Nebraska hospital changes status in Sanford system

From Modern Healthcare:

West Holt Memorial Hospital, an 18-bed facility in Atkinson, Neb., will see its designation with the Sanford Health system changed from “associate” to “managed,” effective Oct. 1.Under the arrangement, West Holt CEO Michael Coyle will become a Sanford employee, and the system will provide assistance in daily operations and provide purchasing and other services at a reduced fee to the hospital, a news release said.

The release added that the local West Holt board of directors will “remain in full control” of hospital operations and that the change is being made to provide stability and to take advantage of the reduced fees in order to be more competitive. The hospital is part of West Holt Medical Services, which includes the hospital, two clinics and a retail pharmacy.

Sanford Health is a Sioux Falls, S.D.-based system that owns eight hospitals, leases seven and, come Oct. 1, will manage nine. West Holt has had the Sanford “associate” designation since June 1, 2000, and is currently the only Sanford facility in that category.

Impact of Hypothermia (below 36°C) in the Rural Trauma Patient

From the Journal of the American College of Surgeons:

Hypothermia is an independent predictor of mortality based on urban studies. But this association has not been described in the rural setting. This study’s purpose was to evaluate hypothermia as a cofactor to mortality, complications, and hospital length of stay (LOS) parameters in the rural trauma setting.

Study Design

The National Trauma Registry of the American College of Surgeons database for our rural, Level I trauma center was queried for a 5-year period (July 2002 to June 2007) to identify adult trauma patients. Multivariate regression models were used to evaluate the association of hypothermia with mortality; infectious complications; organ dysfunction; and, among survivors, hospital LOS parameters.

Results

Of 9,482 adult patients admitted, 1,490 (15.7%) patients were hypothermic. Hypothermia had an adjusted odds ratio of 1.70 for mortality (95% CI, 1.35 to 2.12; p < 0.001). After controlling for covariates, hypothermia was not significantly associated with infectious complications or organ dysfunction, except for arrhythmia (adjusted odds ratio, 1.40; CI, 1.03 to 1.90; p = 0.031). Hypothermia was not associated with a difference in ICU (p = 0.310) or ventilator (p = 0.144) LOS. But a slight increase in hospital days was noted in the hypothermic patient (hazards ratio, 0.890 for discharge; 95% CI, 0.838 to 0.946; p < 0.001).

Conclusions

Hypothermia is a common problem at admission in a rural trauma center. It is associated with an increase in hospitalized days but not with increased ICU or ventilator days among survivors. Other than arrhythmias, it was not significantly associated with other National Trauma Registry of the American College of Surgeons infectious or organ dysfunction complications. Hypothermia is an independent risk factor for mortality in the rural trauma patient.

First Person Account of H1N1 from CNN’s Dr. Gupta

From CNN:

It started as a cough.

It wasn’t the kind of cough where something is temporarily stuck in your throat. It wasn’t the kind of cough where simply clearing your throat would’ve been adequate. This was the kind of cough that hurts when you do it. A stinging pain that makes you wince and guard and hope that you don’t have to cough again any time soon.

I thought I might have a fever, but of course, I was in the middle of covering a war in Afghanistan, and the conditions were … well, hot. So, maybe it was that.

Problem was, the next day I wasn’t feeling any better — in fact, I was worse. I woke up in my dusty desert tent and tried to step out of my sleeping bag. Two steps later, I almost hit the deck. Incoming. Except this wasn’t due to any sirens going off, this was due to my own body simply being unable to hold myself up. I was lightheaded and freezing cold — even though it was over 100 degrees outside at that early hour of the morning.

Rationing?

From Newsweek:

With concerns over health-care rationing reaching near-hysterical levels, imagine this scenario in an ER in the not-too-distant future. A 4-year-old suffers minor head trauma, perhaps from falling off a swing and hitting her head on the ground. She is dazed, and although she doesn’t lose consciousness her worried parents—visions of subdural hematomas and concussion dancing in their own heads—rush her to the local emergency room, expecting that the doctors there will immediately do a CT scan.

Surprise. The ER intake nurse talks to the child, who is able to say her name and explain what happened in the playground. She did not lose consciousness, her mother (who witnessed the fall) tells the nurse. The little girl is not vomiting, the ER doctor determines that there are no signs of fracture of the base of her skull, and she does not have a severe headache. Verdict: no CT scan.

In a more innocent age, the parents might have been puzzled, but accepting. What do you want to bet that, whatever happens to health-care reform (since the nation will continue to struggle with skyrocketing medical costs), in the current climate of rationing fears, they will be suspicious, even furious, believing that their child is being denied proper medical care for some nefarious economic reason? Yet the conclusion that children with head injuries do not necessarily need a CT scan—and that such scans expose them to high levels of cancer-causing radiation for no benefit—is supported by the largest study of its kind.

The nature and causes of unintended events reported at ten emergency departments

From BMC Emergency Medicine:

Background

Several studies on patient safety have shown that a substantial number of patients suffer from unintended harm caused by healthcare management in hospitals. Emergency departments (EDs) are challenging hospital settings with regard to patient safety. There is an increased sense of urgency to take effective countermeasures in order to improve patient safety. This can only be achieved if interventions tackle the dominant underlying causes. The objectives of our study are to examine the nature and causes of unintended events in EDs and the relationship between type of event and causal factor structure.

Methods

Study at EDs of 10 hospitals in the Netherlands. The study period per ED was 8 to 14 weeks, in which staff were asked to report unintended events. Unintended events were broadly defined as all events, no matter how seemingly trivial or commonplace, that were unintended and could have harmed or did harm a patient. Reports were analysed with a Root Cause Analysis tool (PRISMA) by an experienced researcher.

Results

522 unintended events were reported. Of the events 25% was related to cooperation with other departments and 20% to problems with materials/equipment. More than half of the events had consequences for the patient, most often resulting in inconvenience or suboptimal care. Most root causes were human (60%), followed by organisational (25%) and technical causes (11%). Nearly half of the root causes was external, i.e. attributable to other departments in or outside the hospital.

Conclusions

Event reporting gives insight into diverse unintended events. The information on unintended events may help target research and interventions to increase patient safety. It seems worthwhile to direct interventions on the collaboration between the ED and other hospital departments.

Business Week’s Take on Tort Reform

From Business Week:

President Barack Obama tapped into a large vein of public support when he suggested recently that he is open to reforming medical malpractice laws. It’s common currency in the U.S. that litigation drives medical inflation by forcing doctors and hospitals to resort to “defensive medicine,” overtreating patients to avoid lawsuits.

The evidence suggests a much smaller effect. Study after study shows that costs associated with malpractice lawsuits make up 1% to 2% of the nation’s $2.5 trillion annual health-care bill and that tort reform would barely make a dent in the total.