serious overcrowding," the report said. This can lead to the practice of "boarding" patients-holding them in the emergency department, often in beds in hallways, until an inpatient bed becomes available. It is not uncommon for patients to be boarded for 48 hours or more, the report said. Another consequence of overcrowding has been an increase in the number of ambulances diverted away from an emergency department that is full and sent to one farther away. "Once considered a safety valve to be used only in the most extreme circumstances, such diversions are now commonplace," the report said. Ambulances are diverted half a million times each year-an average of almost once every minute, according to the report. "Each diversion adds precious minutes to the time before a patient can be wheeled into an emergency department and be seen by a doctor, and these delays may in fact mean the difference between life and death for some patients," the report said. Fragmentation There are neither national standards for training emergency medical service personnel nor any national accreditation of the institutions that train them, according to the report Emergency Medical Services at the Crossroads. In addition, federal oversight of the emergency care system is scattered across multiple federal departments, including Health and Human Services, Transportation, and Homeland Security, the report said. "Because responsibility for the system is so fractured, it has very little accountability. In fact, it can be difficult even to determine where system breakdowns occur and why," the report said. Lack of Disaster Preparedness Few hospital and emergency medical service personnel have received even minimal training in how to respond to a natural disaster or terrorist attack, the report authors said. In addition, most emergency departments lack the equipment and supplies necessary to deal with such an event. They also lack protective equipment to keep first responders to a natural disaster or terrorist attack safe, they said. The authors blame this lack of preparedness on scanty funding. They point out that, of the $3.38 billion distributed by Homeland Security for emergency preparedness in 2002 and 2003, only 4% went to emergency service providers. "In general, of the billions of federal dollars being spent on disaster preparedness, only a tiny fraction is spent on medical preparedness, and much of that is focused on one of the least likely threats-bioterrorism," the authors said. Other Problems Few emergency departments are adequately supplied and staffed to treat children, according to the report Emergency Care for Children: Growing Pains. For example, only 6% of emergency departments have all the supplies necessary for handling pediatric emergencies, and only about half of departments had at least 85% of the essential supplies, the report said. In addition, many emergency departments, particularly those in rural areas, lack doctors and nurses with specialized pediatric training, the report said. Finally, emergency departments suffer from a shortage of other on-call specialists, such as neurosurgeons, the authors said. Many specialists find the demands of providing on-call emergency services disruptive to their regular practices and family life, and the insurance premiums are prohibitively high, they said. To achieve this, the various components of the system-9-1-1 and dispatch, ambulances and EMS workers, hospital EDs and trauma centers, and the specialists supporting them-must be able to communicate continuously and coordinate their activities. Key recommendations the authors made include:
Primary source: Institute of Medicine 5.....Protect Patients Now June Newsletter Emergency in the ER Volume 1, Issue 2 June, 2006 {}Three reports released by the Institute of Medicine detail a nationwide crisis in Emergency Care, and recommend that Congress pass medical liability reform to help alleviate the shortage of on-call physicians available to treat patients suffering a medical emergency. You can read NPR’s compelling report, “‘Study: Emergency Rooms at Breaking Point” describing the mounting ER crisis. Dr. Patrick O’Neal gives an account of his frantic search for an ER to treat a child who sustained head trauma. “‘The first hospital -- which was the closest -- we radioed and indicated what we had,’ O'Neal recalls. ‘We were told that they were on diversion because they did not have a neurosurgeon available." Specialists have begun avoiding emergency-room duty because many uninsured patients can't pay, and because of the cost of malpractice insurance. Diverted from a second ER they finally found one that would admit them….45 minutes away. Read the full story here. Study: Emergency Rooms at 'Breaking Point' by Joanne Silberner All Things Considered, June 14, 2006 · The Institute of Medicine released three reports Wednesday on emergency medical care in the United States. The reports describe a system working far past capacity and plagued by long waits and serious crowding. Dr. Patrick O'Neal in Atlanta knows the problems firsthand. He is medical director of Georgia's Emergency Medical Services office. Several years ago, he was in an ambulance carrying a child who had lost consciousness after a bad fall. O'Neal was anxious. A bleed within the brain would require immediate treatment, but he couldn't get into the nearby emergency room. "The first hospital -- which was the closest -- we radioed and indicated what we had," O'Neal recalls. "We were told that they were on diversion because they did not have a neurosurgeon available." Specialists have begun avoiding emergency-room duty because many uninsured patients can't pay, and because of the cost of malpractice insurance. "We radioed the next-closest available facility and we were told that they had no spaces left in the emergency department where they could even evaluate patients," O'Neal says. The third hospital was a 45-minute drive away. After a tense ride, the exam there showed no bleeding within the skull. "We were lucky," O'Neal says. "But you're not always lucky." At a press conference today, one of the reports' authors, trauma surgeon Brent Eastman, said that type of incident can happen to any patient. "Because of long waits and crowded EDs, the ambulance may get there and not be able to offload and you," Eastman says. "You will be diverted." An incident such as this occurs once every minute, every hour, every day in the United Sates, Eastman says. If a patient isn't diverted somewhere else, crowding can lead to waits of as long as two days. The emergency medical services or EMS transport system itself has problems. Shirley Gamble of the United Way of Austin, Texas, says people are misinformed if they think things will go smoothly once they call an ambulance. "Most of us think about TV shows and imagine EMS coming in, immediately saving your life and getting you to the hospital without any barriers to success," Gamble says. "That's not the case." Other barriers include ambulance services in neighboring communities that can't or won't communicate with one another; inadequate ambulance coverage in rural areas; and no national training standards for emergency medical technicians. The system is so uneven that heart attack survival with one emergency medical transport service can be ten times worse than with another. Marianne Gausche-Hill of Harborview-UCLA Medical Center says there's a crisis for children in the ER as well. "There's over 110 million emergency department visits in the United States every year, of which 30 million visits are with children,” Gausche-Hill says. Yet only 6 percent of emergency departments are fully equipped to deal with children. The report calls for better coordination of hospitals and transport systems, a single government agency to oversee emergency medical care, an end to emergency room closures and diversions, and $50 million for hospitals that see a lot of uninsured patients. Many of the reports' authors say that emergency rooms are victims of their own success. There have been no catastrophic failures so the public hasn't noticed that the system is at the breaking point. The authors say public perception will change if something comes along to overload the system -- like pandemic flu, a bioterrorism attack or another major hurricane. Related NPR Stories
PHYSICIAN SHORTAGE LOOMS, RISKING A CRISIS, AS DEMAND FOR CARE EXPLODES Daily Policy Digest - HEALTH ISSUES http://www.ncpa.org/newdpd/dpdarticle.php?article_id=3448 Twelve states, including California, Texas and Florida, report some physician shortages now or expect them within a few years, says the Los Angeles Times. The shortages are putting pressure on medical schools to boost enrollment, and on lawmakers to lift a cap on funding for physician training and to ease limits on immigration of foreign physicians, who already constitute 25 percent of the white-coated workforce. Consider:
Source: Lisa Girion, "Physician Shortage Looms, Risking a Crisis, as Demand for Care Explodes," Los Angeles Times, June 4, 2006. For text (subscription required): http://www.latimes.com/business/la-fi-doctors4jun04,0,7252831,full.story For more on Health: 7....Reading Eagle We must change use of emergency system June 22, 2006 http://www.readingeagle.com/blog/editorials/archives/2006/06/we_must_change.html The Issue: One report praises hospitals for cutting down on medical errors, while another warns of the dire condition of emergency medicine. Our Opinion: We must change the way we use our health-care system, just as the hospitals are changing procedures to cut down on medical errors. More than 3,000 hospitals across the country were praised last week by the Institute of Health for altering procedures to cut down on medical errors. The same day the Institute of Medicine released a report indicating the nation’s emergency-care system is in crisis. The facilities that were recognized for changing their procedures included Reading Hospital and St. Joseph Medical Center, which is good news indeed. A 1999 study indicated that between 44,000 and 98,000 patients died annually as a result of care-related errors. That prompted many facilities to examine their practices and make changes that have been credited with saving an estimated 122,300 lives nationwide in less than two years. “Does it mean there no longer are any errors?” Dr. Gerald P. Malich, medical director at Reading Hospital, asked rhetorically. “No, but there is a significant improvement.” And that was one of the issues that was in the forefront of the crisis that revolved around medical-liability insurance in the commonwealth. Doctors and hospitals were complaining about the high cost of malpractice insurance, while lawyers and insurance companies complained that no effort was being made to correct errors. Certainly the reduction in errors is not going to have an immediate impact on malpractice-insurance rates, but if maintained over the long haul, it will result in fewer lawsuits, lower premiums and, most important, better care for patients. ((Pie in the sky assumption - there's VERY little correlation between medical errors and lawsuit filings and/or payouts - in fact, a recent study showed that 40% of suits filed were groundless....it IS annoying, though, to keep hearing and reading the comments of tort reform opponents who say that hospitals and doctors have done "nothing" to reduce medical errors or improve patient safety...)) But the good news may have been overshadowed by the institute report on emergency rooms, which indicated that hospitals barely are able to handle the day-to-day emergencies, let alone what would result from a bird-flu pandemic or a terrorist strike. The study found 114 million people visited emergency rooms in 2003, an increase of 26 percent from a decade earlier. Only about half of those were true medical emergencies. During the same 10 years, 425 emergency rooms closed, that includes the one at the former Community General Hospital, which closed in 1997. Since Reading Hospital opened its trauma center, emergency-room visits have jumped from 231 a day to 275 a day — a 19 percent increase, according to Dr. Charles F. Barbera, chairman of emergency medicine at Reading. Dr. Sam Alfano, vice president of medical affairs at St. Joseph, said that facility is expecting to see 50,000 people in its emergency department this year, an increase of 13 percent in three years. Many of these patients don’t have access to a family physician because they are uninsured or on medical assistance, Alfano said, and many doctors will refuse to see them. Emergency rooms cannot do that. By law, anyone who goes to an emergency room seeking help must be seen, no matter how minor the problem. Barbera said many emergency-room visits are a result of social problems, such as elderly who have nowhere to go, so they go to a hospital until a room opens at a nursing home. The report recommended Congress set aside $50 million to reimburse hospitals for uncompensated services. That would help, but Congress must address reimbursement for medical-assistance patients. Reimbursements must cover the cost of treatments so that doctors and hospitals are not donating their services every time they see an indigent patient. Also education is important. People must learn that they should not go to an emergency room to get a doctor’s note indicating they are well enough to return to work or school. “It happens often,” Barbera said. Posted by readingeagle at June 22, 2006 01:00 AM 8....The Evening Bulletin Physician Shortage By: Andrew Miller 06/21/2006 If physicians continue to leave, then there will ultimately be a substantial increase in the workload for the remaining physicians in Pennsylvania. ((There already IS, in many specialties and in some regions....)) And if these physicians are not the "best and brightest" as Dr. Piasio mentioned, further cases of medical malpractice may be expected. Additionally, with the baby boomer generation entering their golden years, there is an increased demand for services and a shortage of high-risk specialties, particularly in Pennsylvania. "Hospitals are having trouble covering certain specialties" Dr. Frederick described. "Even then, high-risk specialties are less inclined to perform operative procedures depending on the patient and the circumstances."
9.....Washington Post In U.S., Medical Visits Rose 31 Percent From 1994 to 2004 Saturday, June 24, 2006 http://www.washingtonpost.com/wp-dyn/content/article/2006/06/23/AR2006062301546.html Americans are seeking medical care in greater numbers than ever before, with the number of visits growing at nearly three times the rate of population growth, according to government statistics published yesterday. People made more than 1 billion visits in 2004 to doctors' offices, emergency rooms and hospital outpatient departments, according to the report from the National Center for Health Statistics This is an increase of 31 percent from 10 years before, while the population grew only 11 percent during the same time, according to the center, part of the Centers for Disease Control and Prevention. Nearly half of the 1.1 billion visits were to primary-care doctors in office-based practices. Another 18 percent were to medical specialists, and 16 percent were to surgical specialists. Ten percent were to emergency departments. Medicaid patients, those with no health insurance and charity cases used hospitals more, and the average waiting time at emergency rooms, which by federal law must take in everyone who comes, increased significantly, the report found. "The amount of time a patient waits before seeing a physician in the emergency department increased from 38 minutes in 1997 to 47 minutes in 2004," the CDC said. "There was no change in the average time -- about 16 minutes -- a patient spends face to face with a doctor in an office visit," the report said. The most common diagnosis was high blood pressure, seen in 42 million visits, the CDC said. Diagnoses of diabetes rose by 117 percent, and diagnoses of spinal disorders rose by 94 percent. 10.....Idaho Statesman Campaign helps reduce hospital deaths Valley hospitals participated in program that saved 122,300 lives nationally MIKE STOBBE 6/16/06 http://www.idahostatesman.com/apps/pbcs.dll/article?AID=/20060616/NEWS02/606160358/1029 Seven years ago, a report said medical errors nationwide were killing the equivalent of a jet plane full of people each day. Today, many of those needless deaths are being prevented by procedures that 3,100 hospitals across the nation put in place — including four hospitals in the Treasure Valley, officials said this week. Two Boise hospitals — Saint Al's and St. Luke's Regional Medical Center — joined the effort. So did West Valley Medical Center in Caldwell and Mercy Medical Center in Nampa. "(The processes) intuitively make sense, but it is building the processes so ... they happen regularly and consistently," said Aline Lee, director of patient safety and regulatory compliance at Saint Al's. Medical mistakes were the focus of a widely noted 1999 national report that estimated 44,000 to 98,000 Americans die each year from errors. Perhaps the best known of the six changes was to deploy rapid-response teams for emergency care of patients whose vital signs suddenly deteriorate. Another change urged checks and rechecks of patient medications to protect against drug errors. A third focused on preventing surgical site infections by following certain guidelines, including giving patients antibiotics before their operations. "What the campaign did was to focus efforts and give us some guidance on how to save these lives," said Deb Compton, patient safety manager at St. Luke's. "That's what we wanted. We wanted some guidance." 11....Wilkes-Barre Times Tribune Hospitals campaign to save lives successful BY JEFF SONDERMAN http://thetimes-tribune.com/site/index.cfm?newsid=16792936&BRD=2185&PAG=461&dept_id=415898&rfi=8 U.S. hospitals saved an estimated 122,300 patient lives in an 18-month campaign to improve safety and reduce unnecessary deaths and lethal errors, organizers said Wednesday. The toll exceeded the goal of the “100,000 Lives Campaign” organized by the Cambridge, Mass.-based Institute for Healthcare Improvement.
12.....Accreditation Association for Ambulatory Health Care 05/03/2006 WILMETTE, Ill. -- Increasing numbers of outpatient healthcare providers are involved in programs for reporting medical errors or adverse events, with the vast majority having adopted strategies to prevent four of the most well known and potentially serious types of events. This is the finding of a newly published special report on medical event reporting systems (MERS) by the AAAHC Institute for Quality Improvement (AAAHC Institute), a subsidiary of the Accreditation Association for Ambulatory Health Care (AAAHC). The four types of events explored within the 2005 study report, Medical Event Reporting and Prevention in the Ambulatory Health Care Setting, and the percentage of organizations that have policies in place to prevent them and techniques for avoiding them, include: -- Nearly all (99 percent) outpatient medical treatment organizations have policies or procedures to avoid prescribing or administering a drug to a patient with a known allergy. Successful techniques appear to include checking for allergies/vital signs at every visit and not relying solely on chart stickers. -- Nearly all (97 percent) have policies or procedures to prevent wrong-site surgery, including a "time out" before surgery, the physician and patient signing or marking the site and a witnessed patient affirmation of the site. Physician and redundant patient confirmation seems to be most effective in preventing this event. -- Nearly all (97 percent) have policies or procedures to prevent surgical site infection. The three most commonly cited prevention techniques are antibiotic prophylaxis, scope/instrument cleaning and topical antibiotic at the surgical site. -- Most (88 percent) have policies or procedures to ensure that abnormal test results are communicated to patients. Successful techniques include using order logs, not just result logs, to ensure that patients receive results. Of the more than 900 AAAHC-accredited organizations that responded to the AAAHC Institute survey, those with MERS increased to 45 percent (from 33 percent in 2001). |