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| Study: Hospitals With Joint Commission Approval Safer
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Hospitals accredited by the Joint Commission are more likely to have implemented systems to promote patient safety, according to a study published in the May/June 2007 issue of the Journal of Healthcare Management.
Further, accreditation was found to be the most significant factor, even though researchers also considered hospital size, management (such as for-profit or non-profit) and location (such as rural or urban).
"Accreditation status was the only organizational characteristic that consistently emerged in identifying which hospitals have more extensively implemented patient safety systems," the authors write.
Patient safety initiatives undertaken by the hospitals include computerized physician order entry systems, computerized test results, assessment of adverse events, use of data in patient safety programs, specific patient safety policies, handling adverse event/error reporting, root cause analysis and medication management.
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| Abnormal Hematocrit a Surgical Risk
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Here's something to keep a pre-operative eye on: hematocrit, a measure of red blood cells. Older men who have too few or too many red blood cells have a higher risk of dying after surgery than those who have the right amount, suggests new research.
The study, which appears in the June 13 issue of the Journal of the American Medical Association, found that when an elderly man with a higher than normal or lower than normal red blood cell count undergoes non-cardiac surgery, he has a higher risk of post-operative cardiac events and death.
The study examined data from more than 310,000 veterans older than 65 years who had non-cardiac surgeries in more than 130 VA centers across the United States. Study participants were nearly all male and most were in their 70s. Forty-three percent had a hematocrit of less than 39 percent before surgery, while 0.2 percent had polycythemia, or a high hematocrit, before surgery.
Among the surgical procedures included in the study were hernia repair, knee or hip replacement, leg amputation, gallbladder removal, lung removal, repair of femur fracture and cancerous tumor removal.
The risk of death went up if hematocrit levels deviated from normal, the study found. For each percentage point above or below the normal range, the risk of mortality increased by 1.6 percent. Overall, 3.9 percent of the study group experienced a cardiac event and 1.8 percent died within 30 days of surgery.
Researchers weren't able to determine from this study whether improving hematocrit levels would improve surgical outcomes.
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| Failed Protocols Result In Two Wrong-Site Surgeries
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A pediatric patient undergoing outpatient ear tube surgery at St. Joseph Hospital in Orange, Calif., on June 5 had tubes implanted into both ears, instead of just the intended right ear. Physicians removed the left ear tube immediately upon discovering the error.
This surgical error was compounded by the fact that the hospital had established safety protocols to prevent wrong-site surgery in January 2006, after a surgical team cut into the wrong side of a child's skull to remove a brain tumor. In that incident, a state investigation found that the team failed to complete a time out before the procedure to identify the correct incision site, didn't mark the child's skull and didn't document the mistake in the patient's medical records.
Later that year the state health department approved the hospital's new rules, which included not allowing cutting instruments in the operating room before surgeons arrived and marking the planned incision in the presence of a family member. So far the facility's owner, Children's Hospital of Orange County, has not released any details about what went wrong on June 5.
"Quality patient care and safety is of utmost importance to both hospitals," the facility says in a prepared statement. "CHOC and St. Joseph Hospital are investigating this incident thoroughly as is the standard practice. All parties are committed to identifying the cause of the incident and working to improve processes."
The identity of the patient was not released. In a written statement, the patient's family says, "We are happy with the results of our child's procedure and are grateful for the care our child received."
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| News and Notes
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A pediatric patient undergoing outpatient ear tube surgery at St. Joseph Hospital in Orange, Calif., on June 5 had tubes implanted into both ears, instead of just the intended right ear. Physicians removed the left ear tube immediately upon discovering the error.
This surgical error was compounded by the fact that the hospital had established safety protocols to prevent wrong-site surgery in January 2006, after a surgical team cut into the wrong side of a child's skull to remove a brain tumor. In that incident, a state investigation found that the team failed to complete a time out before the procedure to identify the correct incision site, didn't mark the child's skull and didn't document the mistake in the patient's medical records.
Later that year the state health department approved the hospital's new rules, which included not allowing cutting instruments in the operating room before surgeons arrived and marking the planned incision in the presence of a family member. So far the facility's owner, Children's Hospital of Orange County, has not released any details about what went wrong on June 5.
"Quality patient care and safety is of utmost importance to both hospitals," the facility says in a prepared statement. "CHOC and St. Joseph Hospital are investigating this incident thoroughly as is the standard practice. All parties are committed to identifying the cause of the incident and working to improve processes."
The identity of the patient was not released. In a written statement, the patient's family says, "We are happy with the results of our child's procedure and are grateful for the care our child received."
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