Too many avoidable errors in patient care, says report [Press release]

From the 8 March 2016 Imperial College London press release

Excerpts

by Kate Wighton

Avoidable harm to patients is still too high in healthcare in the UK and across the globe.

Safety therefore must be a top healthcare priority for providers and policy makers alike.

These are the findings of two reports launched today by researchers from Imperial College London.  Both reports, produced by NIHR Imperial Patient Safety Translational Research Centre (PSTRC), provide evidence on the current state of patient safety and how it could be improved the future.  They urge healthcare providers to embrace a more open and transparent culture to encourage continuous learning and harm reduction.

…

The first report focuses on the current system used by NHS staff to report patient safety incidents, called the National Reporting and Learning System (NRLS). The report authors explain this system requires refinement and renovation, so as to take advantage of new technologies and recent behavioural insights. For example app-based technologies offer a simplified platform that engages staff in the incident reporting process. This will not only improve the ease of reporting, but also the accuracy of data reported.

In particular, the report reiterates problems around under-reporting of safety incidents, and reveals structural concerns within the NRLS, that have inhibited its usefulness as a tool to drive safety improvement.

…

The second report, Patient Safety 2030, suggests a ‘toolbox’ for patient safety. This would include: using digital technology to improve safety; providing robust training and education, and strengthening leadership at the political, organisational, clinical and community levels. Other points in the ‘toolbox’ include effective and high-quality education and training; strengthening measurement methods, including incident reporting, and exploring new digital solutions.

However, the authors warn that interventions implemented to reduce avoidable patient harm must be engineered with the whole system in mind, and empower patients and staff to become more involved in preventing harm and improving care.

Ultimately, both reports issue a global call-to-action on patient safety: both for individual health systems to convert the evidence on how to improve patient safety into everyday practice, and for the global community of health systems to share learnings from each other’s successes and failures.

The publications: “NRLS Research and Development Final Report”, funded by NHS England, will be presented on March 8th at the Royal Society in London. The “Patient Safety 2030”, funded by a grant from the Health Foundation, an independent charity committed to bringing about better health and healthcare for people in the UK, will be presented on March 9th at the Patient Safety Global Action Summit 2016.

Precision medicine is ‘personalized, problematic, and promising’

Precision medicine is ‘personalized, problematic, and promising’.
From the  10 July 2015 University of Pennsylvania news release

Since President Barack Obama’s State of the Union Address in January 2015, the nation has been talking about a revolution in patient care, known by many as precision medicine.

Of course, the country is used to hearing the president talk about health care, especially the Affordable Care Act. But when the White House starts launching $215 million initiatives to accelerate research—in this case, the Precision Medicine Initiative, according to a White House Press release—you can be sure it’s not just a passing fad.

First, what is precision medicine?

Precision medicine is about tailoring treatments to the patient’s genome and body function. The promise is that this detailed personal health data can determine what’s most effective for each individual, which can lead to better outcomes.

Most of precision medicine’s application currently focuses on cancer. Launched in 2013, Penn Medicine’s Center for Personalized Diagnostics (CPD) helps oncologists determine the best treatment for their cancer patients by looking at the cancer’s genome.

Here’s how precision medicine is being practiced at Penn:

1. A patient is diagnosed with cancer.
2. If the cancer involves a solid tumor—like breast, lung, or colon cancer—the tumor is surgically removed during a biopsy, and a chunk of the tissue is sent to Penn Medicine’s CPD. If the cancer involves blood or bone marrow—like leukemia—a sample of the blood or bone marrow is sent.
3. The CPD sequences a panel of genes that are known to be involved in cancer. This test examines DNA within the tumor, blood or bone marrow sample. The goal is to find DNA mutations that are driving the cancer.
4. A report on the mutations found is sent to the patient’s oncologist.
5. The oncologist determines if there are therapies or treatments available that work better than others—or not at all—on the patient’s particular type of cancer.

“We’re using precision medicine to give patients the right drugs, guided by the DNA sequence information from their cancer, so we’re not exposing them to potentially toxic effects,” explains David Roth, MD, PhD, director of the CPD. “This individualized therapy is better than treatment based on the ‘average patient.’”

Precision Medicine is being researched, translated and applied across Penn Medicine. Here,
experts from the Center for Personalized Diagnostics share four predictions on how precision medicine will change how cancer is treated in future generations.

1. Cancer will be diagnosed earlier.

Jennifer Morrissette, PhD, clinical director of the CPD:

“There are different stages of tumors. The earlier you catch the tumor, the more likely you are to survive it. My theory is that this century will be the century of diagnostics. We will be diagnosing people’s cancers earlier and earlier.

“That way, we are not dealing with advanced metastatic tumors that have acquired so many different changes that they’re hard to treat. We’ll be capturing tumors very early, in stage one; have a definitive surgery; follow the patient for a certain number of years to make sure that the cancer hasn’t spread; and then they’ll be cured.

“Some people put off seeing a physician because they don’t want chemo, but the longer they put it off, the more likely they are going to have metastatic disease.”

2. Cancer treatment will be based on each person’s health profile.

David Roth, MD, PhD, director of the CPD:

“[In the past,] doctors had been treating [the average patient] based upon results from a large study.

“The revolution in precision medicine is that now we have better tools to understand what’s going on with you as an individual. Instead of saying, ‘Okay, you have this particular cancer, and you have a 30 percent chance. So, go ahead and get this toxic therapy,’ we can be much more specific.

“If we were able to tell you that you have a five percent chance of responding to a chemotherapy based on the makeup of your tumor, would you still do it?”

3. Gene paneling will be used for diagnosis, not just treatment.

David Lieberman, MS, CGC (certified genetic counselor):

“We tend to see certain genes mutated in certain cancers. For example, there is a certain set of
genes [that are] typically mutated in lung cancer or another set in lymphoma.

“It is not always clear using historical methods what type of cancer a patient has. This makes treatment decisions challenging. Sequencing the tumor’s DNA on a panel of known cancer-related genes may help clarify the cancer’s origin and, in this way, assist the clinician in determining treatment or prognosis.”

$215 million: The amount the White House will invest in the Precision Medicine Initiative in 2016
Source: WhiteHouse.gov

4. More cancer patients will have a treatment team, rather than just an       oncologist.

Jennifer Morrissette PhD, clinical director of the CPD:

“It’s not going to be one physician making all the decisions. Cancer treatment has gotten much more complex. Because of the availability of multi-gene testing, you need a group of people with different types of expertise to make the best decision for a patient.

“In addition to the team directing care for the appropriate approach—whether it’s surgery, radiation, chemotherapy, pain management—now there is also the genetic component.

“[The team’s] able to sit in a room with people from the lab who can talk about what the result means, have the oncologist tell them about the patient and then get the clinical geneticist’s notion that there may be an inherited predisposition. Then, they walk out with a consolidated treatment plan for that patient.”

The future of medicine

For more than 250 years, advancements like “precision medicine” have been the hallmark of Penn Medicine. As the first school of medicine in the United States, it has been and continues to be a place where the future of medicine and the future leaders in medicine are being developed.

[Reblog] The hospital that will remain nameless

One person’s journey through an unhealthy health care system.  Definitely not patient centered. Have had similar insurance problems, mostly because of errors in the insurance company erring in my personal identifiers.

From the 19 February 2015 item  By LISA SUENNEN at The Health Care Blog

Let me start this story by telling you the end: I am just fine. For those of you who like me, there is nothing to worry about and all is well. For those of you who don’t like me, sorry to disappoint you, but you’re stuck with me for a while.

I’m telling you these things—news to make you happy or disappointed, depending on your point of view about me—because this story is about my recent trip to the hospital, an unexpected journey that I wasn’t sure I was going to talk about publicly.

…

And from one of the comments…

William Palmer MD says:

February 19, 2015 at 9:45 pm

You sound true and authentic to me too. I am embarrassed as to how often we do screw up. The only excuse I think is that we have so much internal and external regulation that we become nervous nellies, unable to relax and enjoy what we are doing. You should go to a Pharmacy and Therapeutics meeting in a hospital and listen to the barrage of complaints from everyone to everyone. Wrong dose, wrong timing, wrong drug, wrong patient. I have walked out of these meetings because of the hostility. We would all do better if we could start some little village clinic in the Congo, without the interminable watching from a thousand eyes.

Related articles

• Experts warn 2015 could be ‘Year of the Healthcare Hack’

[News]Checklist devised to spot elderly patients most at risk of death — ScienceDaily

Checklist devised to spot elderly patients most at risk of death — ScienceDaily.

English: An elderly patient at St. Elizabeths Hospital in Washington, D.C. (Photo credit: Wikipedia)

Excerpt

Date:January 22, 2015

Source:BMJ-British Medical Journal

Summary:A checklist has been designed to spot elderly hospital patients likely to die within the next three months, a new article outlines. The researchers emphasize that the checklist is not intended to substitute healthcare for the elderly who are terminally ill. Instead, it is meant to “provide an objective assessment and definition of the dying patient as a starting point for honest communication with patients and families about recognizing that dying is part of the life cycle.”

From the journal article

Related articles

• Australian doctors devise checklist to spot elderly patients most at risk of death
• Full checklist that makes up the ‘death test’
• Death test predicts chance of dying within 30 days
• Hospitals Giving ‘Death Test’ to Seniors
• Controversial assisted dying Bill giving some patients right to die will not be passed before the election
• Should D.C. Approve ‘Death with Dignity’?
• California lawmakers propose physician aid-in-dying law

[Press Release] Efforts to improve patient safety result in 1.3 million fewer patient harms, 50,000 lives saved and $12 billion in health spending avoided

#172216716 / gettyimages.com

Efforts to improve patient safety result in 1.3 million fewer patient harms, 50,000 lives saved and $12 billion in health spending avoided

From the US Health and Human Services press release

Hospital-acquired conditions decline by 17 percent over a three-year period

A report released by the Department of Health and Human Services today shows an estimated 50,000 fewer patients died in hospitals and approximately $12 billion in health care costs were saved as a result of a reduction in hospital-acquired conditions from 2010 to 2013.  This progress toward a safer health care system occurred during a period of concerted attention by hospitals throughout the country to reduce adverse events. The efforts were due in part to provisions of the Affordable Care Act such as Medicare payment incentives to improve the quality of care and the HHS Partnership for Patients initiative.  Preliminary estimates show that in total, hospital patients experienced 1.3 million fewer hospital-acquired conditions from 2010 to 2013.  This translates to a 17 percent decline in hospital-acquired conditions over the three-year period.

“Today’s results are welcome news for patients and their families,” said HHS Secretary Sylvia M. Burwell. “These data represent significant progress in improving the quality of care that patients receive while spending our health care dollars more wisely.  HHS will work with partners across the country to continue to build on this progress.”

Today’s data represent demonstrable progress over a three-year period to improve patient safety in the hospital setting, with the most significant gains occurring in 2012 and 2013. According to preliminary estimates, in 2013 alone, almost 35,000 fewer patients died in hospitals, and approximately 800,000 fewer incidents of harm occurred, saving approximately $8 billion.

Hospital-acquired conditions include adverse drug events, catheter-associated urinary tract infections, central line associated bloodstream infections, pressure ulcers, and surgical site infections, among others.  HHS’ Agency for Healthcare Research and Quality (AHRQ) analyzed the incidence of a number of avoidable hospital-acquired conditions compared to 2010 rates and used as a baseline estimate of deaths and excess health care costs that were developed when the Partnership for Patients was launched. The results update the data showing improvement for 2012 that were released in May.

“Never before have we been able to bring so many hospitals, clinicians and experts together to share in a common goal – improving patient care,” said Rich Umbdenstock, president and CEO of the American Hospital Association. “We have built an ‘infrastructure of improvement’ that will aid hospitals and the health care field for years to come and has spurred the results you see today. We applaud HHS for having the vision to support these efforts and look forward to our continued partnership to keep patients safe and healthy.”

…

Additional Information

• Interim Update on 2013 Annual Hospital-Acquired Condition Rate and Estimates of Cost Savings and Deaths Averted from 2010 to 2013
• May 2014 patient safety results report
• Partnership for Patients Preliminary Evaluation Report

[News article] Pharmacists say collaboration bill will improve care | CJOnline.com

Pharmacists say collaboration bill will improve care | CJOnline.com.

From the 7 July 2014 article

Kansas pharmacists say a bill that went into effect this past week will improve patient care by allowing them to enter into agreements with physicians to do things like monitor and change medication levels without new orders.

Greg Burger, a pharmacist at Lawrence Memorial Hospital who helped push for the bill, said studies have shown reductions in cost and improvements in care when pharmacists have the authority to adjust medication levels, provide the right antibiotics for certain infections and adjust for drug allergies without waiting for a doctor’s say-so.

“There’s all kinds of things we do in hospitals now that we’re hoping to expand out to where pharmacists might be in clinics,” Burger said.

….

English: Well Street Late Night Pharmacy This pharmacy is tucked in behind 1594903 making it very handy for getting prescriptions filled after visiting the Doctor’s surgery. The flat-roofed building to the left and behind is a Co-operative pharmacists, one would have thought that the competition would be quite high, but they seem to manage alright. (Photo credit: Wikipedia)

[News item] British hospital to become first in Europe to use Skype for consultations

From the 21 March 2014 Daily Telegraph article

 

A hospital in Staffordshire is set to become the first in Europe where doctors consult with their patients via Skype

A hospital is set to become the first in Europe to tackle waiting times by getting overworked doctors to consult with their patients via Skype.

Managers at the University Hospital of North Staffordshire claim using the online video calling service could reduce outpatient appointments by up to 35 per cent.

They argue that using Skype will help free up consultants’ time and car parking spaces – while also helping patients who are unable to take time off work.

If approved, they would become the first UK hospital to use Skype to consult with patients.

The proposals, by Staffordshire’s biggest hospital, also include doctors treating patients via email consultations……..

…

“The key issue for doctors will be to recognise when this mode of consultation is not sufficient to properly assess the patient and address the problem, and to arrange a face-to-face consultation instead.”

…….

Skype (Photo credit: Wikipedia)

 

Related articles

• Skype saves man’s life as doctors monitor wife’s health over internet

 

[KevinMD Reblog] The one little question that could save your life

A patient having his blood pressure taken by a physician. (Photo credit: Wikipedia)

 

By VAL JONES, MD | PHYSICIAN | at the 12 November 2013 KevinMD.com blog

 

I realize that my blog has been littered with depressing musings on healthcare lately, and so I thought I’d offer up one very positive and “actionable” suggestion for all you patients out there. In the midst of a broken system where your doctor is being pressured to spend more time with a computer than listening and examining you, where health insurance rates and co-pays are sky-rocketing, and where 1 in 5 patients have the wrong diagnosis… There is one “magic” question that you should be asking your physician(s):

“What else could this be?”

This very simple question about your condition/complaint can be extremely enlightening. Physicians are trained to develop extensive “differential diagnoses” (a list of all possible explanations for a set of signs and symptoms) but rarely have time to think past possibilities 1 through 3. That’s one of the reasons why so many patients have the wrong diagnosis – which is both costly in terms of medical bills, time, and pain and suffering.

There is a risk in asking this question – you don’t want to be over-tested for conditions that you are unlikely to have, of course. But I maintain that the cost/risk of living with the wrong diagnosis far exceeds the risk of additional testing to confirm the correct diagnosis. So my advice to patients is to keep this very important question in mind when you see your doctor for a new concern.

 

Read the entire post here

 

Related articles

• Better tests needed to improve patient care, public health (medicalnewstoday.com)
• Mistakes even good doctors make (consumerreports.org)
• Hypochondriacs Rejoice: WebMD is Beefing Up Its Real-Life Doctor Support (betabeat.com)
• Admit when you fall short: The power of “I don’t know” (kevinmd.com)

 

Reduce Unnecessary Lab Tests, Decrease Costs by Modifying Software

From the 4 November 2013 ScienceDaily article

When patients undergo diagnostic lab tests as part of the inpatient admission process, they may wonder why or how physicians choose particular tests. Increasingly, medical professionals are using electronic medical systems that provide lists of lab tests from which medical professionals can choose. Now, a University of Missouri researcher and her colleagues have studied how to modify these lists to ensure health professionals order relevant tests and omit unnecessary lab tests, which could result in better care and reduced costs for patients.

“Ordering numerous lab tests can result in unnecessary testing and can cause physical discomfort and financial stress to patients,” said Victoria Shaffer, an assistant professor of health sciences in the MU School of Health Professions. “We found that by changing the way electronic order set lists were designed, we could significantly alter both the number and quality of lab tests ordered by clinicians.”

Shaffer and her research team studied how physicians selected lab tests using three order set list designs on the same electronic medical system. The first order set list design was an opt-in version in which no lab tests were pre-selected; this is the standard method of lab test ordering in electronic health records for most healthcare facilities. A second option was an opt-out version in which physicians had to de-select lab tests they believed were not clinically relevant. In the third design, only a few tests were pre-selected based on recommendations by pediatric experts. On average, clinicians ordered three more tests when using the opt-out version than the opt-in or recommended versions. However, providers ordered more tests recommended by the pediatric experts when using the recommended design than when using the opt-in design.

 

Read entire article here

Related articles

• MU researcher finds way to reduce unnecessary lab tests, decrease patient costs by modifying software (eurekalert.org)
• Majority of ambulatory physicians had capability to exchange prescription and laboratory data in 2011 (hispanicbusiness.com)
• Researchers find way to reduce unnecessary lab tests, decrease patient costs by modifying software (medicalxpress.com)

 

Goal Oriented Patient Care

 

From the National Library of Medicine (NLM) Director’s Comments (5/14/2012)

The success of medical treatment might improve if the outcomes for persons with multiple conditions, severe disability, and short life expectancy were more based on a patient’s (rather than a health care provider’s) goals, suggests a stimulating commentary recently published in the New England Journal of Medicine.

The commentary’s two authors note the primary outcomes for patients with multiple conditions, severe disability, and short life expectancy often are based on medically-posited, condition-specific protocols. The authors add treatment success often is envisioned as meeting short and longer-term clinical indicators.

David Reuben M.D. and Mary Tinetti M.D. write (and we quote): ‘rather than asking what patients want, the culture has valued managing each disease as well as possible according to guidelines and population goals’ (end of quote).

However, the authors explain for patients with multiple conditions, severe disability, and short life expectancy (and we quote): ‘the overall quality of care depends on more than just disease-specific care processes’ (end of quote). As an alternative, the authors suggest a more patient-centered option should focus treatment on individual tailored goals, which might be quite different than what health care providers admirably hope to achieve.

The authors (who are from the University of California-Los Angeles and Yale University respectively) provide several hypothetical examples where a patient’s goals do not match the clinical indicators physicians seek and there may be differences in how physicians versus patients perceive the ultimate success of medical treatment….

…

Overall, underlying the commentary’s thought-provoking ideas is the foundational importance of good communication between doctors and patients, which is the focus of MedlinePlus.gov’s talking with your doctor health topic page.

MedlinePlus.gov’s talking with your doctor health topic page provides an array of links to help you improve interpersonal communication with a health care provider. One highly useful site (from the Agency on Healthcare Research and Quality) provides 10 basic questions to ask a clinician that cover a wide range of medical situations. This website is available within the ‘overviews’ section of MedlinePlus.gov’s talking with your doctor health topic page.

A website from Harvard Medical School (available in the ‘related issues’ section) supplements the former site with specific questions about 40+ diseases and conditions that you can take with you to a doctor. Let’s Talk … and Listen also in the ‘related issues’ section helps you establish more rapport and shared decision making with a physician.

MedlinePlus.gov’s talking with your doctor health topic page additionally contains updated research summaries, which are available within the ‘research’ section. Links to the latest pertinent journal research articles are available in the ‘journal articles’ section. Links to related clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. From the talking with your doctor health topic page, you can sign up to receive email updates with links to new information as it becomes available on MedlinePlus….

Related articles

• “Patient-centered care” vs. CAM in the New England Journal of Medicine (scienceblogs.com)

[Infographic] Making Patient Experience a Priority & Link to Other Infogaphics by the Author

Created by Dan on Pinterest. Dan presently has 28 other health care related infographics at his Pintereset site.
Titles include Over Medicated America, How Technology Changed the Healthcare Industry, What Really Happens on a Hospital Night Shift, and Social Media in Healthcare

Source: berylhealth.com via Dan on Pinterest

 

Source: berylhealth.com via Dan on Pinterest

How algorithm driven medicine can affect patient care

How algorithm driven medicine can affect patient care

From the KevinMD article of  Mon Jan 30, 2012

 

Whenever someone is scheduled for an operation, the assigned nurse is required to fill out a “pre-op checklist” to ensure that all safety and quality metrics are being adhered to. Before the patient is allowed to be wheeled into the OR we make sure the surgical site is marked, the consents are signed, all necessary equipment is available, etc. One of the most important metrics involves the peri-operative administration of IV antibiotics. SCIP guidelines mandate that the prophylactic antibiotic is given within an hour of incision time to optimize outcomes. This has been drilled into the heads of physicians, health care providers, and ancillary staff to such an extent that it occasionally causes total brain shutdown.

Let me explain. For most elective surgeries I give a single dose of antibiotics just before I cut. For elective colon surgery, the antibiotics are continued for 24 hours post-op. This is accepted standard of care. You don’t want to give antibiotics inappropriately or continue them indefinitely.

But what about a patient with gangrenous cholecystitis or acute appendicitis? What if, in my clinical judgment, I want to start the patient on antibiotics right away (i.e. several hours before anticipated incision time) and then continue them for greater than 24 hours post-op, depending on what the clinical status warrants? I should be able to do that right?

Well, you’d be surprised. You see, at two different, unaffiliated hospitals I cover, the surgeons have seen that decision-making capability removed from their power….