This blog will explore in the coming days several aspects of the American Health system.
I'll look at cost, mortality rates, infection control, the hospital incentive structure and other items seeking an answer to the question to why our health care system costs twice as much as those of other countries and we have poor and mediocre outcomes compared to those other countries.
But first we look at the most deadly of all situations for a patient entering a hospital for any reason: the threat of getting infections while there.
This is crucial and hospitals have not solved this problem. Death caused by compliations of surgery, or some other items most often is code for infection and means a patient, even a healthy one, got an infection after being admitted to the hospital. Doctors and hospitals will say pneumonia, sepsis and other seemingly unrelated items or blame it on the age or other unrelated diseases. But shock is a major reaction to serious infections: this leads on to these "complications."
(By the way many surgeons have to redo operations because a sponge was left inside the patient. Sponge counts are critical before closing the patients.)
See:
http://www.sciencedaily.com/releases/2012/12/121219111336.htm
We will identify the problem of infection first and then talk about what to do if you or loved one has to go to a hospital-The Wise Patient's Guide to Surviving a Hospital Stay."
See articles on infection below.
http://www.sciencedaily.com/releases/2013/05/130522141841.htm
http://www.sciencedaily.com/releases/2013/09/130902181001.htm
Private rooms reduce infection and mortality rates
http://www.sciencedaily.com/releases/2011/01/110110164742.htm
Patients changing hospitals often carry infections with them
http://www.sciencedaily.com/releases/2010/03/100319085304.htm
Hospitals which cooperate on infection control have better outcomes
http://www.sciencedaily.com/releases/2012/10/121009161059.htm
Infection related deaths in Europe
http://www.sciencedaily.com/releases/2011/10/111011171544.htm
ICU most dangerous for infections
http://www.sciencedaily.com/releases/2012/10/121015161916.htm
What some hospitals are trying in order to control infections
http://www.sciencedaily.com/releases/2011/08/110811181718.htm
A World Wide Study on Infections
http://www.sciencedaily.com/releases/2011/08/110824115846.htm
Infections in Nursing Homes
http://www.sciencedaily.com/releases/2010/12/101201162115.htm
Putting Grandma in a nursing home can be bad for her health
http://www.sciencedaily.com/releases/2009/06/090604095131.htm
Even if you are getting out-patient or in the doctor's office treatments you are not safe
http://www.sciencedaily.com/releases/2009/11/091124082801.htm
"MRSA kills an estimated 20,000 people in the United States each year. The superbug, which is resistant to most common antibiotics, can attack wounds and trigger potentially lethal blood stream infections. Community-associated strains, while generally less virulent and susceptible to more antibiotics, can still cause significant morbidity and mortality.
"MRSA has generally been a significant problem only in hospitals," said Eili Klein, the report's lead author and researcher at Resources for the Future. "But the findings from this study suggest that there is a significant reservoir in the community as well." This community reservoir leads to a dangerous spread of community-associated strains from outpatient units into hospitals, according to Klein.
To curtail this spread, hospitals will need to step up infection control procedures, including those practiced in outpatient units."
Medline offers some suggestion on infection control
http://www.nlm.nih.gov/medlineplus/infectioncontrol.html
Healthcare-associated infections
From:
http://www.healthinsight.org/Internal/Hospital.html
5/26/13
Now we are ready to summarize to this point:
:
1. Infection is important because certain kinds of infections require fluids and/or antibiotics in a matter of hours and others can enter the blood stream and in 24 hours bring on fatal results. So speed is important.
2. Always get the name of the attending doctor and nurse so that you can call and keep up to date from the admission/treatment point from inception.
3. Always ask about what is being used to treat you or a loved one, and what are the alternative, less instrusive options. Never agree to emergency surgery unless you have throughly explored the options.
4. Get clear from the beginning on who is making decisions in the family on treatment and at decision points
5. Read up on what complaints or aliments you are dealing with on the internet-before not after treatment.
6. Look up the doctor treating your loved one and the hospital and the department--what has been their infection rates, mortality rates, accreditation issues and the like.
7. Check is to what are the details of any DNR(Do Not Resuscitate) you or your loved one might have.
8. If coma is involved ask before hand if doctors in their treatment plan will induce a comma or not.
Other check lists from attorneys
http://www.urymoskow.com/CM/Articles/10-Things-You-Need-to-Know-About.asp
http://www.bakerandgilchrist.com/legal-services/hospital-malpractice/10-things-you-need-to-know-about-hospitals/
The Consumer Report Hospital Survival Guide
http://www.consumerreports.org/cro/2012/10/your-hospital-survival-guide/index.htm
More tommorow.
Sepsis in NY Hospital system. Read this carefully
http://www.nyc.gov/html/hhc/html/safety_quality/prev_inf.shtml
5/27/13
70 percent of patients leave it up to the doctor on health care decisions?
But note doctors and medical law legally assume patients participate and make the decisions-even though we and they know patients don't. Doctors, therefore, have little responsibitity if things go wrong. (Same thing is now true in the accounting profession. Audits now mean nothing.)
http://www.consumeraffairs.com/news/studies-examine-the-patients-role-in-healthcare-decision-making-052813.html
http://www.ct.gov/agingservices/lib/agingservices/pdf/advancedirectivesenglish.pdf
5/28/13
So we ask, who exactly is responsible if something goes wrong with treatments from the doctor and the hospital? It varies state by state but let's look at the over-all picture.
First doctors and hospitals have limited their liabilities under various laws such that the burden of proof falls upon the patient, under the guise of "patient rights."
What this actually means is that under most state laws patients are legally responsible for making their own health care decisions, or the family. The doctor is only an "advisor." Couple that with limits on the dollar amounts patients can sue for and and limits on class action suits and doctors and hospitals have little liability for patients that die in their care.
15-20 percent of all patients in this country are harmed by the care they received.
If you realize that this occurs with the 2.2 million disease-related deaths a year the number is more than huge.
http://www.cdc.gov/nchs/fastats/deaths.htm
Couple this with the fact that unecessay testing is done by doctors and hospitals 90 percent of the time on patients resulting in higher hospital and doctor bills as well.
Doctors and hospitals justify all this testing claiming they are protecting themselves from lawsuits, but the fact of the matter is that their incomes are based on tests and procedures they perform and you get at the real reason for the testing-increasing their income.
Moreover, all this testing has been shown to be of little benefit to patients and the picture and incentive structure is clear: more tests, more money for doctors and hospitals. Add infection related income and the picture in not a pretty one.
The argument that such testing reduces doctors and hospitals liability and protects against lawsuits has been shown to be unrelated to both lawsuits and patient outcoms.
What is wrong with this picture?
Let's start with this article:
"However, AHRQ researchers reviewing the impact of these approaches found "little solid evidence" about the impact of medical liability reforms on the cost of care and even less information about the impact of these reforms on patient safety (Hellinger et al., 2009). Furthermore, the medical liability system may actually hamper progress on patient safety by dissuading physicians from disclosing and examining the root causes of medical errors (Studdert et al., 2004)."
http://www.ahrq.gov/news/newsroom/commentaries/putting-patients-first.html
More tommorow.
More info:
http://www.aaos.org/about/papers/position/1118.asp
I'll look at cost, mortality rates, infection control, the hospital incentive structure and other items seeking an answer to the question to why our health care system costs twice as much as those of other countries and we have poor and mediocre outcomes compared to those other countries.
But first we look at the most deadly of all situations for a patient entering a hospital for any reason: the threat of getting infections while there.
This is crucial and hospitals have not solved this problem. Death caused by compliations of surgery, or some other items most often is code for infection and means a patient, even a healthy one, got an infection after being admitted to the hospital. Doctors and hospitals will say pneumonia, sepsis and other seemingly unrelated items or blame it on the age or other unrelated diseases. But shock is a major reaction to serious infections: this leads on to these "complications."
(By the way many surgeons have to redo operations because a sponge was left inside the patient. Sponge counts are critical before closing the patients.)
See:
http://www.sciencedaily.com/releases/2012/12/121219111336.htm
We will identify the problem of infection first and then talk about what to do if you or loved one has to go to a hospital-The Wise Patient's Guide to Surviving a Hospital Stay."
See articles on infection below.
http://www.sciencedaily.com/releases/2013/05/130522141841.htm
http://www.sciencedaily.com/releases/2013/09/130902181001.htm
Private rooms reduce infection and mortality rates
http://www.sciencedaily.com/releases/2011/01/110110164742.htm
Patients changing hospitals often carry infections with them
http://www.sciencedaily.com/releases/2010/03/100319085304.htm
Hospitals which cooperate on infection control have better outcomes
http://www.sciencedaily.com/releases/2012/10/121009161059.htm
Infection related deaths in Europe
http://www.sciencedaily.com/releases/2011/10/111011171544.htm
ICU most dangerous for infections
http://www.sciencedaily.com/releases/2012/10/121015161916.htm
What some hospitals are trying in order to control infections
http://www.sciencedaily.com/releases/2011/08/110811181718.htm
A World Wide Study on Infections
http://www.sciencedaily.com/releases/2011/08/110824115846.htm
Infections in Nursing Homes
http://www.sciencedaily.com/releases/2010/12/101201162115.htm
Putting Grandma in a nursing home can be bad for her health
http://www.sciencedaily.com/releases/2009/06/090604095131.htm
Even if you are getting out-patient or in the doctor's office treatments you are not safe
http://www.sciencedaily.com/releases/2009/11/091124082801.htm
"MRSA kills an estimated 20,000 people in the United States each year. The superbug, which is resistant to most common antibiotics, can attack wounds and trigger potentially lethal blood stream infections. Community-associated strains, while generally less virulent and susceptible to more antibiotics, can still cause significant morbidity and mortality.
"MRSA has generally been a significant problem only in hospitals," said Eili Klein, the report's lead author and researcher at Resources for the Future. "But the findings from this study suggest that there is a significant reservoir in the community as well." This community reservoir leads to a dangerous spread of community-associated strains from outpatient units into hospitals, according to Klein.
To curtail this spread, hospitals will need to step up infection control procedures, including those practiced in outpatient units."
Medline offers some suggestion on infection control
http://www.nlm.nih.gov/medlineplus/infectioncontrol.html
Reducing Healthcare-associated Infections
"99,000 people die due to health care-associated infections (HAI) every year in the United States and nearly 28 to 33 billion dollars are spent on these infections. Nationwide efforts through many organizations are now working to address this issue.Healthcare-associated infections
- Put patients at risk
- Increase days of hospitalization
- Add healthcare costs
- Are associated with morbidity/mortality being higher in acute care hospital settings
From:
http://www.healthinsight.org/Internal/Hospital.html
5/26/13
Now we are ready to summarize to this point:
:
1. Infection is important because certain kinds of infections require fluids and/or antibiotics in a matter of hours and others can enter the blood stream and in 24 hours bring on fatal results. So speed is important.
2. Always get the name of the attending doctor and nurse so that you can call and keep up to date from the admission/treatment point from inception.
3. Always ask about what is being used to treat you or a loved one, and what are the alternative, less instrusive options. Never agree to emergency surgery unless you have throughly explored the options.
4. Get clear from the beginning on who is making decisions in the family on treatment and at decision points
5. Read up on what complaints or aliments you are dealing with on the internet-before not after treatment.
6. Look up the doctor treating your loved one and the hospital and the department--what has been their infection rates, mortality rates, accreditation issues and the like.
7. Check is to what are the details of any DNR(Do Not Resuscitate) you or your loved one might have.
8. If coma is involved ask before hand if doctors in their treatment plan will induce a comma or not.
Other check lists from attorneys
http://www.urymoskow.com/CM/Articles/10-Things-You-Need-to-Know-About.asp
http://www.bakerandgilchrist.com/legal-services/hospital-malpractice/10-things-you-need-to-know-about-hospitals/
The Consumer Report Hospital Survival Guide
http://www.consumerreports.org/cro/2012/10/your-hospital-survival-guide/index.htm
More tommorow.
Sepsis in NY Hospital system. Read this carefully
http://www.nyc.gov/html/hhc/html/safety_quality/prev_inf.shtml
5/27/13
70 percent of patients leave it up to the doctor on health care decisions?
But note doctors and medical law legally assume patients participate and make the decisions-even though we and they know patients don't. Doctors, therefore, have little responsibitity if things go wrong. (Same thing is now true in the accounting profession. Audits now mean nothing.)
http://www.consumeraffairs.com/news/studies-examine-the-patients-role-in-healthcare-decision-making-052813.html
http://www.ct.gov/agingservices/lib/agingservices/pdf/advancedirectivesenglish.pdf
5/28/13
So we ask, who exactly is responsible if something goes wrong with treatments from the doctor and the hospital? It varies state by state but let's look at the over-all picture.
First doctors and hospitals have limited their liabilities under various laws such that the burden of proof falls upon the patient, under the guise of "patient rights."
What this actually means is that under most state laws patients are legally responsible for making their own health care decisions, or the family. The doctor is only an "advisor." Couple that with limits on the dollar amounts patients can sue for and and limits on class action suits and doctors and hospitals have little liability for patients that die in their care.
15-20 percent of all patients in this country are harmed by the care they received.
If you realize that this occurs with the 2.2 million disease-related deaths a year the number is more than huge.
http://www.cdc.gov/nchs/fastats/deaths.htm
Couple this with the fact that unecessay testing is done by doctors and hospitals 90 percent of the time on patients resulting in higher hospital and doctor bills as well.
Doctors and hospitals justify all this testing claiming they are protecting themselves from lawsuits, but the fact of the matter is that their incomes are based on tests and procedures they perform and you get at the real reason for the testing-increasing their income.
Moreover, all this testing has been shown to be of little benefit to patients and the picture and incentive structure is clear: more tests, more money for doctors and hospitals. Add infection related income and the picture in not a pretty one.
The argument that such testing reduces doctors and hospitals liability and protects against lawsuits has been shown to be unrelated to both lawsuits and patient outcoms.
What is wrong with this picture?
Let's start with this article:
"However, AHRQ researchers reviewing the impact of these approaches found "little solid evidence" about the impact of medical liability reforms on the cost of care and even less information about the impact of these reforms on patient safety (Hellinger et al., 2009). Furthermore, the medical liability system may actually hamper progress on patient safety by dissuading physicians from disclosing and examining the root causes of medical errors (Studdert et al., 2004)."
http://www.ahrq.gov/news/newsroom/commentaries/putting-patients-first.html
More tommorow.
More info:
http://www.aaos.org/about/papers/position/1118.asp
