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Post by kenobewan » Sat Aug 06, 2011 6:41 am

Initiatives by hospitals save time for patients

IT took 3 1/2 years for politicians to achieve the health reform agreement they signed this week. But while they squabbled over finances and who should run the health system, the states got on with the job of real reform.

In 2008 the Austin Hospital in north-east Melbourne tackled its lengthy elective surgery waiting list by setting up a stand-alone elective surgery hospital with four operating theatres, 20 beds and 16 recliner chairs.

The idea, says Austin Hospital clinical services unit director Ruth Griffiths, was to quarantine elective surgery beds and operating theatres so they couldn't be poached by emergency patients.

The centre is 1km from the hospital building, inside the old Repatriation Hospital. It treats about 47 patients a day.

The results are impressive. In 2007-08, before the centre opened, 13.5 per cent of Austin Hospital patients had elective surgery postponed. Now it's down to 7.7 per cent. Similarly, before the centre, 35 per cent of patients requiring surgery within 90 days were treated on time. Now, it's 80 per cent.

The hospital's waiting list for elective surgery decreased by 22 per cent in 2008-09 - despite a 15 per cent increase in demand for such surgery - and it performed an extra

5000 procedures. So impressive are the results, the centre is refurbishing another four operating theatres and preparing to open 12 new beds.

The expert panel that advised governments on health reform says other states too should adopt this model.

Two years ago WA had the nation's worst performing hospital emergency departments, with up to 60 per cent of patients in some hospitals waiting more than eight hours for a ward bed.

In 2009 the state introduced a target encouraging hospitals to admit, discharge or transfer 85 per cent of patients within four hours. Now, 70 to 85 per cent of patients are treated within that deadline.

Before the reforms the peak demand for a new hospital bed was at 10am but patients weren't discharged until 5pm. They're now discharged at 10am.

"We've moved the whole slot forward, in effect creating more beds," says WA Health Minister Kim Hames.

Westmead neurosurgeon Brian Owler says his hospital is trialling new clinical care centres for people with renal, gastro and respiratory problems.

The western Sydney hospital is also changing emergency department protocol so patients are seen first by a senior rather than a junior doctor, reducing unnecessary tests and ensuring they get on the right treatment track from the start. ... 6108323892

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Post by kenobewan » Sun Aug 07, 2011 7:03 am

More than 20,000 nurses needed in aged care

The aged care sector needs an injection of almost $500 million to close the wages gap and attract an extra 20,000 nursing staff, according to the Australian Nursing Federation.

Ahead of Monday’s release of the final Productivity Commission report into aged care, the ANF has called for urgent funding for more nursing staff to address critical workforce issues.

After delivering on health reform this week, Prime Minister Julia Gillard has foreshadowed major changes to the under-resourced aged care sector.

Figures show throughout the next 40 years, the over-65 population will go from representing one in six people to one in four, and those over 85 from one in 200 to one in 20.ANF federal secretary Lee Thomas said almost $500 million was needed to close the wages gap for nurses and assistants in nursing working in aged care.

Ms Thomas said aged care nurses are paid between $168 and $390 on average less a week than nurses working in public hospitals.And she said the aged care workforce needs to be tripled to cope with the demands of the nation’s ageing population. “Fixing aged care can’t wait – it has to happen now,” Ms Thomas said.

“The shortage of aged care nursing staff is already having a real impact, with independent analysis showing…nursing home residents are on average receiving just 22 minutes of care from a nurse each day.

“But one of the main reasons we can’t recruit and then retain aged care nurses and AINs is because of the significant wages gap experienced by aged care nursing staff across the country.”
Ms Thomas said while the PC draft report acknowledged the wage disparity in the nursing workforce, she said the final report must lay the foundations for the Federal Government to fix aged care in its 2012 budget. ... e-anf/733/

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Post by kenobewan » Mon Aug 08, 2011 7:19 am

Iowa hospitals see rise in unpaid, charity care

DES MOINES, Iowa— The prolonged U.S. economic downturn has led to an increase in "charity care" and unpaid medical costs for Iowa hospitals, officials said.

The 118 members of the Iowa Hospital Association provided more than $850 million in care in 2010 that was not fully compensated, The Gazette in Cedar Rapids reported.

A member survey showed that is up $54 million, or 6.8 percent, from 2009. Scott McIntyre, the association's spokesman, said the total stood at $252 million in 2000.

The rise in the number of people who are unable to pay due to mounting debt problems is a growing concern, McIntyre said. The increase has followed a trend of rising health care costs and the number of people who are unemployed or uninsured.

"People lose their jobs, and jobs in America are ironclad links to insurance, so they lose their insurance," McIntyre said. "And they may or may not qualify for Medicaid, and it's kind of left to the hospital to deal with it."

Hospitals try to work with patients to set up payment plans with the goal of creating a situation so they don't end up in debt and the hospital doesn't end up with bad debt, McIntyre said.

Overall, the organization's 2010 statewide survey showed Iowa hospitals provided "community benefits" that were valued at more than $1.3 billion. McIntyre said community benefits are activities designed to improve health status and provide greater access to health care. Along with uncompensated care, the category includes such services and programs as health screenings, support groups, counseling, immunizations, nutritional services and transportation programs valued at nearly $212 million.

Kirk Norris, the hospital association's president, said the programs listed in the survey were implemented in response to the needs of individual communities as well as entire counties and regions.

Norris said the ability of hospitals to respond to various communities' needs is challenged by the ongoing economic downturn and by losses in Medicare and Medicaid. Those programs account for about 60 percent of all Iowa hospital revenue. ... 1216.story

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Post by kenobewan » Tue Aug 09, 2011 6:37 am

Man With Breast Cancer Denied Medicaid Coverage Because He's Not a Woman

For Raymond Johnson it was bad enough being diagnosed with cancer when he was just 26 and with no health insurance, but his shock was only aggravated when he was denied Medicaid, because rules say men are not covered for breast cancer.

Johnson, a construction worker from Charleston, S.C., is one of the roughly 2,000 men who develop breast cancer each year -- just 1 percent of all breast cancer cases.

But doctors say even though the numbers of cases may be small compared to the number of women who get the disease, what male breast cancer patients suffer is no less real.

When Johnson developed the lump, he said he ignored it, thinking it was just a cyst and wanting to avoid the cost of a doctor's visit. Besides not having health insurance, he said, his job for a small construction company does not allow him to make ends meet as it is.

But then over the July 4 weekend, he said, the lump caused an unbearable pain and he rushed to the emergency room.

"They thought it had to do with my heart, but I showed them the lump and they sent me to get a biopsy," Johnson said. "That Tuesday, I was notified I had breast cancer."

Johnson said he was shocked, because he'd never had health issues before, but more than that he was concerned about how he would pay for treatment.

"I get paid $9 an hour, I don't know how I'm going to pay for it," Johnson said he told his doctors.

Though Johnson wouldn't normally qualify for Medicaid in the state of South Carolina because he is a single, non-disabled man with no children, he was advised to apply for a special supplementary program created specifically for those diagnosed with breast cancer whose income is 200 percent of the poverty line ($21,780 per year) -- even those with no dependent children. What Johnson didn't know is that the program, created by the Breast and Cervical Cancer Prevention and Treatment Act, is women's only.

He was sent to the Charleston Cancer Center to seek treatment and arrange for surgery to remove the baseball-sized tumor, according to his medical records at the center.

He and his family met with Susan Appelbaum, a breast cancer navigator and patient advocate for the Charleston Cancer Center, and he told her he had applied to the Department of Health and Human Services for Medicaid.

On July 11, he called Appelbaum to tell her he'd been denied coverage because he's a man.

"I told him to appeal and, in the meantime, I started to reach out to the community and anyone that could give me advice on how to help him," Appelbaum said.

Medicaid told Johnson that the supplemental breast cancer coverage is for women only and that it's written as such in the ... atment.asp target="external">Breast and Cervical Cancer Prevention and Treatment Act of 2000, Appelbaum said.

Jeff Stensland, public information officer for South Carolina's Department of Health and Human Services, agrees that the situation is "really wrong" but says that they can't get around this "overly rigid interpretation" of the Act, which specifically states that these benefits apply to women with breast or cervical cancer. South Carolina DHHS has urged the federal government to change their opinion to allow the program to cover men, but has been told on "numerous occasions" that it is only for women, says Stensland.

Though health care reform may change Johnson's position because single, childless men and women will then be eligible for Medicaid if they make under a certain income, for now, Johnson is left on his own.

Dr. Marisa Weiss, the founder of, told ABC News there is definitely something wrong with the situation.

"We treat people, including men, with breast cancer who have Medicaid all the time," Weiss said.

When there's an unusual case with HHS, she said, it's a matter of being persistent, making several calls, and speaking to a lot of people until you reach the right one that will take the case, she said.

" I've never had a male denied national insurance [because] of their gender," said Weiss, who is based in Philadelphia. ... d=14241171

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Post by kenobewan » Wed Aug 10, 2011 7:22 am

Lost in translation: emergency staff don't listen properly

HOSPITAL emergency departments function almost entirely on undocumented conversations that are frequently misunderstood, which puts patients at risk of wrong diagnosis or treatment, the first big study into the question has found.

And the situation is worsening as hospitals are overwhelmed with a growing number of emergency visits, including from an increasing proportion of elderly people with complex conditions and people whose language or cultural background poses extra communication challenges.

The research by the University of Technology, Sydney - based on more than 1000 hours of direct observation in NSW and ACT hospitals - identified the failure of doctors and nurses to listen properly to patients' descriptions of their illness as particularly problematic.

Clinicians were often too focused on formal diagnostic protocols to pick up on crucial information people volunteered about their symptoms, and failed to empathise with distress or pain, said the study leader, Diana Slade, professor of applied linguistics, who conducted the study with colleagues from the nursing and sociology departments.

Professor Slade, whose team was given unprecedented access to watch and record the work of the emergency departments at the Prince of Wales, Hornsby, Gosford, St George and Canberra hospitals, said she had witnessed an incident in which clinicians treating an elderly woman for dizziness failed to elicit the vital information that her son was in the same hospital after a suicide attempt. The eventual diagnosis of depression was delayed, Professor Slade said.

''Doctors and nurses say, 'we're too busy, we're too stressed','' to explore matters patients raised, said Professor Slade, whose report was published yesterday. ''We're saying, unless you attend to their issues, to their interpersonal needs, you won't make your diagnosis as quickly as you might otherwise.''

Clinicians wanted to treat people sympathetically and were mortified when they read the transcripts, Professor Slade said. ''What people think they are saying is very different from what they actually say,'' she said. ''I'm not being critical at all of the doctors and nurses. It's a system issue.''

The president of the Australasian College for Emergency Medicine, Sally McCarthy, said Professor Slade's work would help clinicians balance clinical problem-solving with more personal support to patients.

But junior doctors - who provided much of the state's emergency care - were legitimately concerned not to miss physical symptoms, Dr McCarthy said.

''There's not enough doctors to see the volume of patients coming through,'' she said. ''They're quite worried about getting things right in terms of patients' medical care.'' ... 1ikzi.html

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Post by kenobewan » Thu Aug 11, 2011 6:55 am

Tick of approval for district hospitals

SYDNEY, Aug 11 AAP - People being treated as outpatients at district hospitals in NSW are generally happier with their care than those at their larger city counterparts.

A survey of more than 6500 outpatients has shown a general happiness with NSW's public hospitals, with smaller district services scoring the highest in the satisfaction stakes.

The Bureau of Health Information survey found that overall 32 per cent of outpatients rated their care as excellent, with 34 describing it as very good, 25 per cent good, seven per cent fair and two per cent poor.

Wyong Hospital on the state's Central Coast topped the list of having the most satisfied outpatients, with 54 per cent of those surveyed in February 2010 reporting excellent care.

Camden Hospital was next on 46 per cent followed by Bowral and District Hospital (44 per cent), Mount Druitt Hospital (42 per cent) and Murwillumbah District Hospital (40 per cent).

Rounding out the top 10 were Grafton Base Hospital, Muswellbrook District Hospital, Gosford Hospital, Calvary Mater Hospital, Shoalhaven and District Memorial Hospital all with 39 per cent of outpatients saying they received excellent care.

Larger flagship hospitals in Sydney including Auburn, Blacktown and Westmead hospitals were among the lowest ranked facilities with only 22-24 per cent of patients rating their care as excellent.

The Tweed Hospital, Dubbo Base Hospital and Coffs Harbour Base Hospital received the lowest number of excellent ratings (16 per cent).

Outpatients visit hospitals for various services, including speciality clinics for diabetes and cardiology patients as well as physiotherapy, dietary advice and speech therapy.

The issues that mattered most to outpatients visiting the state's 53 public hospitals were receiving comprehensive care, staff teamwork and courtesy.

Outpatients gave the highest ratings to hospitals with staff who did everything necessary to arrange appointments and treated them with dignity and respect.

Good advice on taking medication and providing facilities to wash their hands also impressed outpatients.

Delays relating to appointment times were the biggest bugbear, with most outpatients saying hospitals did not give enough information about the hold-ups.

"Patients who felt they waited too long were more likely to rate the care as fair or poor," the report said.

"This shows that reducing the waiting time or giving more information about the delays relates to patient ratings of overall care."

Outpatients were also more likely to mark down a hospital's performance if the reception staff were not courteous and if they had problems with parking, noise levels and signage.

"Finding out what matters most to patients shows hospitals the key areas they should target to ensure more people have positive experiences and fewer have negative experiences," the bureau's chief executive Dr Diane Watson said. ... 1in5t.html

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Post by kenobewan » Fri Aug 12, 2011 7:15 am

Hospital rates below state average

COFFS HARBOUR'S public hospital has rated below the state average in the overall quality of outpatient care in the latest Bureau of Health Information report.

The Patient Care Experience: Outpatient Services in NSW Public Hospitals report shows that comprehensive care, staff teamwork and courtesy are the most important drivers of high-care ratings for hospitals.

The Coffs Harbour Health Campus received a poor rating from 4% of respondents and an excellent rating from only 16% of respondents to the survey, with 12% rating it fair, 36% good, and 32% very good.

The hospital received its highest marks for patients knowing who to call if they needed help after leaving the appointment, second highest on visits to a healthcare professional being arranged, and third highest on hand basins and alcohol hand wash being available in the treatment area.

The hospital rated lowest on the availability of parking, a statistic which will surprise no one.

“Finding out what matters most to patients shows hospitals the key areas they should target to ensure more people have positive experiences and fewer have negative experiences,” said Bureau of Health Information chief executive Dr Diane Watson.

The report shows that most outpatients are happy with the care they receive. Across NSW, 32% of people who received outpatient services rated their overall care as excellent, 34% said it was very good, 25% said it was good, 7% said fair and 2% said it was poor.

The Bureau's report shows that hospitals receiving the highest and lowest ratings of care are found right across the state and not confined to one geographical area.

However ratings do vary according to hospital type. Outpatient services in smaller, district hospitals were often rated highly by patients, but there are few large flagship hospitals in the list of top-performers.

There are also big differences between the highest and lowest rated hospitals. For example, about 50% of people describe their care as excellent in the highest rated hospitals compared with about 15% in the lowest.

The 6500 patients surveyed were asked nearly 50 questions about the outpatient care they received.

Outpatients are people who visit hospital for appointments but are not admitted.

The report and performance profiles providing fair comparisons for more than 50 hospitals are available at ... -patients/

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Post by kenobewan » Sat Aug 13, 2011 7:56 am

Fake doctor jailed after abusing trust of friends

A WOMAN who told her unsuspecting friends and neighbours that she was a doctor because she wanted to ''feel special'' has been jailed for nine months.

Nora Zacardas convinced staff at Royal Prince Alfred and St George hospitals that she was an intern at Liverpool Hospital so she could view their medical procedures and scans.

Even her GP, who had been treating Zacardas for more than 15 years, offered her a job once she finished her medical training.

In handing down the prison sentence yesterday, magistrate Louise McManus said Zacardas had ''narcissistic, histrionic and antisocial personality traits'' and was a ''risk to the community''.

The Downing Centre Local Court was told her neighbour Anne Papoutsis took advice from Zacardas about her chronic gynaecological problems and allowed her to watch as she was examined and treated while naked from the waist down at St George Hospital.

Zacardas then took gloves and medical equipment to help Ms Papoutsis perform the procedure at home. ''Your actions were a gross breach of trust,'' Ms McManus said.

In May, Zacardas pleaded guilty to three counts of holding out to be a registered medical practitioner under the Medical Practice Act. In the mid 1990s, she was convicted of falsely acting as a psychologist and charging patients thousands of dollars in consultation fees.

The court was told her latest deception began to unravel when her close friend and Ms Papoutsis's mother, Irene Zakis, contacted the former Medical Board of NSW following a tip-off, and discovered Zacardas had no medical training and had never worked at the hospital.

Outside the court, Ms Papoutsis said: ''I trusted her as a doctor. She was giving me advice. She told me not to have certain surgeries done. I feel manipulated and really used.''

Mrs Zakis said Zacardas examined her bowel and abdomen and accompanied her husband, Stephen, to hospital to see a lung specialist who, believing her to be a medical student, took her through Mr Zakis's scans. ''She's a con artist,'' Mrs Zakis said.

Zacardas's barrister, Julieanne Levick, told the court that after the death of her brother in 2009 ''Ms Zacardas was feeling not special and her underlying personality traits emerged, and she called herself a doctor to feel more special in herself''.

Ms McManus said Zacardas was at a high risk of reoffending and ordered her straight into custody. An appeal on the sentence will be heard next month. ... rom=smh_sb

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Post by kenobewan » Sun Aug 14, 2011 7:24 am

Elderly in hospital despite aged-care spaces

Dozens of elderly people have been unnecessarily taking up ACT hospital beds while they wait for residential aged-care places, health insiders say.
Sources have told The Canberra Times that at the beginning of last month 85 patients in Canberra hospitals had been assessed as requiring residential aged care.

Keeping aged people in hospital is more expensive than placing them in residential aged care and can carry an increased risk of falls or infection.

The ACT Health Directorate said yesterday that last month 68 patients in Canberra’s two public hospitals were referred to the Aged Care Assessment Team to identify what services they required.

Only two patients in the Canberra Hospital were waiting for residential aged-care places, a spokesman for the Health Directorate said.

Anton Hutchinson, who owns the 80-bed Kankinya Aged Care Facility in Lyneham, said elderly people could experience excessive stays in hospital before a place was found for them despite the fact there was about about a 12 per cent vacancy rate in the local residential aged-care sector.

“The Aged Care Assessment Team used to supply facilities with direct contacts for recently assessed people to assist both the resident and the facility in gaining occupancy but over recent months this practice has ceased,” Mr Hutchinson said.

“Previously the hospitals were aware and conscious of nursing home vacancies and contact was made to deliver services, this has also ground to a halt. These vacancies are both frustrating and critical in an industry that sees one in three high-care facilities operating in the red.”

Mr Hutchinson said his facility, which specialises in caring for high-needs dementia patients, was operating at a profit but currently had eight vacancies.

If the vacancy rate increased for a prolonged period he could be forced to reduce staff levels.

Anglicare Canberra and Goulburn aged-care business manager Gayle Sweaney said there were vacancies at her agency’s two ACT aged-care homes. ... 57426.aspx

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Post by kenobewan » Mon Aug 15, 2011 7:16 am

Hunter cancer review recommendations

A DRAFT review of cancer treatment services in the Hunter prompted by public anger about chemotherapy waiting times has produced several pages of recommendations for health authorities.
The independent review by two oncologists and a specialist oncology nurse was presented to Hunter New England Health and the Calvary Mater Newcastle hospital in early July.

Hunter New England Health chief executive Michael DiRienzo said the health service and the hospital would respond to the draft in coming weeks and the review would be finalised as soon as possible.

The review followed a series of Newcastle Herald articles in February and March showing chemotherapy waiting times were more than double those in other parts of the state.

The health service confirmed that Hunter cancer patients requiring chemotherapy waited an average nine weeks between diagnosis and starting treatment, more than double the recommended four weeks.

The series prompted Hunter New England Health to announce the review, and funding for a Taree medical oncology specialist to take the pressure off Hunter cancer specialists forced to service the northern area on a rotational basis.

The Taree position was identified as a priority by the health service last year, but until publicity about the cancer treatment crisis no funding had been found.

Hunter New England Health has offered the position to a medical oncologist or chemotherapy specialist. Mr DiRienzo said he expected a successful candidate to be appointed and working at Taree by April.

The service recently appointed a transitional oncology nurse at Manning Hospital to support oncologists and administer treatment to patients.

Mater director of oncology services, Dr Tony Bonaventura, was not prepared to comment until the report was finalised. ... 57835.aspx

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Post by kenobewan » Tue Aug 16, 2011 6:51 am

One mistake after the next: how the health system failed Jacob

IT WAS a litany of errors - from misdiagnosis and a lack of communication, to extended delays and poor post-operative care.

And yesterday the NSW Coroner found that these errors contributed substantially to eight-year-old Jacob Belim losing his life. The boy from Sydney's south-west died on the operating table from septic shock caused by a ruptured appendix on March 28, 2009.

Deputy Coroner Scott Mitchell's findings reveal Jacob was the victim of a series of grave errors by doctors at Liverpool Hospital and the Royal Alexandra Hospital for Children at Westmead, as well as basic systemic failures.

Advertisement: Story continues below The area health services responsible for these facilities yesterday issued public apologies and assurances policy changes had been made.

But they and the doctors involved now face possible investigation by the Health Care Complaints Commission and civil action from Jacob's parents, Yvonne and Emanuel.

When Jacob presented at First Care Medical Centre in Busby with severe abdominal pain, vomiting and a fever on March 26, Dr Chandra Gounder suspected a burst appendix and quickly called an ambulance.

But from there Jacob was let down by doctors and healthcare professionals at virtually every stage of treatment.

The ambulance driver, James Clark, was not aware that Liverpool Hospital - in a region with more than 20,000 children - did not perform paediatric surgery.

When the boy arrived at the hospital in severe pain, the referral letter with Dr Gounder's diagnosis was in effect ignored, with the emergency department registrar Dr Claire Ferreira diagnosing a bowel obstruction.

The coroner found that although it was clear that urgent surgery was essential, no urgent surgical review was ordered, nor was an ultrasound, despite Mrs Belim demanding one.

Paediatric registrar Dr Sam Nassar was called, but made a ''less-than-adequate intervention'' continuing the misdiagnosis and reportedly telling Mrs Belim to ''get an ultrasound out of your mind''.

The coroner said there was still no written protocol for medical staff detailing how children requiring surgery should be treated at Liverpool Hospital.

Seven-and-a-half hours after he arrived at Liverpool Hospital, Jacob boarded an ambulance for Westmead. He was screaming in pain and dehydrated.

At Westmead, Jacob was finally given an ultrasound, but this was severely delayed. At about 10.30pm, five hours after his arrival, Jacob went into theatre.

After the operation, anaesthetist Susan Hale said she thought Jacob had responded well and did not need intensive care.

But the next day Jacob was in a ''critical and perilous condition''. He died at about 2.30am during emergency surgery.

Liverpool Hospital said it had ''reinforced and improved access to surgical review'' since Jacob's death, apologising ''unreservedly'' for care delays.

Westmead said patient handover procedures had been improved so that deteriorating children were identified promptly and management plans communicated to staff. ... 1iuw3.html

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Post by kenobewan » Wed Aug 17, 2011 7:25 am

Saving lives in hospitals

THE healthcare system is killing us. The landmark American report of injuries and deaths caused by medical errors, To Err Is Human, counted almost 100,000 deaths in US hospitals a year.

In Australia, about 10 per cent of patients encounter a mistake during their treatment. Many are trivial, but in NSW in 2007-08 medical instruments were left in 19 patients after surgery, medication errors caused 17 deaths and 18 operations were carried out on the wrong patient or body part. It is human to look around for someone to blame. But several inquiries into deaths in Australian hospitals, such as the overdose of pain medication which killed a Sydney teenager, Vanessa Anderson, in 2005, found the system had been unravelling long before the final, fatal error occurred.

This week the State Coroner reaffirmed the risks posed by the ''systemic failure'' which ''contributed significantly'' to the tragic death from septic shock of eight-year-old Jacob Belim in 2009. Less well known is that the risk of blood clots increases a hundredfold in hospitals or that one in 30 Australian patients develops a ''healthcare associated infection'' every year.

Advertisement: Story continues below Healthcare systems are among the most complex organisations in the world. Ensuring heart surgery, for example, is expertly performed or the right dose of radiotherapy is delivered depends not only on drugs, equipment and the competence and knowledge of individual professionals, but on every single human interaction in very long treatment chains. Modern medical care depends entirely on teams, but teamwork is routinely compromised by fatigue, excessive workloads, inadequate resources and facilities, and any number of random factors such as gaps in rosters because of illness. To Err Is Human offered no excuses for the inadequacies or negligence of individuals, but argued that patient safety can be improved only by tackling problems system-wide. Organisational research shows system risks increase sharply when deviance is normalised: that is, when small mistakes, sloppy record-keeping or poor shift handovers are routinely tolerated.

In Australia, the Productivity Commission has begun recording serious harm and death, offering the first clear picture of what is going wrong. Persistent shortfalls in health funding continue to undermine the quality and safety of healthcare in Australia. However, studies of patient safety show ''vigilant'' work cultures - in which hands are routinely washed, surgical instruments are accounted for and instructions delivered clearly - can also save many lives.

Not only do we need more, better-rested medical staff, but organisations which openly report and act on errors, and which hold all staff members, whether they are making tea or carrying out brain surgery, to the same high standards. ... 1iwaz.html

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Post by kenobewan » Thu Aug 18, 2011 7:15 am

Hospitals' error levels revealed

PREVENTABLE hospital errors affect almost one in three elective surgery patients and one in four emergency patients at one of Melbourne's biggest hospitals, new research shows.

Health Department data analysed by researchers showed that ''adverse events'' occurred on average in 17.8 per cent of elective surgery patients and 16.9 per cent of emergency patients across 34 public hospitals in Victoria.

A study published in the journal Health Policy showed there were almost 20,000 adverse events - or incidents that cause harm to patients - in Victoria in 2005-06.

The data showed for the first time the extent of errors and complications in Victoria's hospitals and highlighted how little the state government reports such problems. It discloses only the most serious problems, or ''sentinel events'', each year.

In 2005-06, the same year as the study, it disclosed only 91 serious adverse events, including 29 deaths.

In the Health Policy study, which used confidential data, adverse events varied from hospital-acquired infections to errors leading to permanent disability or death, and their frequency varied widely between hospitals.

Researchers did not name hospitals but listed them in categories. The hospital with a 30.1 per cent error rate for elective patients and 25.7 per cent for emergency patients - even after researchers made adjustments for risks associated with its more complex patients - was classified as a teaching hospital. Melbourne's five teaching hospitals are The Alfred, Austin, Monash Medical Centre, Royal Melbourne and St Vincent's.

The study, led by Katharina Hauck of the Imperial College London's centre for health policy, found that adverse-event rates varied greatly between hospitals - from 6.8 per cent to 30.1 per cent for elective and from 3.6 per cent to 25.7 per cent for emergency patients.

The researchers found error rates in most teaching hospitals were lower or similar to those in other hospitals but comparatively high in certain country and suburban hospitals.

''[Adverse event] rates of several regional or suburban hospitals, especially the ones located far from Melbourne or in areas of low socio-economic profile, are very high and in some cases exceed the rates of teaching hospitals,'' they said.

''High rates should … lead to a careful investigation within the affected hospitals and a constructive search by government for ways for preventing their occurrence.''

The researchers said poor performance in rural hospitals could be due to ''underqualified or overworked doctors and nurses''.

Dr Hauck said rural doctors were sometimes called on to perform emergency procedures on patients who could not wait to be transported to a teaching hospital, which saved lives but possibly also led to adverse events.

She gave the example of a Maryborough doctor who saved a 12-year-old boy's life in 2009 by using a power drill to bore into his skull and relieve pressure on his brain.

The researchers said high adverse-event rates in some suburban hospitals might be due to a higher likelihood of patients with ''lower socio-economic status [and] greater unobserved medical needs''.

They said suburban hospitals could be encouraged to specialise in certain procedures. This had reduced adverse-event rates overseas.

Dr Hauck said the study showed the importance of investigating hospital adverse-event rates. ''Usually, measures of hospital performance are just mortality - or how many patients die in comparison to other hospitals,'' she said.

''With this study we show there are other and better measures which can supplement these traditional mortality rates as measures of quality.''

The vice-president of the Victorian branch of the Australian Medical Association, Stephen Parnis, said people should not be alarmed by the data because it showed hospitals were tracking adverse events, which included mild, moderate and severe complications.

However, he said hospitals should make it easier for staff to take time out from treating patients to report, analyse and learn from adverse events.

A spokesman for the Health Department declined to comment on what, if anything, it would do with the study results. ... 1iyb2.html

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Post by kenobewan » Fri Aug 19, 2011 7:22 am

State falters at first test of hospital reform

Better care depends on openness about the facts of failure.

PEOPLE make mistakes. Some matter more than others. When errors are made in hospital, the consequences range from inconvenient and uncomfortable to life-changing and heart-breaking. The death of mother-of-four Kelly Richards after a routine operation in Wonthaggi Hospital will be the subject of inquiries by health officials and the Coroner. This tragedy is awful, made worse by the fact that it represents the tip of an iceberg of errors in hospitals.

Health Department data reported yesterday by The Age reveals an unacceptably high level of ''adverse events'' - incidents that harm patients - across 34 public hospitals in Victoria. A report in the journal Health Policy shows for the first time the full extent of errors. The government discloses only the most serious ''sentinel events''. The study analyses state data for 2005-06, when 91 such events, including 29 deaths, were reported. The full picture extends to almost 20,000 adverse events, ranging from hospital-acquired infections to errors causing permanent disability or death. On average, 17.8 per cent of elective surgery patients and 16.9 per cent of emergency patients were affected. The worst rates were 30.1 per cent and 25.7 per cent at one big Melbourne hospital - compared to the best of 6.8 per cent and 3.6 per cent.

Recent trends suggest the wildly uneven standards are unlikely to have improved. While the highest rate of adverse events was at a teaching hospital, rates at most teaching hospitals were lower or similar to the state average. Some country and suburban hospitals had very high rates, ''especially the ones located far from Melbourne or in areas of low socio-economic profile'', the study found. Possible reasons were ''underqualified or overworked doctors and nurses''.

Soaring demand from a growing and ageing population is adding to the strains on outer suburban hospitals. A three-year analysis showed admissions last year were up 25 per cent at Maroondah in the east and 19 per cent at Sunshine in the west. The Royal Women's and Royal Melbourne treated 13 per cent and 12 per cent fewer than in 2006-07. Victorian hospitals failed five out of nine performance measures last year, one worse than the year before. Australian Medical Association Victorian president Harry Hemley, noting that hospitals such as the Western (Footscray) and Dandenong were struggling to cope, said last October: ''More pressure from government and administration to do more with less will mean more chance of errors and may affect patient care.''

The national health agreement is meant to offer hospitals more. At the AMA's annual dinner, Prime Minister Julia Gillard reaffirmed the promise: ''More funds driven by activity, efficient pricing, performance monitoring, achievable targets and localised control - each addressing the weak points that had made our health system progressively more inefficient and more unsustainable.'' AMA president Steve Hambleton reminded his political guests of the only meaningful measures of whether health policy is working for patients or failing them. ''We will know we have genuine meaningful health reform when there are more beds. We will know we've got health reform when our patients can get into the right place at the right time for the right care.''

For preventable errors to be kept to a minimum, not only must adverse events be rigorously scrutinised, but the government must end the lack of transparency that the AMA has rightly identified as an obstacle to improvement. Before last year's election, Coalition spokesman David Davis, now Health Minister, promised a more transparent system. Yet he refused last week to provide basic details such as the number of hospital beds in Victoria and where promised new beds would go. As for the startling evidence of adverse events, the Health Department refused to comment. The government must do better to restore Victorians' confidence in their hospitals. ... 1j027.html

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Post by kenobewan » Sat Aug 20, 2011 6:38 am

Man sues hospital over delay

A YOUNG Melbourne man is suing the Northern Hospital for a series of alleged errors which caused him permanent brain damage and left him unable to walk.

Tony Assi was a fit and healthy year 11 student in 2006 when he sought help from the Northern Hospital's emergency department for a persistent headache and fever.

According to a writ lodged in the Supreme Court of Victoria, doctors diagnosed him with a viral illness before sending him home several hours later on November 4.

However, the next day, hospital staff called Mr Assi and told him to come back at his convenience because blood tests revealed a bacterial infection. Given the instructions, Mr Assi returned to the hospital the following day on November 6. Just after 1pm, a doctor prescribed him antibiotics, but for an unknown reason they were not commenced until the following day - 28 hours later.

By that stage, Mr Assi's health had deteriorated. He developed a bone infection at the base of his skull which led to a permanent brain injury. Now aged 21, he is unable to walk, has weakness in one of his arms and says he finds it difficult to concentrate. He has also suffered immense psychological pain and says he will find it difficult to trust the medical profession again.

In the writ, lawyers from Slater and Gordon said Mr Assi should not have been sent home on November 4 and that if he had been treated earlier, he would not have developed the bone infection.

In a defence filed with the court, lawyers for the Northern Hospital said they disputed the facts of the case and denied staff were negligent.

The case emerged as The Age yesterday reported a study showing nearly 20,000 adverse events - or incidents that cause harm to patients - occurred in Victorian hospitals in 2005-06. The study, published in the journal Health Policy, provided the clearest picture yet of the problem, given the Health Department only reveals the most serious, catastrophic errors each year.

The study found that one of Melbourne's large teaching hospitals recorded a 30.1 per cent error rate for elective patients and 25.7 per cent for emergency patients - even after researchers made adjustments for risks associated with its more complex patients.

The researchers said the five teaching hospitals examined in the study were The Alfred, Austin, Monash Medical Centre, Royal Melbourne and St Vincent's.

Chief executive of the Australian Patients Association, Stephen Mason, yesterday called for mandatory reporting of adverse events in hospitals and urged governments to reveal more about the rate and nature of adverse events to improve care.

A spokesman for Health Minister Nicola Roxon would not comment on whether she would make hospitals report all adverse events. ... rom=age_sb

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