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Digital Issues

Hospitals Aren't Getting Safer, Experts Tell Congress

Are patients in U.S. hospitals safer than they were 15 years ago, when the Institute of Medicine estimated that preventable events were responsible for up to 98,000 deaths a year?

"The unfortunate answer is no," Ashish Jha, MD, MPH, told a U.S. Senate subcommittee last week. "We have not moved the needle in any demonstrable way overall. No one is getting it right consistently."

Dr. Jha, a Harvard School of Public Health professor, was one of several speakers invited to the hearing, convened by Sen. Bernie Sanders (I-Vt.), who chaired the health and aging subcommittee.

Recent reports have suggested that the 98,000 annual deaths estimated in the report, "To Err is Human: Building a Safer Health System," may be far too conservative. A study published last year in the Journal of Patient Safety concluded that the number is likely closer to 400,000 a year. The author of that study, John James, PhD, was among the speakers.

Experts assert that what's needed to improve the situation are data, metrics and monitoring systems that provide accurate comparisons on outcomes; accountability and incentives that encourage providers to focus on safety; and a healthcare equivalent of the Federal Aviation Administration or National Transportation Safety Board.

Jim Burger

Aspirin's Anticoagulation Potential in Ortho

What's the best anticoagulant to use after orthopedic surgeries? That depends on the type of procedure, say the authors of a study published in the Journal of Hospital Medicine.

Their review of 8 trials involving about 1,400 patients compared rates of venous thromboembolism (VTE) and bleeding with the use of aspirin, heparin and warfarin after major lower extremity surgeries.

According to the findings, aspirin was just as effective as heparin and warfarin in preventing blood clots and caused 68% fewer serious bleeding events following hip or knee replacements. However, the study notes, administering the conventional anticoagulants is best after hip fracture repair.

The study's authors note that national guidelines recommend the use of pharmacologic thromboprophylaxis to prevent VTE in these patients, but fail to identify which agents are best, leaving individual physicians to determine the optimal therapy. Lead author Frank Drescher, MD, of the Veterans Affairs Medical Center in White River Junction, Vt., hopes the findings will help guide physicians' decision-making about how to minimize surgical risks.

"We expect that the number of hip and knee replacements and hip fracture repairs will continue to grow as the population ages," he says. "Major complications after these procedures — often clots or bleeding — contribute to suffering and costs."

Daniel Cook

Brain Pathways to Anesthesia Emergence

The stimulation of a dopamine-producing region of the brain may actively restore consciousness to anesthetized patients, researchers have found, which could provide a greater understanding of how anesthesia drugs work.

The researchers' findings are published in the August issue of the journal Anesthesiology. For their study, they administered isoflurane or propofol to laboratory rats, then targeted electrical stimulation to their brains, which caused them to wake.

Ken Solt, MD, an anesthesiologist at Massachusetts General Hospital, assistant professor at Harvard Medical School in Boston and lead author of the study, notes that "patients should not be under general anesthesia longer than necessary," but that providers don't currently have reversal agents, other than waiting for the drugs to wear off. "Having the ability to control the process of arousal from general anesthesia would be advantageous as it might speed recovery to normal cognition after surgery and enhance operating room efficiencies."

The stimulation produced similar results to those of other recent studies, in which the drug methylphenidate awakened patients, leading researchers to believe that the affected brain region drives emergence to consciousness and could play a role in treating post-op delirium or impaired cognitive function.

David Bernard

InstaPoll: Are RNs Working Longer and Delaying Retirement?

Are baby-boomer RNs working beyond retirement age? Tell us in this week's InstaPoll, then check back next week for the results.

What matters most to surgeons? At 48%, "efficient ORs" was the top vote-getter of the 399 respondents to last week's poll. The results:

What matters most to surgeons when deciding where to bring their cases?

  • quality of the staff 24%
  • latest equipment and technology 6%
  • efficient ORs 48%
  • ease of scheduling 16%
  • other 6%

Dan O'Connor

News & Notes

  • Don't touch that button Elevator buttons may be a bigger infection risk than restroom surfaces, according to Canadian researchers. For a recent study, they swabbed the buttons, along with door pulls, toilet flushing handles and stall latches at 3 Toronto hospitals over the course of 10 days. While each surface was frequently touched by ungloved hands which could easily pass on the bacteria there, they found 61% of the elevator buttons were colonized, as compared to 43% of the restroom surfaces. The researchers recommend hand hygiene before and after patient contact, and pushing elevator buttons with an elbow or a pen.
  • Ortho OK for older patients In-hospital mortality rates for patients aged 80 and older undergoing elective spinal fusion, total hip arthroplasty or total knee arthroplasty decreased between 2000 to 2009, notes a study in the Journal of Bone and Joint Surgery. Additionally, overall in-hospital complication rates remained consistent for spinal fusion and total knees, but increased slightly for total hips. The findings show these procedures can be performed safely on the growing number of elderly who are seeking the care, according to the researchers.
  • Could cataract surgery curb dementia? A small preliminary study suggests that by improving vision, cataract surgery in people with Alzheimer's Disease and other forms of dementia can help to slow declines in memory and other cognitive abilities and improve quality of life for both patients and caregivers. Researchers hope to verify their findings in a larger study.