The Supporting Safer Healthcare Blog (formerly MSSPNexus) reached a milestone this month - it's fifth anniversary. The first post was on November 12, 2004.
It's been more fun, more educational, and far more work than I could have ever imagined.
Thanks for stopping by and giving me the opportunity to add one small voice to the medical blogosphere, and for adding your voices to the conversation through emails and comments.
Every day is a new adventure!
Rita
What is being discussed these days in the medical blogosphere? I took a little time this weekend to browse some of the blogs linked on the Supporting Safer Healthcare sidebar and found that as usual, the topics range from quirky to thoughtful. Here are a few that caught my fancy:
If you fly often, GruntDoc offers a bit of clever advice about finding your car in those huge airport parking lots when you get back home.
Dr. Deb Serani's timely request to mental health professionals is worth considering.
The always post-prolific Kevin M.D. shares statistical findings about a long-held belief. Do patients hospitalized in July face greater safety risks?
The humanity of healthcare is featured in posts by both the Anesthesioboist and Dr. Charles. The Anesthesioboist (Anesthesiologist who also plays the Oboe if you're having a little trouble with that one) shares a touching tale of long-time love, and Dr. Charles, one of the blogosphere's most talented story tellers, shares a bit of his family history with readers.
For new doctors just about to sign on the dotted line for their first professional liability insurance policy, (nearly as scary a prospect as signing your first mortgage!) Presidio Insurance News shares some practical advice about what to look for in a policy, and what to avoid.
And finally, as a medical blogger who spends quite a bit of time researching and writing posts in an effort to give readers useful information, Paul Levy, CEO of Beth Israel Deaconess Hospital in Boston and author of the Running A Hospital blog, addresses an issue near and dear to my heart - how many hospitals block social media, including blogs, on their intranets. (Not so at Beth Israel Deaconess by the way.)
I've been visiting other health systems as part of my work recently and have been discouraged to realize how many medical staff, quality, risk management, and legal offices do not have access to the articles in this and other useful blogs. On a positive note, nearly everyone who has contacted their Information Technology Department and requested specific exceptions to the block has been granted access. So make a list of your favorite blogs and put in your request.
And now, on to another week. Happy Monday everyone!
The Joint Commission has released its list of the standards that healthcare organizations found most difficult to meet in the first half of 2009. These standards will no doubt be high-priority for surveyors in the months to come, so make a note if you're up for survey soon.
The full list across accreditation and certification programs can be found in the November 4th issue of Joint Commission Online.
Here's a peek at what hospitals are struggling with this year, and it's not what you might expect:
Life Safety Chapter Advice from Joint Commission Resources -->
Minimize your risk by documenting and addressing patient complaints promptly.
Related link: Complying With CMS Patient Grievance Regulations
This week's edition of Grand Rounds - the best of the medical blogosphere, is up at Non-Clinical Medical Jobs. The featured categories include
It's Medical Staff Services Awareness Week, an appropriate time to drop a note, or just say "thanks" to the professionals who work in the Medical/Professional Staff Services Department in your organization. They help keep all of us safer.
![Safe[2]](http://www.simpledatasolutions.com/blogassets/safe.jpg)
How much important information is locked away from those who need it in your organization? And how much added expense and potential patient harm does that create, at a time when national efforts are focused on eliminating both?
Because of legitimate concerns related to privacy and confidentiality, hospital leadership allows, and even encourages, protecting sensitive information. However, that action often creates the unintended consequence of hiding valuable data behind locked doors.
Let's consider the case of Dr. Z, a General Surgeon on the staff of Mythical Hospital.
The Quality Management Department has identified a trend related to Dr. Z's practice, a pattern of unexpected post-operative complications causing an increased length of stay. Depending on hospital policies, that trend may be reported to a Department Chair, a Quality Committee, etc. The information may also be placed in a file to be reviewed every two years at the time of the physician's reappointment to the medical staff.
Infection Control has also detected a trend in Dr. Z's patients. Part of the reason they have a longer than average length of stay is that they have a higher than average post-operative infection rate. Depending on hospital policies, that trend may be reported to the Department Chair, an Infection Control Committee, etc.
The Patient Advocate's Office, which handles patient complaints, has received several regarding the way Dr. Z talks to patients and families. The Advocates have worked hard to develop good service-recovery techniques and have done their best to re-engage Dr. Z's disgruntled patients. They have also reported the trend in their monthly reports to hospital administration, and they know that the CEO has spoken personally to Dr. Z regarding improving his communication skills.
Speaking of complaints, Nursing Leadership has received a few from the surgical nursing staff regarding Dr. Z's demeaning attitude toward them in the OR. The Perioperative Surgical Director has spoken to Dr. Z about the matter, and believes that there has been some improvement.
The Medical Records Review Committee has sent two letters to Dr. Z in the past year regarding his documentation practices. While Dr. Z does complete his records in a timely fashion, the documentation is often sloppy, contains unapproved abbreviations, and even some inappropriate remarks about other members of the staff. The issue remains on their agenda for further review.
Enter Risk Management, which is called in to investigate a post-op complication resulting in serious harm to one of Dr. Z's patients. During their investigation Risk discovers that the surgery took far longer than expected, there was injury to surrounding tissue, possibly due to poor surgical technique, and that the family is very unhappy and intends to file a lawsuit against both the physician and the hospital. The Risk Management files are protected by attorney-client privilege, and are reviewed by the hospital's legal counsel.
![Surgeon[1]](http://www.simpledatasolutions.com/blogassets/surgeon.jpg)
Two years have passed and it's time for Dr. Z's appointment and privileges to be reviewed. The Medical Staff Office gathers information to assure that Dr. Z's credentials are up-to-date and that he remains in good standing with the State licensing board, etc. A query is made to the National Practitioner Data Bank, which reveals no new settlements or disciplinary actions over the past two years. The physician's quality file is pulled and given to the Department Chair to review. The Department Chair again sees the data regarding Dr. Z's post-op complication trend and extended length of stay. He notes the issue in his comments, and adds that he has personally spoken with Dr. Z about the matter. However, he doesn't feel it warrants a recommendation for non-reappointment to the staff, and so recommends that Dr. Z's appointment and privileges continue as requested.
Everyone at Mythical Hospital is working hard to do the right thing to protect patients and the organization. They also don't want to unnecessarily harm the reputation of a staff physician. But none of them have the whole picture. So how can the problem of the missing pieces be solved?
There must be a central repository for all data related to a physician's practice. The logical repository is the Medical Staff Services Department.
With appropriate technology support, the information can then be compiled and combined with Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE) data and (frequently) reported through the Department Chair, the Credentials Committee, the Medical Executive Committee and finally in summary to the Board, which has the ultimate responsibility for appointing and reappointing members of the medical staff.Because Dr. Z practices in nearly every hospital.
Autumn in Ohio simply requires a few photos - enjoy.
They lurk where you least suspect, preying on the weak and ill. Their attacks can be devastating, even deadly, and like many enemies they gain strength in numbers.
The soldiers defending the front lines are armed, not with guns and grenades, but with chlorhexidine glutonate and similar compounds. They engage the enemy where it hides; often just inches from the hand of a fevered toddler or a beloved grandmother. These front-line defenders, as well as others who battle this often unseen enemy, protect us and those we love. Their dedication and training can mean the difference between life and death.
Who are the enemy kingpins? MRSA and Clostridium difficile are among the most-widely feared, but there are many others.
Enter, Philip Carling, an epidemiologist at Caritas Carney Hospital in Dorchester, Mass. According to an article in today's Wall Street Journal, Ten Steps to Preventing Infections in Hospitals, Dr. Carling went undercover to spray a solution containing fluorescent markers around patient rooms in dozens of hospitals. After cleaning crews left he went over each room with a black light, causing any spot the crews missed to glow fluorescent.
"Toilets sparkled. But bathroom light switches and door knobs did not. Telephones, nurse-call buttons and grab rails were all routinely contaminated."
There is work to be done.
But what about the Officers who direct the battle?
Stephen Streed, director of epidemiology at Lee Memorial Health System in Florida, says "Don't underestimate the motivational power of data." Dr. Streed tracks infection rate by surgeon—and then posts a list annually in his four hospitals. The list is coded to protect anonymity, but each surgeon knows his or her ranking.
"They growl a bit, but then they find their way to my office and ask, 'Why am I in the bottom third of this list?' " Dr. Streed says. Those at the bottom soon improve. "It's a very, very powerful tool."
The WSJ article also reminds caregivers that mother knows best. "The key to preventing infection is simple: Listen to your mother. "Wash your hands and clean your room."
Infection control is not just the role of a few doctors and nurses, it is a vital component of everyone's job.
Read the full text of Ten Steps to Preventing Infections in Hospitals.
Related Information: Not On My Watch Prevention Campaign
Is a physician suspension for incomplete medical records that lasts 31 days or longer reportable to the National Practitioner data bank?
Maybe.
Most hospitals consider the action administrative and, therefore, do not file a report with the NPDB. However, Katten Muchin and Rosenman Law recently posted a response they received from Daryl Gray, Director of the Division of Practitioner Databanks regarding reportable matters. That response stated in part "Delays in completing medical records are not uncommon and not all suspensions should be reportable, repeated offenses and/or lengthy time lapses during which the records are not completed can certainly lead to actual or potential adverse affects on patient health, and therefore a report may be required."
There's more.
Katten Law posed a question to the NPDB regarding a hypothetical scenario of a physician deliberately withholding information, or submitting misstatements on an application for hospital membership and privileges. Their basic question was, is this an action reportable to the NPDB?
Probably.
In essence, the response stated that "in the “hypothetical” presented, “there was a purposeful failure to disclose information to the hospital. The NPDB views intentional misrepresentations to the hospital body making determinations about clinical competence of providers almost per se as having the potential to adversely affect the health or welfare of a patient."
An updated Data Bank Guide Book is in the works.
Read the full text of Katten Law's NPDB response summary here.
Via the NAMSS Blog
The National Association Medical Staff Services (NAMSS) has revealed their new web site design that's been in the works for several months. Stop by and take a look.
