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| Outbursts in OR Put Patients at Risk
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Verbal confrontations in surgical settings impact team dynamics and ultimately negatively affect patient care, say researchers at the Voluntary Hospital Association. Investigators circulated a 25-question survey to physicians, nurses, nurse anesthetists, surgical techs and other members of the perioperative team at a large urban medical center to assess the significance of disruptive behavior in the ORs. The results were published in the July issue of the Journal of the American College of Surgeons.
Based on the responses of 244 participants, the most common types of disruptive behavior witnessed were yelling (79 percent), disrespectful interaction (72 percent) and abusive language (62 percent). Results show that 19 percent of respondents were aware of a specific adverse effect that occurred as a result of disruptive behavior.
The researchers note that disruptive behavior tended to occur more frequently among attending surgeons in certain subspecialties, including general, cardiovascular, neuro- and orthopedic surgery.
"Surgery is a classic setup due to the intensity and complexity of the situation, the interdependency of multiple team members working both independently and together and the small spatial confines of activity," says the study's lead author, Alan Rosenstein, MD, MBA, vice president and medical director of the VHA.
While organizations recognize the impact of disruptive behaviors on patient safety, difficulty arises in the willingness to deal with intimidating individuals, particularly physicians who are well-skilled and bring a lot of patients and revenue to a hospital, says co-author Michelle O'Daniel, MHA, MSG, director of member relations for the VHA.
The study's authors suggest the development of a universally accepted code-of-behavior policy that establishes a process for equitably reviewing and addressing issues and taking appropriate action for solutions. They further advise that the reporting of disruptive behaviors be confidential and behavior policies be implemented and applied in a consistent manner across the organization.
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| Report Highlights Effectiveness of Colonoscopy
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Colonoscopy, regardless of the annual volume performed by a facility, is the most efficient method to find and remove polyps for many patients, according to a report recently released by the Accreditation Association for Ambulatory Health Care's Institute for Quality Improvement.
The report shows polyps were discovered in 1,961 of the 2,383 uncomplicated procedures studied at 107 facilities. Forty-six percent of the polyps and 62 percent of other abnormalities were found in the upper bowel, emphasizing the importance of examining the entire colon, says the Institute.
The research also shows that the average colonoscopy screening procedure lasts 17 minutes and suggests the annual volume of colonoscopies performed by a facility does not correlate with procedure times. Patient preparation, pre-procedural patient education and bowel preparation were contributing factors to case efficiency, according to the researchers.
"These findings are expected and reiterate the importance of colonoscopy as the screening test of choice," says Anil Minocha, MD, FACP, FACG, professor of medicine at the University of Mississippi Medical Center in Jackson, Miss., and director of its digestive diseases division. "The patient's education level and employment are key factors in efficiency. Educated patients tend to follow colon prep instructions, the colon is cleaner and case output is better."
Patients generally prefer to avoid drinking large volumes of PEG solution, says Dr. Minocha, leading to the recent popularity of Fleet phospho-soda oral saline laxatives with bisacodyl (Dulcolax) or magnesium citrate as bowel prep regimens. Warnings issued on the use of Fleet laxatives, however, have since caused Dr. Minocha to switch back to a prep of PEG solution and Dulcolax.
"Everyone has his own recipe," says Dr. Minocha, who recommends the use of written instructions and pre-procedure visits to improve patient compliance and reduce no-show rates.
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| Cataract Case Efficiency Hindered by Payment Systems
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Ophthalmologists who perform simultaneous bilateral cataract surgeries, treating both of a patient's eyes in one case, can do 15 percent more procedures in a day, according to researchers. The catch? Many nations' healthcare payment systems make it financially prohibitive to do so.
In a study published in the August 2006 edition of the Journal of Cataract & Refractive Surgery, two Canadian researchers analyzed ophthalmology reimbursement rules in Canada, the United States, the United Kingdom, Japan, Israel and Australia.
Examining reimbursements for simultaneous bilateral and sequential unilateral cataract surgeries, Steve A. Arshinoff, MD, of the University of Toronto and Sylvia H. Chen of McGill University found that many nations' systems offer only a portion of the unilateral payment for the second eye in a bilateral procedure, thus negating any efficiency gains the bilateral procedure would reap due to financial reluctance.
In the United States, they note, Medicare pays only 50 percent for the second eye. In Canada reimbursement ranges from 50 percent in the provinces of Quebec and British Columbia to 85 percent in Ontario. While Ontario's rate makes bilateral procedures slightly more popular among ophthalmologists, the study notes that anesthesiologists make only 65 percent of the fee for the second eye.
Across the United Kingdom, ophthalmologists are paid 80 percent of the first-eye fee for the second eye, making the procedure a popular one. In Japan and Israel, however, physicians are not reimbursed for the second eye in bilateral surgeries.
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| News and Notes |
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MEDICARE'S PROPOSED ASC PAYMENT SYSTEM REVISION will be summarized and discussed during a CMS conference call on Thursday, Sept. 7, from 2 p.m. to 3:30 p.m. Eastern time. The conference call is an opportunity for healthcare professionals to ask questions and voice initial reactions to the proposed payment system outlined in the Federal Register. To participate in the conference call, dial (800) 837-1935 and enter conference ID 5300639. CMS is accepting written comments on the proposed update of the ASC procedure list until Oct. 10. Written comments about the 2008 revised payment system are due November 6.
A FEDERAL JURY FOUND JOHNSON & JOHNSON, the New Brunswick, N.J.-based medical manufacturer, not guilty of antitrust practices following a lawsuit filed by rival Applied Medical Resources Corp. of Rancho Santa Margarita, Calif. Applied Medical, which sought $54 million in damages, alleged that Johnson & Johnson's Ethicon division illegally restrained competition in the trocar market by offering discounted suture for customers who bought the instruments. Johnson & Johnson countered that such bundling contracts did not block competitors and were sought out for their cost savings.
NUMBING A CHILD'S SKIN BEFORE PLACING AN IV can make the task easier for both sides. While two topical anesthetics are frequently and effectively used for numbing — amethocaine (Ametop) gel and EMLA cream (a combination of lidocaine and prilocaine) — a recent study suggests that amethocaine does the job faster. For the study, published in the Cochrane Collaboration's Cochrane Library, researchers reviewed six clinical studies comparing the use of the two anesthetics on 534 children between the ages of three months and 15 years, assessing their pain and numbness through patients' reports and clinicians' observations. While EMLA took up to 90 minutes to completely numb the IV site, amethocaine numbed the site in 30 to 60 minutes. |
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