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The CMG Voice

Recent federal investigation uncovers “numerous” patient safety issues at Swedish Cherry Hill

Posted Monday, September 11, 2017 by Tyler Goldberg-Hoss

In response to the Seattle Times articles in February examining Swedish’s neurosurgical department, the state Department of Health began investigating themselves. The DOH recently released its report, finding a number of problem areas that must be solved if Swedish is to remain Medicare eligible.

Such concerns included Swedish’s failure to properly define the role and scope of work performed by medical fellows, failure to address behavioral issues, failure to document which surgical tasks were done by fellows instead of the attending physician, failure to track when the attending was in the operating room, and failure to listen to staff concerns about patient safety within the neurosurgical department.

Other allegations were not substantiated by the DOH investigation. In particular, the investigation did not find that primary surgeons were unavailable for critical portions of surgeries, and that nursing staffing levels were unsafe.

To Swedish’s credit, many of these issues have been addressed prior to this report being released. In particular, Swedish began new policies of largely banning the practice of overlapping surgeries, and monitoring when surgeons were in the operating room.

Mike Baker at the Times has done a phenomenal job, increasing patient safety for everyone in the state. As a result of his investigative work surrounding Swedish, he received the WSAJ Excellent in Journalism Award for 2017.

You can read more about the DOH report here:

Investigators find ‘numerous’ issues related to patient safety at Swedish’s Cherry Hill site

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New study highlights the danger in delaying emergent surgery

Posted Friday, September 8, 2017 by Tyler Goldberg-Hoss

“Emergent” is synonymous with the need for something to occur quickly. Whatever is “emergent” is also acute, pressing, critical, imperative.

In the context of a patient needing surgery, the word takes on even greater weight and importance. You hope and trust that if you or a loved one is in such a situation, whatever surgery is needed will happen right away. The implication is that if it doesn’t, something bad will happen.

Perhaps it didn’t take a study to confirm what may be obvious, but a new study does just that. Recently the results of a study looking at delays in urgent/emergent surgeries were published in the Canadian Medical Association Journal. The study looked particularly at delays at a hospital in Ottawa.

The study found that 19% of such surgeries were delayed, often due to unavailability of an operating room or staff. The study found that those patients had an increased risk of dying while in the hospital: 5% versus 3% of patients who didn’t have a delay in their surgery.

If hospitals and other health care providers didn’t need more of an incentive to reduce that number of delayed surgeries, the study also found that it cost more for the delayed surgery patients.

You can read the full study at the CMAJ website here:

Association of delay of urgent or emergency surgery with mortality and use of health care resources: a propensity score–matched observational cohort study

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Kids with cerebral palsy may benefit from using exoskeletons to help them walk

Posted Wednesday, September 6, 2017 by Tyler Goldberg-Hoss

You may recall the paraplegic man wearing an exoskeleton kicking a soccer ball to begin the 2014. For some time now, exoskeletons have been researched to aid adults with spinal cord injuries or other paralysis walk again.

A recent study looked at exoskeletons for children, specifically those born with cerebral palsy. Cerebral palsy, or CP, is a neurologic disorder caused by a brain injury that occurs while the child’s brain is being developed. It often refers to the loss of impairment of motor function which accompanies such a brain injury.

Many children with CP walk with a crouch gait. Over time, it gets more difficult to walk, and half of all people with CP end up wheelchair bound by the time they are adults.

The study hoped to see whether the use of an exoskeleton may improve a child’s crouch gait. The results were mildly encouraging, as 6 of the 7 participants saw improvements in their gait. The hope is that, by using the exoskeletons, including outside the lab, gaits will improve and allow children increased mobility as they age.

For a more in depth look at this new research, including a video showing the improved gait of one participant using an exoskeleton, read this:

Robotic exoskeletons show promise as tool to help kids with cerebral palsy walk easier

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Does Tele-Medicine Really Work in Primary Care?

Posted Thursday, August 31, 2017 by Gene Moen

We have several blogs discussing the advent of tele-medicine, which can mean anything from remote reading of radiology films to ”virtual” medical visits via a computer. The latter aspect seemed to offer a great deal of promise, because it would encourage preventive medicine by making it easier for patients to bring their medical concerns or problems to their physician without the delays occasioned by setting up an actual visit. And doctors would spend less time in responding to those concerns. It seemed to offer great promise to both patients and their doctors.

A recent study in Management Science questions whether those assumptions are working out. It found that e-visits are leading to more office visits and more phone consultations, and more physician time spent in providing care, and less income to physicians. Study leader Hassam Barfa, PhD, of the University of Wisconsin School of Business, noted that encouraging patients to reach out to their physician, even with minor problems, put doctors in a bind. Health care providers felt that ignoring the signal was a risk, so more patient visits were set up that were not actually needed.

The study used five years of data from a large health care system with multiple hospitals. Over 140,000 patient encounters were included in the study. The results were surprising to many: office visits after online contact with physicians increased by 6%. Physicians were spending an extra 45 minutes more on those visits each month.

Critics of the study, including the president of the American Telemedicine Association, said the findings did not include many patients who benefited by the experience, and actual patient improvement in health was not studied. From a business viewpoint, observers are considering various pricing mechanisms, such as a subscription fee for electronic access, or even a charge for each individual “visit.” One commentator said that tele-medicine has the potential to change the way primary care medicine is practiced: “Think Uber versus taxis, or what Amazon has done to purchasing products.” But much of that promise is yet to be realized.

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Rock tops the list of musical genres surgeons prefer in the Operating Room

Posted Monday, August 28, 2017 by Tyler Goldberg-Hoss

In slightly lighter “news” than usual, a recent Spotify survey found that surgeons prefer Rock and Roll over other types of music when they are performing surgery.

Rock was named as the most popular genre by 49% of surgeons, followed closely by pop and classical music. Fewer surgeons preferred jazz and R&B.

Said one surgeon: “listening to rock puts me in a comfortable place so my full attention is on my patients. I listen to bands from my youth and the feeling of nostalgia brings me to a calm, focused place.”

Some top rock songs include: Rock You Like a Hurricane (Scorpions); Sweet Child O’ Mine (Guns N’ Roses); Just What the Doctor Ordered (Ted Nugent); Break on Through (To the Other Side) (The Doors); and Paint It Black (The Rolling Stones).

Surprisingly, The Beatles “Dr. Robert”, Montey Crue’s “Doctor Feelgood”, and Robert Palmer’s “Bad Case of Loving You” did not make the cut.

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