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The CMG Voice

Technology and Patient Safety

Posted Tuesday, May 20, 2014 by Gene Moen

For a decade or so, technology has made inroads into hospitals and clinics as a means of enhancing patient safety and efficiency in delivering care. The major development and the most apparent has been electronic medical records (EMR).

The use of electronic records has been mandated by the Affordable Care Act and almost all hospitals — and many clinics — now have almost all patient records in electronic format. The arguments for this are strong ones, but the practice has often been less than desirable. The use of pull-down menus and “check the box” clinical information often means that the nuances of clinical observation are lost. Many clinicians have trouble navigating the computer systems and do not access key information because it is cumbersome to use.

Other technologic tools are also becoming more prevalent. Physicians can now use their smart phones or tablets to access patient records and films and can use diagnostic apps to narrow down the potential diagnoses. Just key in the signs and symptoms, and get a list of possible or likely causes of the condition. Concerned about drug reactions? In the old days, a physician would rely on his/her memory or thumb through the Physicians Desk Reference. Now this information is readily available on hand-devices that can be accessed at the bedside.

A more recent use of technology involves bar codes, the ubiquitous device at the grocery checkout counter or the airline check-in. Bar codes have become common as a means of matching hospital patients with their medications, but the push is on to make them much more widely used in hospitals. Bar code technology can be used to verify the right patient, the right drug, the right dose, the right route, and the right time (sometimes called the five “rights”).

Because bar codes can now be at the bedside, many substances can be labeled with a bar code and verified at that point (examples include blood, stem cells, bone marrow specimens, etc.). This can avoid tragic mistakes, such as when a similar-looking bottle was used but which had a solution that could kill or injure a patient. Just swipe the bottle across the bar code and it is instantly verified as the correct one.

We are probably at the infancy of medical care technology, and the question is whether the technology will actually enhance patient care and safety or whether it will be one more obstacle to the exercise of old-fashioned concepts like listening attentively to the patient and thinking carefully about what the patient really needs. As anyone knows who has been in an examining room and watched the doctor or nurse focus on the computer screen rather than the patient, technology isn’t always the answer.

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Mississippi’s caps on damages works well, unless you are an injured victim

Posted Saturday, May 10, 2014 by Tyler Goldberg-Hoss

In the early 2000s, in response to a rising call from medical professionals and their organizations, Mississippi enacted significant tort reform, including capping damage awards at $500,000.

Now, nearly 10 years later, a fascinating recent article takes a look at the consequences of that change.

Here is a link to the article:

TORT REFORM: Caps averted liability crisis but was the price diminished accountability?

Medical malpractice insurance for doctors has gone down significantly. But those savings have not been passed on to Mississippians: medical insurance premiums for consumers have not been reduced. There are many less malpractice lawsuits brought, due to the risk of such cases and the lack of victims to recover their full measure of damages in catastrophic cases.

And perhaps most important, there is a lack of accountability for medical professionals who negligently harm and kill Mississippians.

Oliver Diaz, attorney in Jackson and famously one subject in the documentary Hot Coffee, was quoted in the article. He has had to turn away victims with otherwise meritorious claims because the numbers involved in a lawsuit simply don’t pencil out.

What was sold to citizens as a response to ‘frivolous lawsuits’ is instead preventing most injured victims from getting full – or any – recovery.

Citizens in Washington should count themselves fortunate that such tort reforms bills have not been passed in our state. Those reforms that have been passed that have created barriers to victims seeking justice have nearly all been overturned by the State Supreme Court.

Victims’ rights champions, including the Washington State Association for Justice, are to thank for lobbying the State legislature against the kinds of harmful laws that are in place in states like Mississippi.

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Avoiding Misdiagnosis: Tips for Doctors, Patients, and Health Care Organizations

Posted Monday, May 5, 2014 by Tyler Goldberg-Hoss

The most recent edition of Inside Medical Liability includes an article titled “Minimizing Diagnostic Error: 10 Things You Could Do Tomorrow.”

In it, the author describes the current state of diagnostic errors in healthcare. Approximately 1 out of every 1,000 diagnostic encounters results in harm due to a diagnostic error, while the number is much higher when including errors that don’t result in harm. Diagnostic errors resulted in lawsuits more than any other type of claim, and it’s not the rare diseases that get missed. Most often it’s the common ones.

The article ends with 10 tips for doctors, 10 tips for healthcare organizations and 10 tips for patients to avoid diagnostic errors.

For doctors, these tips include taking time to think, really listen to your patient, and taking advantage of resources such as other doctors for second opinions.

For health care organizations, tips include encouraging communication when there is an error, encouraging communication between radiologists and laboratory doctors with the front line physicians, and empowering patients.

Finally, patients can help to avoid diagnostic errors by taking control over their care, including asking for second opinions and coordinating follow up visits, speaking up about their symptoms, and asking doctors questions to learn more about the condition.

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Florida strikes down caps on non-economic damages in medical malpractice cases.

Posted Tuesday, April 29, 2014 by Tyler Goldberg-Hoss

Recently, the Florida Supreme Court found, by a 5-2 vote, that caps on non-economic damages in medical malpractice cases violated the Florida equal protection clause.

Caps were originally set, not only in Florida but in many other states, as a response to worries of a medical malpractice “crisis,” which includes insurance rates rising and doctors being forced to move their practices out of state.

What this Court found was that such a “crisis” was not supported by available data. This decision will not significantly affect access to health care, but will allow families to be rightfully compensated for the negligence of health care providers.

Read the article here:

Florida Supreme Court Throws Out Statutory Caps on Wrongful Death Cases

Fortunately, victims of malpractice in Washington are not faced with such caps on damages. Although every year there is some threat in the legislature to “reform” laws governing medical malpractice, victims of heath care errors have thus far been spared serious erosion of their rights.

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Time loss is brain loss: timely treatment for strokes possible, but not probable in today’s world

Posted Wednesday, April 23, 2014 by Tyler Goldberg-Hoss

A recently published article in the Journal of the American Medical Association (JAMA) has shed some light on the availability for treatment of stroke victims, as well as the barriers there are in getting victims the treatment they need within the time when it makes a difference.

The medication is tPA – officially “Tissue Plasminogen Activator” and colloquially a “clotbusting” drug. Victims of ischemic strokes who are treated quickly – within 60 minutes of experiencing stroke symptoms – have the best chance to avoid brain damage or death. Certainly, tPA is given after this time for patients in the hopes of being effective, but this article highlights the idea that sooner is better.

The problem is, for many reasons, most victims eligible for the treatment do not receive it within this “golden hour.”

The JAMA article details the ways in which hospitals can shorten the time from “Door-to-Needle.” This includes improved communication between ambulance staff and the emergency department, educating the public on how to identify a person who is having a stroke, and even having specialized ambulances bring the treatment to the stroke victim, complete with tPA, a CT scanner, lab equipment, and a neurologist.

As of now, only 30% of stoke victims receive tPA within 60 minutes. JAMA and the American Stroke Association have collaborated on “Target:Stroke,” which is designed to improve the quality of stroke treatment nationally. Target:Stroke is recognizing hospitals who meet their goal of treating at least 50% of stroke victims within an hour.

You can read an article summarizing the JAMA article here:

Hospitals Can Speed Stroke Treatment, But It’s Not Easy

You can find the full JAMA article for free here:

Door-to-Needle Times for Tissue Plasminogen Activator Administration and Clinical Outcomes in Acute Ischemic Stroke Before and After a Quality Improvement Initiative

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