Medical devices and shared decision-making

Medical devices and shared decision-making.

From the 18 October 2012 article at HealthNewsReview.org

The journal Arthritis Care & Research has accepted for future publication – and posted online (for subscribers) – an unedited paper, “Preceding the Procedure:  Medical Devices and Shared Decision-Making.”  The paper builds on a hypothetical example of a man in his 50s with hip arthritis who is facing a decision about total hip replacement.  Excerpts:

“(The surgeon – Dr. Jones) reviews the procedure with him and confirms that he understands his options. Then (the patient – Mr.Thomas) signs the surgical consent form. This discussion appears to include all the elements of informed consent, but several ethical questions linger beneath the surface. Dr. Jones discussed the risks and benefits of total hip replacement in some detail to help Mr. Thomas decide whether or not to have surgery, but should Mr. Thomas also have participated in the decision about the specific implant to be used?…

This article teases out the ethical issues underlying the choice of a medical device for surgical procedures, using the example of total joint arthroplasty to illustrate the interactions between surgeons and their patients. We highlight shortcomings in the current regulatory process that result in a thin evidence base on which to anchor these technical decisions, and we note the potential for decisions to be influenced by the surgeon’s personal beliefs and possible conflicts of interest. We suggest that the informed consent process could be enriched with a greater focus on shared decision-making. This would include discussing the choice of implant and other technical decisions that may affect the outcome of the procedure, in addition to disclosing any relevant financial relationships. We note the challenge of providing patients with easily digestible information that helps them make decisions consistent with their own values. …

 

…

urgeons reporting “that that they typically face few institutional constraints on their choice of implants, so many are able to decide for themselves when they wish to begin using newer models.”

Photo credit: dpstyles™ via Flickr

And it provides background for consideration of conflicts of interest:  “The choice of implant is complicated further by the possibility for conflicts of interest stemming from the consulting fees that some orthopedists receive from device manufacturers. In 2007, the five largest manufacturers made payments to approximately 4% of the 25,000 registeredorthopedic surgeons in the United States. These payments typically involve surgeons in high volume practices and academic settings. Orthopedists who receive industry support express, on average, a greater sense of shared goals and priorities with their vendors and sales representatives than surgeons who don’t.”

Related articles

• Shared decision making leads to a better patient experience and higher levels of patient satisfaction (introcommblog.wordpress.com)
• What is the Impact on Shared Decision Making of the Daily Tsunami of Health News? (engagingthepatient.com)
• Addressing Health Literacy: A Variation of Perspectives (engagingthepatient.com)

 

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….

Rude Surgeons Hurt Patients, Increase Costs

 

From the 20 July 2011 Health Day article

WEDNESDAY, July 20 (HealthDay News) — The behavior of surgeons in the operating room affects more than their patients’ health, new research indicates.

It also plays a part in determining health-care costs, the number of medical errors and patient satisfaction, according to a commentary in the July issue of The Archives of Surgery. Surgeons who are civil, the report claimed, can more effectively help their patients and reduce costs…

Click here to read the rest of the news article

Related articles

• Polite doctors ‘make for healthier patients’ (telegraph.co.uk)
• Fewer Surgical Errors Reported at VA Medical Facilities (nlm.nih.gov)
• Medical Errors Down at U.S. Veterans’ Hospitals (nlm.nih.gov)

Going ‘Green’ May Cut Hospital Costs

Going ‘Green’ May Cut Hospital Costs
Even surgical staff can reduce waste without harming patients, study says

 

 

From the February 22 Health Day news item by Robert Preidt

MONDAY, Feb. 21 (HealthDay News) — Implementing practical, environmentally friendly practices in operating rooms and other hospital facilities could reduce health-care costs without compromising patient safety, says a new study.

In the United States, health-care facilities are a major source of waste products, producing more than 6,600 tons per day and more than 4 billion pounds a year. Nearly 70 percent of hospital waste is produced by operating rooms and labor-and-delivery suites.

Operating rooms have energy-sucking overhead lights and it’s common for OR staff to open sterilized equipment that is never used, and to fill red bags that are labeled as medical waste with harmless trash that could be disposed of more cheaply, said the Johns Hopkins researchers.

“There are many strategies that don’t add risk to patients but allow hospitals to cut waste and reduce their carbon footprints,” study lead author Dr. Martin A. Makary, an associate professor of surgery at the Johns Hopkins University School of Medicine, said in a Hopkins news release.

He and his colleagues reviewed research on hospitals’ environmental practices and then convened a panel of experts to create a list of practical eco-friendly strategies that could be used in operating rooms.

The top five strategies were: cutting down on and separating operating room waste; reprocessing single-use medical devices; considering the environment when making purchasing decisions; improving energy consumption; and improved management of pharmacy waste.

The study appears in the February issue of the journal Archives of Surgery.***

 

***For suggestions on how to get this article for free or at low cost click here.