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Most ‘sentinel events’ caused by poor communication

LOS ANGELES—I’m on the west coast now, first for the  USC Body Computing Conference here Friday, and then for the annual Health 2.0 conference up in San Francisco Monday and Tuesday.

Friday there was a lot of talk of healthcare reform. One interesting — and plausible — idea I heard for the first time is that the new Medicare policy of denying reimbursements for preventable readmissions within 30 days of discharge for patients with heart attack, heart failure or pneumonia might have an unintended consequence: We’ll start seeing a lot of readmissions on or after Day 31.

The new policy is one of the many aspects of true reform in the Patient Protection and Affordable Care Act beyond the controversial insurance expansion. And there seems to be a loophole that you can be sure  a lot of hospitals will seek to exploit. Even if they don’t, it is hard to change patient behavior, so it’s likely many will come back to the hospital for the same condition, even if it’s not within 30 days.

More importantly, I heard some statistics presented by Stanford dermatology resident Michelle Longmire, M.D., about medical errors: 7o percent of all sentinel events in U.S. healthcare facilities — and there were 8,859 such events voluntarily reported to the Joint Commission between 1995 and the first quarter of 2012, meaning that many times more probably occurred —result from breakdowns in communication. Half occur during patient handoffs such as shift changes, specialist consultations and transfers to other wards or facilities, Longmire said.

I am convinced all the buffoonery that took place while my dad was hospitalized prior to his death was due to communication problems, poorly designed work processes and a culture of covering one’s posterior in an error-prone organization.

This happens far too often, yet some politicians who want to repeal “Obamacare” keep trying to convince the ignorant masses that American healthcare is just in need of a few tweaks.

At the Republican National Convention in August, New Jersey Gov. Chris Christie said the following: “”Mitt Romney will tell us the hard truths we need to hear to end the debacle of putting the world’s greatest healthcare system in the hands of federal bureaucrats and putting those bureaucrats between an American citizen and her doctor.” PolitiFact.com generously rated this as “half true.” However, PolitFact itself noted that the World Health Organization rated U.S. healthcare as 37th of 191 countries in terms of “overall performance.” The Organization for Economic Cooperation and Development says we spend more on healthcare as a share of gross domestic product than any of the other 33 OECD countries. If that’s the “world’s greatest,” I’d sure hate to be worst.

Last week, during the first presidential debate, former Massachusetts Gov. Mitt Romney, the very same Gov. Romney who championed near-universal health insurance coverage with an individual mandate in his home state — a plan first hatched by the conservative Heritage Foundation as an alternative to the Clinton healthcare reform proposal in 1993 — said this:

Look, the right course for — for America’s government — we were talking about the role of government — is not to become the economic player picking winners and losers, telling people what kind of health treatment they can receive, taking over the healthcare system that — that has existed in this country for — for a long, long time and has produced the best health records in the world.

Without getting into what the role of government should or should not do, our health records suck, Our record on producing healthier people is not so wonderful, either. So no matter what Romney meant by “best health records in the world,” he was lying.

I couldn’t help thinking he was playing to this crowd:

 

Now, this cartoon makes it seem like Obamacare is so wonderful. It’s not. As I’ve said before, having insurance does not mean you will get good care. Having “good” insurance that requires very little out-of-pocket for the patient doesn’t guarantee good care, either, nor does being a VIP. Recall the case of James Tyree, who died from a medical error at a prestigious teaching hospital he was on the board of. The late Rep. John Murtha (D-Pa.) suffered a similar fate despite having “Cadillac” insurance coverage.

I’m going to repeat what is fast becoming my mantra: It’s quality, stupid.

UPDATE, Oct.8: Here’s a summary of what actually is in the Affordable Care Act, and when each provision takes effect, courtesy of the Kaiser Family Foundation.

 

October 7, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

MedInfo coverage


After a week of pressing deadlines and erratic sleep courtesy of the worst case of jet lag I’ve ever encountered, I’ve finally collected my thoughts and my wits, and am ready to post a few things from MedInfo 2007 and related conferences.

I thought I’d start by posting links to some of the stories I’ve written from my trip to Australia. I have a couple of podcasts to post as well, plus some more writing to do, but here’s something. I was the only full-time journalist from either North America or Europe at MedInfo, so I’m using that to my advantage. (If there’s any editor out there still interested in coverage, I’m listening. I have nearly 500 poster presentations to draw on, to give you an idea of the breadth of material available.)

From Digital HealthCare & Productivity

“Optimism Marks Opening of the MedInfo 2007″ (Aug. 21)
My report of the keynote address by Sir Muir Gray, NHS director of clinical knowledge.

“A Tale of RHIO Success” (Aug. 21)
I travel all the way to Australia to report on Winona Health in Minnesota.

“Kolodner Says U.S. Will Reach Pres. Bush’s 2014 EHR Goal” (Aug. 28)
My coverage of Dr. Robert Kolodner’s keynote address to MedInfo, with snippets from the interview he gave me.

“Shortage of Health-IT Workers Is Limiting Progress” (Aug. 28)
News of a collaboration between the International Medical Informatics Association and the World Health Organization, based on my interview with officials of both organizations and their presentations to MedInfo.

“Grappling with the Softer Side of Health-IT” (Sept. 5)
This is another exclusive: my coverage of the ITHC 2007: the Third International Conference on Information Technology in Health Care: Socio-technical
Approaches
, a small, focused meeting held in Sydney a week after MedInfo.

“Reporter’s Notebook: From the Land Down Under” (Sept. 5)
Exactly what it sounds like.

From E-Health Insider and EHealth Europe

“IMIA and WHO to ‘revitalise relationships’” (Aug. 23)
Another take, in more depth, of the IMIA-WHO collaboraton.

“Wireless solutions simplify communication” (Aug. 31)
I look at creative applications of wireless technology in Denmark and Austria.

September 9, 2007 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.