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Digital Issues

Patients Rarely Get Apologies, Acknowledgements After Medical Errors

After a medical mistake is made, healthcare providers rarely acknowledge it or apologize, according to a study led by Marty Makary, MD, MPH, FACS, a professor of surgery at Johns Hopkins University School of Medicine.

The study was based on 236 patient responses to the non-profit news organization ProPublica's Patient Harm Questionnaire during a 1-year period. The voluntary online survey inquired into patients' treatment by healthcare facilities following mistakes.

Only 9% of patients said a facility voluntarily disclosed the harm after the mistake was made, the study found. When officials did disclose the harm, 9% of patients said it was because the facility was pressured. Only 11% of patients or their family members reported getting an apology after a mistake, and more than 30% reported paying bills related to the harm, with the average cost calculated at $14,024.

The study also found that 43% of respondents said a complaint was filed to an oversight agency after the mistake, and a malpractice claim was filed in about 20% of events. The authors of the study note that because it's self-reported data, it is impossible to draw definitive conclusions about patient harm.

Kendal Gapinski

New Guideline for Managing Post-op Delirium

The American Geriatrics Society has released a new clinical practice guideline aimed at preventing and treating post-op delirium in the elderly, the most common surgical complication affecting that patient population, according to Andrew G. Lee, MD, chair of the AGS Section for Surgical and Related Medical Specialists.

While alarming for patients and their families, delirium can be prevented in up to 40% of the cases when the evidence-based guideline is followed, says Dr. Lee. Here are a few highlights from the guideline, which was published online in the Journal of the American College of Surgeons.

  • Orient at-risk patients to their surroundings, get them up and walking sooner after surgery when possible, avoid physical restraints, and ensure the delivery of adequate oxygen, fluids and nutrition.
  • Conduct regular in-services for staff about delirium's risk factors and the best ways to manage the condition.
  • Perform medical evaluations to identify and manage underlying contributors to delirium.
  • Optimize post-op pain practices, preferably by avoiding opioid use.
  • Avoid medications that increase risk of delirium. Do not use cholinesterase inhibitors to prevent or treat delirium, benzodiazepines as a first-line treatment of delirium-associated agitation or antipsychotics and benzodiazepines to treat hypoactive delirium.

The guideline states that identifying and treating post-op delirium is an essential, but often overlooked, aspect of optimal surgical care. "We believe that surgical and related medical specialists, together with the multi-disciplinary members of their teams, can play an integral role in prevention," says Dr. Lee.

Daniel Cook

Dual Prep Reduces SSIs in Colorectal Surgeries

For elective colorectal surgery patients, a pre-op regimen combining oral antibiotics and laxatives significantly reduced surgical site infections, hospital stay lengths and readmission rates, says a review of 8,415 cases in the National Surgery Quality Improvement Program.

Among patients who used both pre-op measures (30% of the group), 6.5% developed SSIs, versus a 12% SSI rate with the laxative-only group (45% of the patients) and a 15% rate with the no-prep group (the remaining 25% of patients). Percentages were similar when infections were broken down into superficial, deep wound and organ space.

The dual-prep group was also 26% less likely than the no-prep group to be readmitted, and more likely to leave the hospital earlier (4 days vs. 5), two areas where there was little or no difference between the laxative-only group and the no-prep group.

Those having minimally invasive procedures also had fewer SSIs, lead investigator Melanie Morris, MD, of the University of Alabama at Birmingham, reported at the annual clinical congress of the American College of Surgeons.

Jim Burger

InstaPoll: Where Is the Best Site to Start an IV?

Some say it all depends on where there's a good vein, but you likely have a preferred site for starting an IV. Maybe the hand? Or the wrist? Or the forearm? Tell us in this week's InstaPoll, then check back next week to see how your answer compares to those of other respondents.

For 90% of the 178 respondents to last week's poll, the fallout from the Joan Rivers case has not impacted surgical volume. The results:

How has the publicity surrounding the Joan Rivers case affected surgical volume in your facility?

  • It has decreased volume significantly 5%
  • It has decreased volume somewhat 5%
  • It has increased volume significantly 0%
  • It has increased volume somewhat 0%
  • It has had no effect on volume 90%

Dan O'Connor

October 21st E-WEEKLY

News & Notes

  • FDA clears new opioid Hysingla ER (hydrocodone bitartrate), an extended-release opioid analgesic from Purdue Pharma, has received the U.S. Food and Drug Administration's approval for daily, long-term management of chronic, severe pain. According to the FDA, "the tablet is difficult to crush, break or dissolve [and] forms a viscous hydrogel [which] cannot be easily prepared for injection," to deter abuse.
  • By the numbers In its annual report on the financial health of the state's ASCs, the Pennsylvania Health Care Cost Containment Council calculates that, in the fiscal year ending in 2013, 285 ASCs saw 1.1 million outpatient procedures (a 0.5% increase over fiscal 2012) and earned $1.2 billion in net revenues. Their average operating margin decreased from 25.74% to 24.94% and their average total margin from 26.92% to 25.13%, with Medicare and Medical Assistance covering 41.9% of the cases. In a response posted on its website, the Ambulatory Surgery Center Association noted that in 2012, Pennsylvania's ASCs saved Medicare more than $39 million on cataract surgeries, $2.6 million on arthroscopic knee and shoulder surgeries and $5.8 million on colonoscopies.
  • Young and hip Hip replacement surgery is beneficial to young patients suffering from juvenile idiopathic arthritis (JIA), according to research presented this month at the annual meeting of the American College of Rheumatology. According to researchers at the Hospital for Special Surgery in New York, N.Y., implants lasted 10 years in 85% and 20 years in 50% of the 56 patients aged 35 years and younger who underwent total hip replacement. The researchers say the procedure is an excellent treatment option with reasonable long-term outcomes for JIA sufferers.