It has all the fixings of a front-page health narrative – the handsome baseball star, the stunning neurological condition, the virtuoso brain surgeon and the arduous, improbable comeback – but Charlie Pierce’s piece in The Boston Globe Magazine is remarkable not for these stuff-of-legend elements, but for the mundane ones.
From how his first symptoms affected top prospect Ryan Westmoreland’s ability to gun down the bad dudes in “Call of Duty” to how he spent a week practicing stair climbing before he could board the Red Sox owner’s private plane, Pierce nails the niggling medical realities that drive this profile home. I could recap the highlights, but this is a case where the value lies in the storytelling as much as in the story.
In the wake of several high-profile incidents, The Boston Globe‘s Liz Kowalczyk has assembled a thorough investigation of alarm fatigue in hospitals. Alarm fatigue, for the record, is the idea that the huge arsenal of patient monitors in any given hospital floor are going off so often that nurses become slower in their responses to the alarms. For example, in one 15-bed unit at Johns Hopkins, staff found that, on average, one critical alarm went off every 90 seconds throughout the day.
With the help of ECRI, Kowalczyk has managed to attach some numbers to the issue.
The Globe enlisted the ECRI Institute, a nonprofit health care research and consulting organization based in Pennsylvania, to help it analyze the Food and Drug Administration’s database of adverse events involving medical devices. The institute listed monitor alarms as the number-one health technology hazard for 2009. Its review found 216 deaths nationwide from 2005 to the middle of 2010 in which problems with monitor alarms occurred.
But ECRI, based on its work with hospitals, believes that the health care industry underreports these cases and that the number of deaths is far higher. It found 13 more cases in its own database, which it compiles from incident investigations on behalf of hospital clients and from its own voluntary reporting system.
Kowalczyk also looks at potential solutions to the problem and how some institutions are trying to make changes to eliminate alarm fatigue, including cutting back on unnecessary monitors and having monitor warnings appear on nurses’ pagers or cell phones.
“Yes, this is real, and, yes, it’s getting worse,’’ said Carol Conley, chief nursing officer for Southcoast Health System, which includes Tobey Hospital. “We want to keep our patients safe and take advantage of all the technology. The unintended consequence is that we have a very over-stimulated environment.’’
“Everyone who walks in the door gets a monitor,’’ said Lisa Sawtelle, a nurse at Boston Medical Center. “We have 17 [types of] alarms that can go off at any time. They all have different pitches and different sounds. You hear alarms all the time. It becomes . . . background.’’
Kowalcyzk’s investigation points out that, while alarms do tend to go off when there’s a real problem, it appears that they do so at the expense of also going off when there isn’t.
Monitors can be so sensitive that alarms go off when patients sit up, turn over, or cough. Some studies have found more than 85 percent of alarms are false, meaning that the patient is not in any danger. Over time this can make nurses less and less likely to respond urgently to the sound.
For more specifics on device design issues, see the final subheading, titled “Looking for solutions.”
For a one year, the Joint Commission made routine alarm testing and training part of their accreditation requirements, but dropped the stipulation in 2004 when it felt the problem had been solved.
Medical Marketing & Media‘s Marc Iskowitz profiles a new continuing medical education provider, Lighthouse Learning.
Started by a Harvard neurologist and an executive, both with former ties to CME firm Pri-Med, along with a third partner, Lighthouse Learning receives no funding from pharmaceutical or device companies for the development of its curricula. Instead, the business model relies exclusively on licensing content nationwide, to medical societies, insurers and meetings companies.
Most American physicians are required to earn CME credits to maintain their licenses. These are often industry-sponsored, but while Lighthouse is in the headlines, it’s not alone. Iskowitz again:
Lighthouse’s funding model is not without precedent, though, said Dr. Murray Kopelow, executive director of the Accreditation Council for CME. He told MM&M that 772—or 35% of the 2,225 ACCME-accredited providers submitting data for the 2009 ACCME annual data report—took neither commercial support nor advertising/exhibit income for their educational programs. A total of 943 providers, or 42%, accepted no commercial support. Many of these are providers accredited by state medical societies, and it’s not known whether any of them operate on a national scale, as the council has not analyzed data in this regard.
Notable psychiatry (and COI) blogger Daniel Carlat has taken notice of the new company as well, noting that coverage of its launch shows that conflicts of interest in CME are officially mainstream news.
The Boston Globe broke the story in this article on their front page, which is in itself significant. It means that mainstream journalists understand that the funding of medical education is no longer an arcane topic that is of interest only to a few insiders.
Carlat also provides a little context on one of the company’s founders and his CME past.
According to new data from the Massachusetts Health Quality Partners, a coalition that includes doctors, hospitals, and health plans, 83 percent of adult patients said when they called their doctor’s office for care they needed right away, they always or almost always got an appointment quickly.
Fewer patients — 78 percent — reported that they always or almost always got an appointment for a routine check-up or after-hours help as soon as they needed it.
To add some context, Kowalczyk compared the results to numbers from the 2007 survey, which was conducted before Massachusetts had fully boarded the expanded coverage train.
Still, said Barbra Rabson, the group’s executive director, the survey showed slight declines in patient access to their doctors, which could be a warning sign of growing strain in the system. “We need to watch this very carefully,” she said.
In addition to the sort of health care access numbers that bear directly upon reform coverage, the survey also included typical consumer satisfaction-oriented questions. By those measures, at least, care in Massachusetts seems to be improving slightly. The one area of decline? Coordination of care.
She interviewed Ivan Oransky, M.D., AHCJ’s treasurer and executive editor of Reuters Health, who reminds us that epidemiological studies are conducted in the real world, not a carefully controlled lab, so they’re often open to misinterpretation.
Weiss’ piece reminds us to take care in how critically we look at studies and to be careful of oversimplifications.
A story by Boston Globe reporters Scott Allen and Marcella Bombardieri questions the provision of nonprofit status for hospitals and the tax breaks that come with it, vestiges of a time when hospitals needed financial incentives to treat the nation’s poor.
The 10 leading hospital companies benefited from an estimated $638 million in federal, state, and local tax breaks as well as state discounts on borrowing in 2007, the latest year for which complete data are available. More than half of that goes to two large and growing companies, Partners and Children’s Hospital. Overall, the 10 hospital companies’ tax breaks and other benefits were worth $264 million more than the value of the “community benefits” – care for the poor and other charity work – they reported to the state attorney general that year.
The reporters also note that Massachusetts health care reform has helped increase the gap; hospitals now provide half as much free care as they did before reforms were instituted (Today, about 1 percent of patients don’t have to pay). In the midst of a climate of tight budgets and potential reforms, a group of politicians led by Republican Sen. Charles Grassley of Iowa is calling for rules holding nonprofit hospitals to higher standards of charity work than their for-profit peers.
The in-depth story digs deeper into potential reforms and issues and paints a detailed financial picture of the impact the nonprofit status of major hospitals is currently having on the state’s budget.