The Most Dangerous Job in America?

By the numbers, healthcare workplaces are among the most hazardous in the nation. Consider this: In 2011, the healthcare industry saw 486 cases of injuries requiring absence for every 10,000 employees, a rate more than four times the national average.

Or this: healthcare sees 653,000 on-the-job injuries or illnesses per year, compared to 152,000 in manufacturing.

These findings, published in a recent report by the Washington, D.C.-based non-profit Public Citizen, highlight what the group sees as a shortfall in attention to the safety and health of the nation's professional caregivers.

From slips, trips and falls, ergonomic stresses and musculoskeletal injuries to sharps, bloodborne pathogens and workplace violence, the healthcare environment can be a risky one. And, as the report suggests, it isn't nearly as safe as a construction site. There are twice as many healthcare workers in America as construction workers, but construction sees 20 OSHA inspections for every safety visit that healthcare receives.

The report criticizes the federal agency for insufficiently monitoring and backing healthcare's employee safety concerns. For its part, the agency points a finger at Congress for a lack of budget and resources to rectify what it is aware is a big inequity.

The report quotes Assistant Secretary of Labor and OSHA head David Michaels, who has argued that "it is unacceptable that the workers who have dedicated their lives to caring for our loved ones when they are sick are the very same workers who face the highest risk of work-related injury and illness."

David Bernard

OR Equipment Causes 25% of Medical Errors

Equipment and technology problems account for about a quarter of all operating room errors, according to a new study, but surgical checklists have the potential to dramatically reduce the incidence of those errors.

The study, published online in BMJ Quality & Safety, was based on a review of 28 quantitative error studies. In a subset of 8 studies, the authors were able to break down the types of failures into problems related to configuration and settings (43.4%), equipment availability (37.3%) and direct malfunctioning (33.5%).

In 4 of the studies, mistakes that were classified as major accounted for about 20% of mistakes overall, and equipment failure accounted for about one-fifth of those. Additionally, technology and equipment issues were cited in about 15% of malpractice claims.

In general, surgeries that relied heavily on technology suffered more equipment- and technology-related problems, say the researchers, who point out that 3 of the studies noted that the use of specific equipment checklists reduced the incidence of errors by 61%.

Jim Burger

Elderly at Increased Risk for Post-Op Delirium

Nearly half of the 91 elderly patients in a recent study who received general anesthesia experienced delirium during their recovery in the post-anesthesia care unit.

Researchers at Johns Hopkins University in Baltimore tested patients aged 70 years and older for delirium after emergent or elective surgery by comparing their dispositions and cognitive function to pre-op baseline tests. They defined delirium as acute changes in the level of consciousness, inattention and disturbed awareness or reasoning.

Delirium started in the PACU in a majority of patients, leading the researchers to suggest recognizing signs of confusion during recovery could help identify patients at increased risk of falling, cognitive impairment and hospital admission at time of their discharge.

According to the study, published in the journal Anesthesia & Analgesia, delirium resolved within 1 day post-op in 53% of the patients, and typically within 3 days in the rest. The authors note that 39% of patients with early and persistent delirium in PACU were more likely to be discharged to a nursing home or other institution instead of to home, compared with 3% of patients without delirium. (Nearly 80% of the observed patients lived independently before surgery.)

The researchers call delirium in PACU a common, but not universal problem. However, they call for caregivers to assess patients for the condition shortly after general anesthesia, noting that initiating monitoring for delirium on the first post-op day instead of in PACU would have missed 53% of the patients in the study who experienced delirium.

Daniel Cook

InstaPoll: Pre-Op Bathing Instructions

Studies have shown that patients who bathed with chlorhexidine gluconate (CHG) for 3 days before surgery suffered fewer surgical site infections than those who followed the traditional night-before-and-morning-of CHG bathing protocol. Tell us in this week's InstaPoll what you instruct your patients to do.

Most (42%) of the 817 respondents to last week's InstaPoll pay their recovery room nurses between $28 and $35 per hour. The results:

What do you pay your PACU nurses per hour?

  • $20 to $27: 27%
  • $28 to $35: 42%
  • $36 to $43: 23%
  • $44 to $51: 6%
  • more than $51: 2%

Dan O'Connor

News & Notes
  • Single-incision skeptics Single-incision laparoscopy has no clear clinical advantage over conventional surgery during GYN procedures, says a report from the American College of Obstetricians and Gynecologists. Issues regarding ergonomics, surgeon learning curve and the need for special instrumentation are also potential drawbacks of the single-incision technique, notes the report. Operating through a single port does however result in improved cosmesis, an important consideration for patients, says Jessica Shepherd, MD, MBA, the report's author and director of minimally invasive gynecology at the University of Illinois Hospital and Health Sciences System in Chicago, Ill.
  • Star ratings from Medicare? Concerned that healthcare consumers are overwhelmed by the more than 100 quality measures it publishes, Medicare is considering creating a vastly simplified composite rating, such as assigning each hospital a particular number of stars, for its Hospital Compare website, says Kaiser Health News. This idea, however, has generated skepticism from healthcare industry observers, who fear that an oversimplified system could "make inappropriate distinctions," "exaggerate minor performance differences," or be based on incomplete information.
  • A glass implant benefits bones A bone repair implant made from glass not only withstands weight and repetitive stress, but also integrates with the bone to promote growth, say researchers at the Missouri University of Science and Technology, who created the synthetic porous scaffolding as an alternative to porous metal implants or cadaverous allografts and who are currently testing the material in laboratory rats.