More than half of the nation's short-term, acute-care hospitals are either insolvent or near insolvency due to declining revenues from patient care and the overall downturn in the U.S. economy, a new study shows.

Fifty-three percent of the nearly 4,000 hospitals studied by professional services firm Alvarez & Marsal aren't treating enough patients to generate a profit, and another 19 percent aren't profitable enough to cover essential capital expenditures. Urban hospitals were found to be at a greater risk of insolvency than rural hospitals.

Although the analysis hinges on data from 2005 and 2006, George D. Pillari, managing director of A&M's Healthcare Industry Group, told the Wall Street Journal that hospital insolvencies and bankruptcies are in "the heyday right now" and are likely to increase this year.

The study identifies several changes in the healthcare industry that have contributed to hospitals' financial woes, including higher costs, declining reimbursements and the migration of both physicians and patients to "alternative settings," including ambulatory surgery centers. Adding to those troubles, the weakening economy is straining the sources of non-patient revenue - particularly state and local governments - on which many hospitals rely. The study's authors point out that the financial squeeze on hospitals is self-perpetuating, as facilities that cannot afford to maintain and upgrade their physical structures are losing even more patients.

Alvarez & Marsal cautions against looking for quick fixes to these issues. "It has become critical for hospital management and boards to deal with these troubling issues head-on and take urgent steps - such as restructurings, mergers or recapitalizations - to improve their finances and allow hospitals to execute on their missions," says Mr. Pillari in a press release.

Irene Tsikitas

Researchers say they've developed a fully automated anesthesia system that administers drugs and monitors their effects in patients undergoing surgery without external intervention.

The closed-loop software system, dubbed "McSleepy" by the researchers at McGill University's Department of Anesthesia and Montreal General Hospital, was recently used during a three-and-a-half hour partial nephrectomy. In a press release, the scientists claim it was the "world's first totally automated administration of an anesthetic."

In addition to delivering anesthesia drugs via infusion pumps, McSleepy constantly monitors three separate patient parameters - depth of hypnosis, pain and muscle relaxation - and adjusts its dosage according to how the patient is responding to each drug throughout surgery. The researchers say the system "calculates faster and more precisely than a human can the appropriate drug doses for any given moment of anesthesia," but they stress that McSleepy is there to assist, not replace, anesthesia providers.

They liken it to a vehicle with an automatic transmission. The software is intended to help anesthesia providers with the basic task of administering drugs while allowing them to concentrate on other aspects of direct patient care. "Automatic systems in life only help us to perform our task better, they will not replace us," lead developer Thomas M. Hemmerling, MD, told reporters last week.

Dr. Hemmerling predicts it will take about two more years to perfect the system, but he anticipates that a commercial version of the technology will be available within the next five years.

Irene Tsikitas

Hospitals and ASCs in New Hampshire have been put on notice: It's time to get on board the first statewide initiative to improve hand hygiene compliance. The New Hampshire Commission on Healthcare Quality Assurance hopes to generate complete compliance with its "High Five for a Healthy N.H." campaign, based on the CDC Guideline for Hand Hygiene in Healthcare Settings.

According to the commission, the High Five program is built on the following five "fingers," which recommend that each facility in New Hampshire: