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The CMG Voice

Robots Versus Humans in Mitral Valve Surgery

Posted Friday, July 6, 2018 by Morgan Cartwright

Mitral valve repair is an operation designed to fix the valve on the left side of an individual’s heart. Some mitral valve diseases include mitral valve regurgitation (valves don’t close tightly, causing blood to leak backward) or mitral valve stenosis (the leaflets become thick or stiff, and may fuse together). To repair or replace mitral valves often requires surgery.

Mitral valve surgery can be either open-heart or minimally invasive (known as mini-thoracotomy). The mini-thoracotomy surgery involves small incisions in the chest to operate on the heart. New technology has provided a robot-assisted method, but human minimally invasive surgery is still more common.

A recent study between human and robot-assisted mini-thoracotomies showed that human operations resulted in fewer transfusions (5% vs. 15%), lower atrial fibrillation rates (18% vs. 26%), shorter surgery time (60 min vs. 83 min), and shorter average hospital stay (1 day shorter). However, the overall outcomes were very similar although the robotic arm had fewer discharges to a facility than a home (7% vs. 15%).

The study does note that patients who had robot-assisted surgery were generally lower risk, lower comorbidity burden, but higher degenerative mitral valve disease. While the researchers did attempt to baseline the imbalances, the study was not causative.

For Mitral Valve Surgery, Mini-Thoracotomy May Trump Robotic Approach

Minimally Invasive Cardiac Surgery

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Identifying the Appropriate Amount of VTE Prophylaxis in Hospitals

Posted Tuesday, July 3, 2018 by Morgan Cartwright

Venous thromboembolism (VTE) is a medical condition that occurs when a blood clot forms in the deep veins of the leg, groin or arm. It is also known as deep vein thrombosis (DVT). If the clot breaks off and travels in the circulation, it can block a blood vessel in the lungs, known as a pulmonary embolism (PE). It is treated through VTE prophylaxis, which refers to both pharmacological (blood thinners typically) and/or non-pharmacological (such as compression stockings) interventions to prevent VTE.

VTE can occur after major general surgery. However, the risk of VTE is different depending on the patient and procedure. PE has been shown to be one of the most common identifiable causes of death in hospitals in the United States. This creates a need for hospitals to recognize the level of risk and order the appropriate amount of VTE prophylaxis.

A recent study suggests that hospitals have been overusing VTE prophylaxis by giving too much to patients. Lower risk patients – those who are not recommended to get any prophylaxis – were giving blood thinners 57.1% of the time, and 77.9% were given at minimum a compression device such as compression stockings.

Higher risk patients have also been systematically given too much prophylaxis. 32.3% of such patients without a contraindication to blood thinning medication (a factor suggesting withholding) were given too much, and 26.9% for those with a contraindication to pharmacological treatments were given too much.

Hospitals have been overusing VTE prophylaxis to various degrees, which can be dangerous. The consequences of overuse include bleeding, impaired mobility, falls, discomfort, and other adverse effects.

Without properly identifying the appropriate amount of VTE prophylaxis, hospitals unnecessarily risk the safety of their patients.


What is Venous Thromboembolism (VTE)?

Venous Thromboembolism Prophylaxis

Study: Hospitals Overuse VTE Prophylaxis

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From Hospital to Nursing Home to Hospital

Posted Friday, June 29, 2018 by Morgan Cartwright

The elderly end up in hospitals due to falls, disease, stroke, and illness. Often, patients are forced to nursing homes sooner than may be ideal for their health. Unfortunately, many of these homes fail to live up to provide the needed care. This includes not heeding or receiving accurate hospital/physician instructions and creating new problems. Many are potentially preventable conditions, including dehydration, infections, and medication errors.

As a result, the elderly patients often arrive to the nursing home from the hospital and are sent back shortly thereafter. Federal records show that one in five Medicare patients sent to a nursing home from the hospital are sent back to the hospital within 30 days. Further, out of the nation’s 15,630 nursing homes, one out of five send 25% or more of their patients back to the hospital. This is largely a result of financial coverage of these patients for both the hospitals and nursing homes, including variable rates according to hospital treatment time, higher nursing home insurance coverage upon return from hospital, and bed-hold insurance.

However, even the fifth of nursing homes with the lowest overall readmission rates were at about 17%. As a result, the government has stepped in to try to address this readmission problem. In 2013, the government began fining hospitals for high readmission rates to discourage premature discharges and encourage referrals to good nursing homes. Starting this October, the government will start giving nursing homes bonuses or penalties on their Medicare rehospitalization rates.

While the government’s readmission policies are just beginning to take form, there seems to be progress. The rate of potentially avoidable readmissions dropped to 10.8% in 2016 from 12.4% in 2011. However, there are some who worry the effect will be that bad nursing homes will stop sending patients to the hospital.

Medicare Eyes Hospital Readmissions from Nursing Homes

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Cyber security attacks on hospitals put Electronic Health Information at risk

Posted Tuesday, June 26, 2018 by Tyler Goldberg-Hoss

Given the nature and depth technology has been incorporated into our lives, it is not hard to imagine how we might be affected if such technology was hacked and malicious entities gained access to it.

Add Electronic Health Information to the list of such concerns. A recent survey of health care institution executives (and some from device manufacturers) counted as many as 1000 patients who have suffered harm due in some part to cyber security attacks.

Preventing attacks can be problematic. Technology becomes antiquated relatively quickly, and it is more and more difficult to support updates or patches to possible vulnerabilities.

Interestingly, the FDA has set forth guidance on cyber security, including regulations for meeting mandatory quality system regulations. 20% of survey respondents said they did not implement these new policies, and another twenty percent said they don’t plan to.

You can read more on this topic here:

New research shows patients harmed by medical device breaches

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Amazon is coming for you(r health care)

Posted Thursday, June 21, 2018 by Tyler Goldberg-Hoss

If you live in Seattle, you’ve probably heard of Amazon. Heck, if you live period, you’ve probably heard of Amazon. Like millions of others, you may also interact on occasion with Amazon’s virtual assistant, Alexa.

Alexa often comes though an Amazon device called an Echo. The Echo sits in your home, and you can tell it to do things, such as set a timer, play a song, turn the volume up or down, and tell you what the weather is like outside.

You may also have heard that Amazon is dipping its rather large toe into the health care industry. Recently it announced a partnership with other corporations to revolutionize health care, including drug manufacturing. Now, it appears that Amazon may use Alexa to help it gain traction in the health care industry.

Now obviously, Alexa isn’t going to be performing surgery anytime soon (though it has been tested in operating rooms to help surgeons go through safety checklists prior to operating), nor is it likely to diagnose you with medical conditions. But it may be useful in managing chronic illnesses such as diabetes, or otherwise helping patients keep compliant on taking medications.

Further, for family members who are elderly, Alexa can be a way for someone to call for help in the event he or she is incapacitated from a fall.

You can read more about this development here:

Why Alexa’s Next Big Move Is Into Health Care

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