Hospital medicine

5,188 articles · Since 2004

Articles, page 142

Ambulatory surgical centers may have higher infection rates

July 8, 2010Jul 8, 20102

by Todd Neale Failure to follow recommendations to control nosocomial infections appears to be common in ambulatory surgical centers -- even during formal inspections, researchers found. Of 68 centers in three states participating in a pilot inspection program, about two-thirds…

by Todd Neale

Failure to follow recommendations to control nosocomial infections appears to be common in ambulatory surgical centers — even during formal inspections, researchers found.

Of 68 centers in three states participating in a pilot inspection program, about two-thirds (67.6%) had a lapse in at least one of five infection control categories, according to Melissa Schaefer, MD, of the CDC’s Division of Healthcare Quality Promotion in Atlanta, and colleagues.

The most common …

Conditions and diseases

The grief men face when their wives undergo mastectomies

Anesthesioboist T., MD

July 8, 2010Jul 8, 201010

I have given anesthesia for a lot of breast surgery. I don't think I'll ever get used to the fog of pain and sorrow surrounding a double mastectomy. All surgery is invasive in some way. Amputations, in particular, have a…

I have given anesthesia for a lot of breast surgery. I don’t think I’ll ever get used to the fog of pain and sorrow surrounding a double mastectomy.

All surgery is invasive in some way. Amputations, in particular, have a horror all their own; the idea that destroying someone – cutting off a body part, violating a coherent whole – should be necessary in order to save a life is almost …

Health policy

Emergency room waits grow as more people become insured

Kevin Pho, MD

July 8, 2010Jul 8, 20107

Remember when I wrote, way back when, that expanding health coverage without a concurrent increase in primary care access will only worsen emergency room waits? For instance, consider this, from CNN.com: What good is having health insurance if you can’t…

Remember when I wrote, way back when, that expanding health coverage without a concurrent increase in primary care access will only worsen emergency room waits?

For instance, consider this, from CNN.com:

What good is having health insurance if you can’t find a doctor to see you? …

… The Massachusetts Medical Society reported that the average wait time for a new patient looking for a primary care doctor ranged from 36 to

…

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Conditions and diseases

Kidney stone pain, as experienced by a man and a woman

StorytellERdoc, MD

July 5, 2010Jul 5, 201013

As a typical guy, there are several painful illnesses that can hit our brotherhood in an instant. No warning was given. No "Get out of jail free" pass, either. Just cruising along, having another fine, healthy day, and bam! --…

As a typical guy, there are several painful illnesses that can hit our brotherhood in an instant. No warning was given. No “Get out of jail free” pass, either. Just cruising along, having another fine, healthy day, and bam! — suddenly, you are lying on the floor in severe distress.

The most feared? A testicular torsion. It can happen spontaneously. It can …

Patient voices

How to treat patients who want everything

Lyle Fettig, MD

July 3, 2010Jul 3, 20102

The Annals of Internal Medicine had a perspective article by palliative medicine communication gurus Drs. Tim Quill, Bob Arnold, and Tony Back which details an approach to discussing treatment preferences with patients who want "everything." When I think of a…

The Annals of Internal Medicine had a perspective article by palliative medicine communication gurus Drs. Tim Quill, Bob Arnold, and Tony Back which details an approach to discussing treatment preferences with patients who want “everything.”

When I think of a patient requesting “everything,” I typically think of it as a response to a physician who offers the patient the choice of “doing nothing” if the patient’s heart should stop or …

Patient voices

Customer service needs to be a priority in health care

John Schumann, MD

July 1, 2010Jul 1, 201073

What do Enterprise Rent-a-Car, KeyBank, and the Cleveland Clinic have in common? They all make customer (patient) satisfaction a top priority. They accomplish this in industry-specific ways, but together their emphasis on service as a passion shares common themes: 1.…

What do Enterprise Rent-a-Car, KeyBank, and the Cleveland Clinic have in common?

They all make customer (patient) satisfaction a top priority.

They accomplish this in industry-specific ways, but together their emphasis on service as a passion shares common themes:

1. Buy-in for a service culture comes straight from the top, and permeates the entire organization.
2. Copious resources are delegated to building a service culture, starting with hiring.
3. Employees are “hired for fit.” If …

Medical education

Medication errors spike when new residents start in July

MedPage Today

June 30, 2010Jun 30, 20107

by Kristina Fiore Deaths from medication mistakes appear to spike in July, when medical residencies begin, researchers say. Over nearly a 30-year period, fatal medication errors appear to jump 10% solely in that summer month in U.S. counties with teaching…

by Kristina Fiore

Deaths from medication mistakes appear to spike in July, when medical residencies begin, researchers say.

Over nearly a 30-year period, fatal medication errors appear to jump 10% solely in that summer month in U.S. counties with teaching hospitals, David P. Phillips, PhD, of the University of California San Diego and Gwendolyn E.C. Barker, BA, of the University of California Los Angeles, reported online in the Journal of General Internal …

Conditions and diseases

Supplemental oxygen during cardiac arrest resuscitation

MedPage Today

June 26, 2010Jun 26, 2010

by Michael Smith Administering high concentrations of supplemental oxygen during resuscitation after cardiac arrest is associated with increased inhospital mortality, researchers said. So-called blood hyperoxia resulting from being given pure oxygen after cardiac arrest was associated with an 80% increase…

by Michael Smith

Administering high concentrations of supplemental oxygen during resuscitation after cardiac arrest is associated with increased inhospital mortality, researchers said.

So-called blood hyperoxia resulting from being given pure oxygen after cardiac arrest was associated with an 80% increase in the risk of death, compared with patients whose blood gases were normal on admission to the intensive care unit (ICU), according to Stephen Trzeciak, MD, of Cooper University Hospital in Camden, …

Physician voices

Obese patients present challenges in the ICU

Ralph Gordon, MD

June 25, 2010Jun 25, 20106

Obesity is a huge healthcare problem in the United States. It has reached the proportions of an epidemic and continues to get worse. Multiple medical problems including heart disease, hypertension, diabetes, sleep apnea and cancer are closely associated with obesity.…

Obesity is a huge healthcare problem in the United States.

It has reached the proportions of an epidemic and continues to get worse. Multiple medical problems including heart disease, hypertension, diabetes, sleep apnea and cancer are closely associated with obesity. The patients with extreme obesity can reach a body weight of five, six or seven hundred pounds and even higher. Riddled with chronic medical conditions, these patients often end up in …

Health policy

Healthcare reform’s focus on outcome and how that affects doctors

David B. Nash, MD, MBA

June 25, 2010Jun 25, 201015

With the signing of national healthcare reform into law, the U.S. healthcare system faces almost immediate -- and substantial -- transformation. I spent a recent Sunday reading all that I could find in order to get my arms around this…

With the signing of national healthcare reform into law, the U.S. healthcare system faces almost immediate — and substantial — transformation. I spent a recent Sunday reading all that I could find in order to get my arms around this massive piece of legislation and to understand its health policy implications.

Here is my view from 50,000 feet.

I needn’t list all of the aspects relating to expanded coverage and insurance reform …

Health policy

7 disruptive changes that will affect medicine

Stephen C. Schimpff, MD

June 24, 2010Jun 24, 20104

Generally we prefer calm seas but often they don’t get us anywhere. We need disruptions, transformations to make the changes necessary for real progress in medicine. Sometimes it is a new technology; sometimes a cultural change. But then a refinement…

Generally we prefer calm seas but often they don’t get us anywhere.

We need disruptions, transformations to make the changes necessary for real progress in medicine. Sometimes it is a new technology; sometimes a cultural change. But then a refinement may occur. The refinement may not seem like a “disruption” but indeed it can be because the refinement may create a demand for change.

Here a few more disruptive changes or refinements …

Physician voices

Healthcare providers still aren’t washing their hands enough

MedPage Today

June 24, 2010Jun 24, 20102

by Chris Emery Nurses and other healthcare providers complied with hand hygiene guidelines less than half of the time before participating in medical procedures, results of a new study showed. Compliance was better after procedures, with 72% following guidelines after…

by Chris Emery

Nurses and other healthcare providers complied with hand hygiene guidelines less than half of the time before participating in medical procedures, results of a new study showed.

Compliance was better after procedures, with 72% following guidelines after procedures compared with 41.7% before procedures, according to a report published in the May issue of Applied Nursing Research.

Overall compliance with hand hygiene guidelines was just 34.3%.

“It is important to note that …

Medical education

Op-ed: Restrictions on physician hours may not improve patient safety

Kevin Pho, MD

June 23, 2010Jun 23, 201016

A version of this op-ed was published on June 2nd, 2010 in USA Today. During medical training, I routinely stayed awake for more than 30 hours straight to care for my patients in the hospital. I strove to be the…

A version of this op-ed was published on June 2nd, 2010 in USA Today.

During medical training, I routinely stayed awake for more than 30 hours straight to care for my patients in the hospital. I strove to be the tireless physician who would be with his patients until they went home. It turns out I may have jeopardized their safety instead.

For many years, the medical field has been rightfully …

Physician voices

How transparency reduces malpractice and defensive medicine

Brad Wright, PhD

June 22, 2010Jun 22, 201011

Physician errors have been the subject of discussions about both health care costs and health care quality. We are told that if we reform the malpractice system -- capping damages -- that physicians will practice medicine less defensively and costs…

Physician errors have been the subject of discussions about both health care costs and health care quality.

We are told that if we reform the malpractice system — capping damages — that physicians will practice medicine less defensively and costs will go down as a result. We are also told that the quality of care delivered by our health care providers is less than optimal — there are estimates that nearly …

Physician voices

Treating friends, and when worlds collide in the hospital

Bruce Campbell, MD

June 21, 2010Jun 21, 2010

All the world is a stage, And all the men and women merely players. They have their exits and entrances; Each man in his time plays many parts. -Shakespeare “There’s a consult downstairs, Campbell. Go check it out and I’ll…

All the world is a stage,
And all the men and women merely players.
They have their exits and entrances;
Each man in his time plays many parts.
-Shakespeare

“There’s a consult downstairs, Campbell. Go check it out and I’ll catch up with you later.”

“Sure, OK.” I was a third-year medical student fumbling through my first clinical rotations. The resident headed off to whatever he needed to accomplish and I trotted down the back …

Physician voices

Clinical trial conflict of interest for doctors

Paul Levy

June 21, 2010Jun 21, 201016

This is a painful story to write. A close friend of mine, in his 40's, had a persistent light cough for many months. Finally, when he had an X-ray taken, it showed a large tumor on his lungs. He was…

This is a painful story to write.

A close friend of mine, in his 40’s, had a persistent light cough for many months. Finally, when he had an X-ray taken, it showed a large tumor on his lungs. He was diagnosed with stage 4 lung cancer. As a non-smoker and strapping, physically fit man, he was shocked, as you can imagine.

He went to his non-Boston-based medical practice, and he was told …

Drugs and prescribing

C. Diff and how dentists overuse antibiotics

Michael Kirsch, MD

June 20, 2010Jun 20, 201012

Why do dentists prescribe antibiotic prophylaxis so often? Because they can. Why am I dissing my dental colleagues? Because I can. Perhaps, this is a simple case of dental envy, since their profession remains within secure borders far beyond the…

Why do dentists prescribe antibiotic prophylaxis so often?

Because they can.

Why am I dissing my dental colleagues? Because I can.

Perhaps, this is a simple case of dental envy, since their profession remains within secure borders far beyond the health care reform line of fire. Consider these dental incidentals:

• Not a syllable in the ~2000 page health care reform law that affects dentists. Every filling is still worth its weight in gold
• …

Health policy

Do large hospital systems increase healthcare costs?

Roy Poses, MD

June 16, 2010Jun 16, 20106

In Rhode Island, hospitals that are part of hospital systems were paid more for the same services than independent hospitals. The price differences could not be explained by quality of care or severity of illness. The results suggested that market…

In Rhode Island, hospitals that are part of hospital systems were paid more for the same services than independent hospitals.

The price differences could not be explained by quality of care or severity of illness. The results suggested that market power determines the price of hospital services, and that increasing concentration of power in hospital networks is likely to further increase costs, without improving quality of care.

Recently, a similar report out of the neighboring state …

Physician voices

Why the medical chart may not improve patient care

Edwin Leap, MD

June 15, 2010Jun 15, 201013

Why do we physicians chart the way we do? Hopefully, you do it perfectly well and have no concerns at all. But where I practice emergency medicine, we are approaching maximum inefficiency in charting. It all became much clearer when…

It all became much clearer when we started using our new EMR system. Let me make it clear, I’m not against EMR. In fact, typing and templates work better for me than dictating. My dictations were usually …

Physician voices

Can chest pain patients be evaluated in the ER waiting room?

MedPage Today

June 12, 2010Jun 12, 20106

by John Gever Emergency department patients with chest pain may safely be evaluated in the waiting room when necessary, researchers said. Among 303 patients triaged to waiting-room evaluation in a prospective study, no acute coronary syndromes were missed and adverse…

by John Gever

Emergency department patients with chest pain may safely be evaluated in the waiting room when necessary, researchers said.

Among 303 patients triaged to waiting-room evaluation in a prospective study, no acute coronary syndromes were missed and adverse event rates overall were lower than among 804 patients who were assessed in conventional monitored beds, reported Frank Scheuermeyer, MD, of St. Paul’s Hospital in Vancouver, British Columbia, and colleagues online in …

Hospital medicine

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