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Post by kenobewan » Sun Aug 21, 2011 7:43 am

Paediatrics promise dumped as Skinner vows to honour victim another way

THE government has abandoned an election promise to guarantee specialist oversight by a paediatrician for all children admitted to NSW hospitals, opting instead for a statewide review of children's treatment.

The proposed legislation was known as Vanessa's Law, after Vanessa Anderson, a teenager whose preventable death in Royal North Shore Hospital in 2005 prompted a commission of inquiry into the public hospital system. But the Health Minister, Jillian Skinner, told the Herald yesterday the bill was ''a very blunt instrument. We knew that at the time''.

It had been intended to highlight shortcomings in the care of children and to emphasise the need for better provision of specialist services, Mrs Skinner said, and both goals would be better addressed by the review, which will advise on whether NSW needs a new statutory authority to safeguard children's interests within the fierce budgetary constraints of the health system.

The review, to be chaired by the former health minister Ron Phillips, includes Peter Garling - who led the special commission - and would ''cover off the principles included in Vanessa's Law'', Mrs Skinner said. ''It's not as simple as all children will be treated a certain way under all circumstances.''

She conceded this meant some children would continue to enter hospital without specialist paediatric care, but said some conditions did not require this. ''If you've got a fairly simple fracture or a cut that needs surgery, that can be done pretty much anywhere,'' Mrs Skinner said.

And paediatric cover in itself did not guarantee children's safety, she said, pointing to coronial findings this week in the case of Jacob Belim, who was attended by a paediatric registrar at Liverpool Hospital but died after delayed surgery for his ruptured appendix.

''It's not just [about] getting paediatric care,'' she said. ''It's the right care.''

Susan Adams, director of surgery at Sydney Children's Hospital, said in an average six-month period seven years ago, the hospital performed about 35 appendix removals. Now it performed 120 or more, resulting in a loss of skills in other centres.

But Warren Anderson, Vanessa's father, said he was frustrated paediatric supervision for all children would not be made law. ''I've made it very clear [to Mrs Skinner] it should be legislated,'' he said. ... 1j2e1.html

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Post by kenobewan » Mon Aug 22, 2011 7:26 am

Hospitals ban pregnant women from having caesareans in cost-cutting move

Cash-strapped hospitals are banning hundreds of women from having a caesarean birth, it emerged today.

A number of NHS trusts have said they will only give the go-ahead for a c-section if the woman’s health would be put at risk by a natural birth.

They have launched the crackdown on women who are ‘too posh to push’ – saying it wastes millions of pounds of NHS money every year.

Most hospitals already discourage women from having c-sections by outlining the potential risks to both mother and baby. But now some trusts are going further by ruling them out on financial rather than medical grounds – meaning it will be even harder for women to get a caesarean on the Health Service.

Some mothers have attacked the restrictions, saying it should be a woman’s right to choose how their baby is born.

One quarter of all births in the UK are now by caesarean section, up from just 9 per cent in 1980, despite a campaign by the World Health Organisation which believes there is no justification for any country having a rate exceeding 15 per cent.

A planned caesarean costs around £2,600 – much more than the £1,200 cost of a natural birth without complications; taking money from strained NHS budgets away from other priorities such as heart disease and cancer.

Economists estimate that a drop of 1 per cent in the proportion of women having the surgery would save the NHS some £5.6million a year.

Dr Michael Dixon, chairman of the NHS Alliance, which represents GPs who run health service budgets, said: ‘We are going to need to balance all sorts of things in future, from cancer to heart disease. When it comes to treatments we may need to spend less on, that [caesareans] may be one.’

The restrictions have been put in place by primary care trusts in Cornwall and the Isles of Scilly, Herefordshire, Bristol, South Staffordshire, County Durham, Dorset, Derbyshire, and Bournemouth and Poole.

The bans only affect planned caesareans, not c-sections which are carried out for emergency reasons. And if a natural birth would pose a health risk for mother or baby, a c-section would be allowed.

Health experts have long argued that women should go for a natural birth because the risks are lower. A birth by c-section increases a baby’s chance of breathing difficulties, and mothers may find it harder to bond with a child while recovering from a major operation. They can also suffer potentially fatal placenta problems.

These risks are usually outlined to mothers-to-be by midwives, meaning a woman has to be very determined to get a caesarean on the NHS. But the financial restrictions being put in place by a number of trusts will make it much harder to get one.

Some mothers’ groups say that patient choice is more important than notions of objective risk.

They argue that woman opt for planned caesareans to avoid the trauma of an emergency procedure and to reduce the risk of post-natal conditions such as incontinence.

Mothers’ rights campaigner Leigh East, 40, from Ilkley in West Yorkshire, had both her daughters by planned caesarean.

She said: ‘This is outrageous because one in four women will have a caesarean whether they want one or not. Women who make a positive choice to have a caesarean and remove the risk of an emergency caesarean stand a far better chance of a positive recovery than women who go into childbirth blindly.

‘To take that choice away, when it has just been shown that it is a valid option, shows it is being done purely on the basis of costs.’

Later this year, the NHS rationing body NICE is expected to bring out a report saying women should be able to choose their method of birth.

Maureen Treadwell, of the British Trauma Association, said: ‘There are a small group of women who appraise the risks of natural birth versus caesarean and consider caesarean is better. They are making a well-informed decision, taking account of the priorities that are most important to them.’

Dr Paul Armstrong, a consultant obstetrician at London’s Portland hospital, said: ‘Just as a woman has a right to choose home birth or other non-interventionist techniques, so should she have the right to choose a caesarean.’ ... s_rss_feed

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Post by kenobewan » Tue Aug 23, 2011 7:16 am

Hospitals are giving faster heart care, study says

In a spectacular turnabout, hospitals are treating almost all major heart attack patients within the recommended 90 minutes of arrival, a new study finds. Just five years ago, less than half of them got their clogged arteries opened that fast.

The time it took to treat such patients plunged from a median of 96 minutes in 2005 to only 64 minutes last year, researchers found.

Some hospitals are moving at warp speed: Linda Tisch was treated in a mere 16 minutes after she was stricken while visiting relatives near Yale-New Haven Hospital in Connecticut this month. Emergency responders called ahead to mobilize a team of heart specialists.

Once she arrived, "they had a brief conversation and I went straight into the OR. My family was absolutely flabbergasted," said Tisch, 58, who went home to Westerly, R.I., two days later.

Tisch wasn't a fluke. The hospital took 26 minutes on another case on Thursday.

"Americans who have heart attacks can now be confident that they're going to be treated rapidly in virtually every hospital of the country," said Yale cardiologist Dr. Harlan Krumholz. He led the study, published online Monday by an American Heart Association journal, Circulation.

What is remarkable about this improvement, Krumholz said, is that it occurred without money incentives or threat of punishment. Instead, the government and a host of private groups led research on how to shorten treatment times and started campaigns to persuade hospitals that this was the right thing to do.

"It's amazing and it's very gratifying. I'm surprised that we were able to achieve that type of dramatic improvement" so quickly, said Dr. John Brush, a cardiologist at Eastern Virginia Medical School in Norfolk, Va., who helped the American College of Cardiology design its campaign, which involved more than 1,000 hospitals.

Heart attacks are caused by clogged arteries that prevent enough oxygen and blood from reaching the heart. Each year, about 250,000 people in the United States and more than 3 million worldwide suffer a major one, where a main artery is completely blocked.

The best remedy is angioplasty, in which doctors push a tube through an artery to the clog, inflate a tiny balloon to flatten it, and place a mesh prop called a stent to keep the artery open.

The period from hospital arrival to angioplasty is called "door-to-balloon" time, and guidelines say this should be 90 minutes or less. Any delay means more heart damage, and the risk of dying goes up 42 percent if care is delayed even half an hour.

Not all hospitals have the capability to do angioplasty around the clock, so part of the effort to speed care involved setting rules for who has to be consulted before deciding to do the procedure.

The study involved more than 300,000 patients who had an emergency angioplasty at hospitals that get Medicare reimbursements. The researchers looked at records from 2005, just before campaigns to shorten treatment times were launched, through September 2010.

Only 44 percent were treated in the recommended time in 2005, but by last year it was 91 percent.

The National Heart, Lung and Blood Institute and the Centers for Medicare and Medicaid Services paid for the study.

"It's not an exaggeration to say that care of heart attacks in the United States has been transformed by this improvement," said Dr. Christopher Granger, a Duke University Medical Center cardiologist who led a Heart Association program to improve care.

"We've made very important progress but there still is a lot of unfinished work in improving heart attack care," such as what happens before people get to a hospital where angioplasty is done, he said.

Patients also need to do their part, by knowing the warning signs of a heart attack:

— Discomfort in the center of the chest lasting more than a few minutes, or that goes away and comes back. It can feel like pressure, squeezing, fullness or pain.

— Pain or discomfort in one or both arms, the back, neck, jaw or stomach.

— Shortness of breath, which might include breaking out in a cold sweat, or feelings of nausea or lightheadedness. ... 136080.php

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Post by kenobewan » Wed Aug 24, 2011 7:20 am

Shining a light on hospital performance

TODAY I will introduce into the federal parliament the second of two bills that, when passed, will fundamentally change Australia's hospital system forever.

The National Health Reform Independent Hospital Pricing Authority and National Health Performance Authority bills sound pretty technical. But these pieces of legislation will give the community and clinicians unprecedented insight into the performance of our hospitals and expose both good and bad performance.

Politicians of all persuasions have talked about greater transparency into our health system, but sadly doing it has eluded them.

It's been easy to say but hard to do when states and territories can be reluctant to share information because of the political risk of exposing poor performance, and a distrust of the way the commonwealth will use such information.

At the same time, people across Australia have been clamouring for more timely information so that they can better manage their health and their care.

The patient waiting for a hip replacement wants to know how their hospital's infection rate compares with the one nearby, and that the staff are actively involved in minimising the problem.

The recent National Health Reform Agreement is therefore a watershed moment in the history of Australia's health system.

All states and territories have agreed to the establishment of the authority, which will report on hospitals that are performing well and those that need to lift their game. Each leader has chosen to commit to improving their health system's performance.

While there is still political risk, as one state health minister said recently, the competitive instinct to make sure their hospitals are doing better than another state's will drive better performance.

Or put another way, greater transparency means greater accountability, and if clinicians and the community see poor performance they will demand better.

A significant part of the agreement that is often overlooked is that the commonwealth will contribute 50 per cent to the efficient growth of funding for public hospital services into the future. This is an unprecedented commitment - it is money the commonwealth was not obliged to provide. We estimate that the commonwealth contribution flowing from this will be an additional $175 billion in public hospital funding to 2030 - a mind-blowing figure.

When the numbers get this big, the responsibility to spend taxpayers' money wisely is paramount. That's why the word efficient is so important in the agreement.

How will we know that our hospitals are performing efficiently and the dollars are not going into a black hole? That's where the work of the Independent Hospital Pricing Authority comes in.

It will advise governments on the efficient cost of performing a procedure or operation by comparing and benchmarking hospitals across the country. It's a complex piece of work.

However, introducing this new way of funding will give taxpayers a level of comfort that their hospitals are performing well because those that have higher costs will have to make improvements to live within their means. In other words, it will drive efficiency and innovation in our hospital system.

We know that this isn't the best way to fund small rural hospitals that don't do enough operations to be viable under this funding method. They will continue to receive a budget based on block funding.

Activity-based funding for hospitals sounds technical, but it's another example of the Gillard government using transparency to drive accountability and ultimately better performance.

It's exciting that we now have coast-to-coast agreement on the way forward in improving our health system, and that all governments, Liberal and Labor, have chosen to act in the best interests of their community.

But there is one thing harder to achieve than a COAG agreement, and that is to get Tony Abbott to show any level of engagement on positive policy.

However, there was a unique moment last week; when speaking at the Australian Medical Association's parliamentary dinner, the Leader of the Opposition said: "And I'm pleased that we are moving towards a system of case-mix funding - or efficient price funding. Because in the end, it's important that if people do more, they get more. We have to fund activity, which is what case-mix funding does. Block funding tends to fund inactivity."

We will wait to see if his actions follow his words and he votes for the legislation.

The significance of these two bills may not be apparent in their bureaucratic titles, but by shining a light on the performance of our hospitals, they will lead to better performance and better services for patients across Australia. ... 6120749855

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Post by kenobewan » Thu Aug 25, 2011 10:24 am

Hospital in China fends off angry mob

Friends and relatives of a patient who died on the operating table marched on Nanchang Hospital No. 1 brandishing pitchforks and clubs. About 100 staff members, among them young doctors, prepared for the onslaught by arming themselves with long sticks and cans of mace, while the security guards donned police vests and helmets.

What followed was a pitched battle in the lobby atrium with horrified patients gawking from the floors above.

Although nobody was seriously injured in Tuesday's melee, the incident brought attention to a wave of violence in Chinese public hospitals. In Nanchang, a provincial capital 300 miles southwest of Shanghai, a young doctor reportedly suffered a serious head injury in June after the family of a deceased patient led a protest that turned violent.

Last year, a doctor and nurse were stabbed to death in the eastern province of Shandong by the son of a man who had died 13 years earlier of liver cancer, while a pediatrician was badly injured jumping from a fifth-floor window to escape relatives of a baby who had died.

Medical personnel advocates complain that the more violent incidents are staged by hired thugs, paid by families of the deceased in hopes of winning compensation from the hospitals. Sometimes the protesters are from the same village or are semi-professionals in causing trouble. The Chinese have even coined a word for the paid protesters: yinao, meaning "medical disturbance."

"It has become a very sophisticated system for chasing profits. Whenever somebody dies in a hospital, the yinao will get in touch with the family and offer their services in exchange for 30% to 40%," said Liu Di, who is setting up a social network for medical professionals.

Liu said the practice arose in the last few years as hospitals became more commercialized. "You see this mostly in second- or third-tier cities where the legal system is less developed."

In Tuesday morning's incident in Nanchang, hospital staff members learned that a mob of about 100 people was heading their way with crude weapons and took it upon themselves to mount a defense. Photographs and video posted on a local website showed men in white coats, apparently doctors, and T-shirted security guards brandishing what looked like oversize baseball bats.

"A lot of the young doctors and hospital security guards couldn't stand it anymore and decided to pick up sticks and defend themselves," a doctor from another Nanchang hospital, who gave his name as Lao Tang, wrote on his social networking site. "My fellow comrades, we fully support you! Well done!"

The switchboard at the hospital referred reporters Wednesday to the local Communist Party office, where telephones went unanswered.

Zhang Yuanxin, an Urumqi-based plaintiffs' lawyer, said it was difficult to sue for medical malpractice, even in the most egregious cases, and that tempted people to take matters into their own hands.

"This is the direct result of the lack of rule of law and the lack of a well-established social welfare system," Zhang said. "Conflicts like these are inevitable and there will be many more if people can't solve their problems through the law."

With overcrowded public hospitals, China has experienced a number of well-publicized scandals in which people were overcharged for unnecessary or dangerous treatments. In the 1990s, at a time when local governments were selling blood for profit, more than 1 million people contracted the AIDS virus through transfusions at public hospitals. Often victims in these cases have had little resource but to protest or petition — an archaic process that involves going to Beijing to file grievances with higher authorities.

There have also been numerous nonviolent demonstrations at hospitals, where families — or their representatives — dress themselves in the traditional Chinese mourning color of white and scatter fake paper money, an offering to the deceased in the afterlife.

This week alone, two major hospital protests were reported in addition to the one in Nanchang. The family of a 29-year-old man who died of stomach cancer in the eastern city of Nanjing picketed the hospital, claiming he hadn't been properly diagnosed and that they were threatened when they questioned his treatment.

In a public hospital in Guangdong, in the south, women staged a sit-in, wailing, screaming and refusing to leave, according to news reports.

Last month, a man who claimed to be a professional protester in Nanchang gave a newspaper interview in which he said that the local government usually chose to pay to quiet the protesters, "for the sake of social stability."

"I always tell my clients, if you start a big disturbance, you'll get a bigger compensation package. If you start a smaller disturbance, you'll get a smaller package. And if you don't do anything, you'll get nothing," the man, identified as 42-year-old Xiao Ming, was quoted as saying.

The Chinese government is getting tougher on hospital protesters. Last week, a court in the northeastern city of Qingdao handed down what was reported to be the first prison sentence in such a case, sending a man to jail for 18 months for staging a riot at a hospital after the death of his father in January. ... 1747.story

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Post by kenobewan » Fri Aug 26, 2011 7:23 am

150 jobs slashed, $80m saved in health restructure

A SHAKE-UP of NSW Health will slash 150 management jobs and save $80 million, which will be transferred to frontline hospital services.

The new director general of health, Mary Foley, commissioned the overhaul, which will abolish a layer of middle management made up of 200 staff who oversee local health districts.

Another 100 positions will be shed from NSW Health's head office in North Sydney.

The Health Minister, Jillian Skinner, said 150 positions would be made redundant. The remaining 150 would be transferred to other areas, including district services.

The restructure is part of the government's promised devolution of management from head office to local area health services.

''We are removing a middle layer of management which will allow resources to be deployed to support frontline health care,'' she said. ''The new structure will provide greater transparency and accountability, duplication of tasks will be stopped and there will be greater clarity of roles and responsibilities.''

The former Labor government introduced the middle-layer management positions last year, calling them clusters across three areas - northern, western, and southern.

The restructure would strengthen the government's so-called pillars: the Agency for Clinical Innovation, the Clinical Excellence Commission, the Health Education and Training Institute and the Bureau of Health Information.

New eHealth, pathology and infrastructure services would be consolidated.

Mrs Skinner said the Department of Health would become the Ministry of Health and be reduced in size, with ''a flatter structure'' giving local health districts greater control.

The Public Service Association said the job cuts would jeopardise the development of health policy in NSW and undermine the quality of health service control.

A PSA industrial officer, Ayshe Lewis, said no voluntary redundancies would be offered. She said the announcement would cut the number of head office employees by a third.

''While some of the positions are vacant, most of them are filled by temporary staff who are carrying out the work,'' she said.

''It's a furphy that cutting these positions will not impact on the delivery of frontline health services. The delivery of effective services is dependent on smart policy and program design. Health professionals on the front line can't do their jobs if they don't have expert guidance and support.''

The opposition spokesman on health, Andrew McDonald, said the job cuts would have ''a major impact on patient care''.

''Job cuts to administration workers means other frontline staff will be left to fill the void,'' he said. ''These job cuts are hitting the very workers responsible for driving change and innovation in health.''

Greens NSW MP John Kaye said the minister had ''deleted'' jobs and destroyed 150 careers.

''She has also removed both the central and cluster support needed to make the public health system run effectively and efficiently,'' he said. ''[Her] rhetoric about deploying resources to the front line is a thinly veiled excuse to slash the health budget.'' ... 1ja6h.html

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Post by kenobewan » Sat Aug 27, 2011 7:07 am

Ramsay in rude health on elevator of growth

GROWING demand for hospital care from an ageing population has helped drive Ramsay Health Care's full-year net profit up 33.8 per cent to $198.4 million.

The country's largest private hospital provider has forecast it will deliver a 10-12 per cent increase in core earnings growth this financial year.

The positive news sent Ramsay's share price up more than 4 per cent, or 71c, to $17.52.

"Our Australian business has performed extremely well, which has driven margin growth," managing director Chris Rex said. "We are sitting on an elevator of growth."

Ramsay will pay a final fully franked dividend of 29.5c a share, up 18 per cent.

However, Mr Rex warned that the country's rural medical services would suffer if the government pushed ahead with its plans to means test the private health insurance rebate.

"The fear is that people would cut back on health insurance cover, which would be detrimental to the profitability of the smaller regional hospitals," Mr Rex said.

"It's a doomsday scenario as this may prompt many doctors and medical staff to leave town, which in turn could lead to regional hospitals being depleted of medical staff."

Ramsay's total revenue was up 9.4 per cent to $3.7 billion.

Australia and Indonesia were up 8.7 per cent to $2.9bn, while Britain and France were up 12.4 per cent to $767.1m.

Mr Rex said the company's hospital business performed well across all markets, despite difficult trading conditions in Britain. He said the hospital business was particularly resilient in the face of turbulent market conditions in Europe.

One of the key drivers for its strong performance was managing costs, he said.

In Australia, Ramsay treated more than 40 per cent of all patients who went to hospitals every year, and its 65 hospitals delivered 15.5 per cent growth in earnings before before interest and tax to $393m.

He said the Australian business continued to deliver strong organic growth, with a number of brownfield developments coming on stream.

He also said that although economic conditions in Britain and France continued to be turbulent, their healthcare sector remained stable with plenty of growth opportunities.

The company is on the look-out for more bolt-on acquisitions in Europe. Ramsay has 117 hospitals across Australia, Indonesia, Britain and France. ... 6122417673

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Post by kenobewan » Sun Aug 28, 2011 7:06 am

SA hospitals on life support

EXTREME overcrowding and stretched resources are putting the lives of hospital patients at risk.

That's according to the nurses and doctors' associations.

Ongoing pressures across the entire health system are unsustainable, the associations say, and are blamed for inciting the five recent violent attacks on Lyell McEwin Hospital nurses.

A graphic illustration of the problems confronting emergency staff in particular comes in a leaked internal Royal Adelaide Hospital email sent on July 15 and obtained by the Sunday Mail:

"We have had a sudden influx, 21 patients in an hour present and Flinders Medical Centre are diverting patients to us. So if anyone could help with a nurse for a few hours that would be great, we have no one to care for patients in the atrium (SA Ambulance Service bay) and corridors," it reads.

Australian Nursing and Midwifery Association state secretary Elizabeth Dabars said the system was "at breaking point - it has gone into crisis mode".

She said the barring of ambulances last week from delivering non-critical patients to the RAH - the state's primary medical facility and long-regarded as the hospital of last resort - and 70 assaults against hospital staff in six months further highlighted the problems.

"The system breakdowns are manifesting in a range of places, our concerns are not specific to a particular hospital - it's a system-wide issue and it requires a system-wide response from the State Government," she said.

She said nurses were concerned acute overcrowding in hospitals could end in tragedy, prompting an urgent meeting with SA Health chief executive David Swan on Tuesday.

"We don't think it's acceptable to wait for some form of tragedy to happen. Because of the chronic nature of the over-capacity, there are people on trolley beds in corridors with no access to call bells, oxygen or suction.

"If someone doesn't have access to a call bell to get attention ... it is just a matter of time before there is a possible tragic incident, which could result in death."

She said ANMF members were also reporting:

AS MANY as 103 patients at the RAH emergency department, which has capacity for 64 patients;

STAFF sustaining injury because trolley beds in corridors were obstructing access to essential equipment;

PATIENTS waiting 24 hours in the emergency department before being transferred to wards; and

FAILURE to supply adequate staff, causing levels to drop below the agreed one nurse for every three patients.

SA Salaried Medical Officers Association president David Sainsbury said doctors were distressed by the increasing number of patients stuck in ambulances or placed in ill-equipped treatment rooms.

"We are continually confronted by the anxiety and anger of families waiting on care for their ageing relatives," Dr Sainsbury said.

"We need more hospital beds and we needed them yesterday, as this will free up beds in the emergency departments.

"The wards should run at 85 per cent occupancy, giving the staff time to plan and arrange early discharge.

"At the current 110 per cent occupancy we are too busy delivering basic care to think about measures of improving performance."

Opposition health spokesman Duncan McFetridge said the Government was continuing to deny that the health system was in crisis, instead "deflecting" to the building of the new RAH, which should open in 2016.

"None of that is being delivered now, while patients are waiting in ambulances for hours and days in corridors," he said.

"Our hospitals will soon be choked." ... 6123583395

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Post by kenobewan » Mon Aug 29, 2011 7:28 am

Hospital stay is a health risk

ONE in five patients who stay a week in hospital will pick up an infection during their stay, new research shows.

The study, titled ''How dangerous is a day in hospital?'' also found that a seven-night stay carried a 6.1 per cent chance of an adverse reaction to a drug because of an error or unknown allergy and a 2.5 per cent chance of a pressure ulcer from not being moved enough.

Researchers from Monash University and Imperial College London produced the estimates after analysing data on more then 206,000 patient experiences in all Victorian hospitals in 2005-06.

The research, which has been accepted for publication in US journal Medical Care, found the longer patients stayed in hospital, the more likely they were to suffer a range of adverse events considered preventable with optimal care.

It found that a one-night stay in hospital carried a 3.4 per cent risk of an adverse drug reaction, an 11.1 per cent risk of an infection and a 0.4 per cent chance of an ulcer.

For a five-night stay, this increased to a 5.5 per cent chance of a drug reaction, a 17.6 per cent chance of a hospital-acquired infection and a 3.1 per cent chance of an ulcer.

On average, every additional day in hospital increased the probability of suffering an adverse drug event by about 0.5 per cent, infection by 1.6 per cent, and ulcer by 0.5 per cent.

Lead author Katharina Hauck, of Imperial College London, said infections were mainly due to non-sterile equipment, sub-standard hygiene or mistakes with catheters, which are known to cause urinary-tract infections.

For the purpose of the study, hospital-acquired infections also included pneumonia and respiratory-tract infections because they are considered complications of hospital care.

Dr Hauck said while a lack of movement was the most common cause of pressure ulcers, adverse drug reactions could stem from incorrect dosage or prescription, mismatched blood types and allergic reactions.

The study did not look at causes of the adverse events, but Dr Hauck said check lists, electronic patient records, extra care with hygiene and staff training could all improve prevention of adverse events.

Dr Hauck said that given the risk of an adverse event increased every day a patient stayed in hospital, policy makers should consider early discharge and home-based care programs to reduce the risk of common problems such as hospital-acquired infections.

''Many of these programs are associated with greater patient satisfaction and lower AE (adverse event) rates,'' she said.

However, Peter Cameron, director of the Centre of Research Excellence in Patient Safety, said Victorians should not be alarmed by the findings because many of the so-called ''adverse events'' may not be preventable.

For example, he said a patient might arrive in hospital with a developing pressure ulcer from being immobile at home and have it diagnosed as an adverse event that occurred in hospital. Infections such as pneumonia could also be part of the natural course of a patient's illness whether they were in hospital or not.

Professor Cameron said although it was wise for policy-makers to minimise hospital stays, this was already happening by default. ''I don't know of any hospital trying to extend length of stay for patients … They have too much demand to deal with,'' he said. ... 1jgnl.html

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Post by kenobewan » Tue Aug 30, 2011 7:07 am

Hospitals 'need more staff, not armed guards'

FRUSTRATION over long waiting times is the main cause of violence in hospital emergency departments and the state government should hire more staff to deal with the problem rather than install armed guards, nurses say.

Australian Nursing Federation Victorian branch assistant secretary Paul Gilbert told a parliamentary inquiry that nurses opposed the government's election promise for armed guards because firearms would increase risk to staff and patients.

He said the $21 million allocated for the guards, which the government has agreed to reconsider, could fund 235 full-time nurses for emergency departments.

''[That] would go a long way to treating the primary cause of violence - frustration about the amount of time waiting to be seen for treatment,'' he said.

''There will always be a degree of unanticipated activity, but a lot of what our members experience is due to long waits and people feeling they are not being treated in the order they should be. Our preference is to fix the cause rather than the symptoms.''

A third of 1500 Victorian nurses and midwives surveyed last year reported experiencing occupational violence. It is estimated that only half of such incidents are formally reported.

A nurse in Dandenong Hospital's emergency department, Leslie Graham, said she experienced violence ''every second day'' and triage nurses commonly dealt with patients ''yelling, screaming and throwing themselves on the floor''.

She said nurses were abused, bitten, punched, slapped and had objects including chairs thrown at them. ''People pull [catheters] out and throw blood-stained cannulas and sharps at nursing staff,'' she said.

Royal Children's Hospital director of emergency services Simon Young said violence in his department could come from patients with developmental disorders such as autism, or those affected by drugs or alcohol who might be brought in by ambulance.

Frustrated patients also contributed to 56 ''code grey'' (unarmed threat) incidents at the hospital last year.

Dr Young said staff needed to deal with ''extreme peaks and troughs'' of demand and triage nurses were at the front line.

''You're very exposed to be out there with 30 or 40 people, trying to dish out medical care. [Nurses] can't do [triage] for long periods of time because it can be threatening,'' he said.

Nurses said the government needed to fully implement recommendations from a 2006 ministerial taskforce, including improved surveillance of waiting areas, personal duress alarms and sufficient staffing to ensure safe care. ... 1jif5.html

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Post by kenobewan » Wed Aug 31, 2011 7:35 am

Big chill brings winter flu crisis

Hospitals are overloaded with patients suffering flu-like and respiratory illnesses.

The epidemic is blamed in part on the icy cold snap in mid-August.

Hundreds of sick people are coming into emergency departments each day, and some are waiting up to eight hours for treatment.

And with another cold southerly outbreak forecast for Friday and Saturday, health authorities are expecting no let-up.

Middlemore Hospital, near Otahuhu, is Auckland's worst affected public hospital - it has had record numbers through its emergency department - but most others in the region report being busy with the late-winter peak.

Waikato Hospital is also seeing an increased number of respiratory cases and was busy with trauma cases at the weekend.

The clinical director of Middlemore's emergency department, Dr Vanessa Thornton, said yesterday that the hospital had used parts of its crisis management plan to cope with the surge.

"[On Monday], 356 patients presented to the emergency department, which is the highest ever.

The previous high was two years ago on Boxing Day - 330."

The total had exceeded 300 daily since Friday and had been in the 290s earlier last week. It was usually around 275, Dr Thornton said.

"The hospital is blocked."

It had postponed some outpatient clinics so it could beef-up staffing of acute services, was putting inpatients in areas such as the gastro-enterology day-stay unit and, to fill gaps caused by staff sickness, was using bureau nurses and asking doctors to work overtime or extra shifts.

"... [yesterday] morning there were 23 patients sitting in the emergency department waiting for a [ward] bed which is extremely unusual for us.

"Unfortunately we've had some patients going up to eight hours, which hasn't been happening for us in the last couple of years."

Since late last week, the emergency department had slipped below 90 per cent on the Government goal of admitting, transferring or discharging 95 per cent of patients within six hours.

Dr Thornton said many patients had respiratory infections that were exacerbating underlying chronic breathing disorders such as emphysema or asthma.

The rate of wintertime respiratory infections had increased since temperatures plunged in mid-August.

"What we are wanting people to do is see their GP early, stay on top of their chronic emphysema or asthma and have their inhalers at home."

"Part of the increase is in the 15-to-39-year-old age group. These are the people that don't often attend a GP. These are the people we want to get to see a GP earlier and have their inhalers on hand."

Other hospitals are reporting similar problems. Rotorua, Tauranga and Taupo hospitals are almost full, with Tauranga getting about 180 cases a day.

Auckland DHB's general manager of operations, Ngaire Buchanan, said yesterday Auckland City Hospital and Starship children's hospital had a late-winter peak of patients.

"We have maintained our winter plans over this period to reduce the impact of this demand for our patients at this stage."

Government figures published yesterday showed Counties Manukau DHB (Middlemore) continued to meet the six-hour emergency department target in the April-June quarter and Auckland met it for the first time.

Waitemata fell short by one percentage point, but board officials said it had consistently met the target during July.

The chairman of the Auckland and Waitemata DHBs, Lester Levy, said the reductions in time patients spent in emergency departments were a remarkable turn-around and had been maintained despite a heavy winter workload and record numbers of patients. ... d=10748478

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Post by kenobewan » Thu Sep 01, 2011 2:38 pm

More hospitals need to close, says ex-NHS boss

The closure of more hospitals is needed if the NHS is going to cope in the future, a former NHS boss says.

Lord Crisp, who was NHS chief executive in England from 2000 to 2006, said the Blair government should have been tougher when it had the chance.

He said there was now an overcapacity in the hospital sector and said the same mistakes should not be made again.

Overhauling hospitals would free up funds for community services to deal with the ageing population, he added.

In an interview with the BBC News website, Lord Crisp said: "In the late 1990s waiting lists, A&E and standards in cardiac care were the big issues and we dealt with them.

"But the challenge now is dealing with the numbers of older people and those with long-term conditions. They need supporting in the community.

"That means a shift away from hospitals. There will be less need for large hospital outpatient departments and some services and whole hospitals will need to close or be merged with others."

Key moment

He said he could not put a figure on how many hospitals needed revamping, but added it could affect the whole spectrum of services provided.

His remarks come as ministers are considering the future of A&E, maternity services and children's units at three hospitals in north London.

Under the plans drawn up by the local NHS one hospital - Chase Farm - could lose its services.

Local campaigners have been fighting the proposals and a decision is expected in the coming weeks.

It is being seen as a key moment in the government's policy on hospital changes because, in opposition, the Tories promised to fight against such closures.

Lord Crisp, who has written a book about his time at the helm of the NHS called 24 Hours to Save the NHS which will be published later this month, said he did not know the full details of that case, but added it was important not to dodge difficult decisions.

He admitted the NHS under his stewardship in the Blair years should have scaled back on hospital services.

In particular, he admitted that the scale of hospital building projects probably went to far. More than 100 new hospitals or rebuilds were given the go-ahead.

He said: "By 2005 there was no hospital that was not thinking it was going to grow. We had major problems with very bad facilities, [but] perhaps we could have built smaller or consolidated on fewer sites.

"We missed that opportunity and this government needs to grasp that. We can't keep services going just because there is a nice building."

However, he said it was essential that any changes made were done to benefit patients not just to save money and that they should be carried out with proper consultation and engagement.

Lord Crisp's intervention comes after similar warnings by various experts. The King's Fund and NHS Confederation have both put the case for scaling back on hospital care in recent months.

Katherine Murphy, of the Patients Association, agreed the government should not be afraid of making difficult decisions.

She said: "What is the point of having brand new hospital buildings if there are not enough funds to treat people in them?"

But she also warned: "We must never forget that by merging services, there will be patients who may struggle to get to them because they are too far away."

Labour said patients had benefited from the investment and reforms during their time in office.

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Post by kenobewan » Fri Sep 02, 2011 7:29 am

Free beds for poor at hospitals

The Supreme Court (SC) on Thursday upheld the high court order of March 2007 that makes it mandatory for private hospitals to provide free treatment to the underprivileged, earmarking 25% of their out-patient department (OPD) capacity and 10% of their in-patient capacity. The apex court reproached private hospitals for not treating enough underprivileged people, especially as most of them had been built on land given at heavily subsidised rates.

The ruling has evoked mixed reactions from private healthcare providers.

While medical care giant Fortis — which has at least three major hospitals in the defaulting list including Fortis Escorts Heart and Research Centre, Fortis Flight Lt. Rajan Dhall Hospital and Fortis Seth Jessa Ram Hospital, refused to comment till they “receive a copy of the order,” Max Healthcare, another leader in the medical service industry said they would find alternate methods to “raise funds to sponsor free treatment”.

“Though the honourable court dismissed the SLP’s (special leave petition), the court accepted our request of being allowed to raise funds to sponsor free treatment and has clarified in its orders that hospitals would be free to find other resources to fund poor patients. We welcome the judgment and shall discharge our obligation accordingly,” said a release from the Max administration.

Some such as the Indian Spinal Injuries Centre and Sir Gangaram Hospital said they were charitable hospitals and had been treating the poor. “We are already following the SC guidelines as this is in-keeping with the vision of the founder. We do not refuse anybody with the blue card,” said Dr RK Ganjoo, medical director, Sir Gangaram Hospital .

“ISIC has been providing higher number of free beds than the mandated requirement. If any hospital takes land at institutional rates its part of the obligation to give free treatment to the poor,” said HS Chhabra, medical director, ISIC.

“We had requested the SC to fix a bar on the costs of consumables to be provided to the poor, which the apex court rejected,” said Dr DP Saraswat, CEO, Sri Balaji Action Medical Institute. ... 40613.aspx

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Post by kenobewan » Sat Sep 03, 2011 7:30 am

Nurses accept offer but beds stay closed

Nurses in Orange, in central Western New South Wales, say beds at the city's hospital will stay closed until the State Government approves a new funding deal.

Members of the NSW Nurses Association voted unanimously yesterday to accept a new offer from hospital management.

The union's western region organiser, Linda Griffiths, says the deal worth more than $400,000 will fund the equivalent of just over four full-time nurses at the new Bloomfield campus.

"It's funding for new positions, funding for a nurse in the resuscitation bay every afternoon extra and funding for nurses, another 4.28 full-time equivalent nursing positions in the surgical 'A' and 'B' unit," she said.

However, Ms Griffiths says the deal still needs to be signed off by the Ministry of Health

"The nurses have voted not to lift that action but in fact to leave those beds capped at 24," she said.

"Because what they are saying is until they have the nurses employed they cannot sustain the workload and provide safe patient care."

The Western Local Health District says it is moving forward with plans to introduce the new nursing award and will continue to work closely with nursing staff. ... ed/2868032

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Post by kenobewan » Sun Sep 04, 2011 6:51 am

Transplant victims receiving custom-made medical care: hospital

Taipei, Sept. 3 (CNA) National Taiwan University Hospital (NTUH) is offering custom-made care for each of the four victims of a recent HIV-infected organ transplant mishap, NTUH Deputy Superintendent Chang Shang-chun said Saturday.

"We have assembled a special medical team for each of the four transplant recipients," Chang said, adding that each team consists of physicians from the hospital's internal medicine and infectious disease departments as well as social workers, psychiatrists and case management staff.

"Each team is offering care and treatment tailored to meet the special needs of each patient," Chang said.

While some of the patients have already been informed by their families that the organs were from a brain-dead HIV-infected donor, others are still unaware of the situation, Chang said.

The four patients began receiving post-exposure anti-viral medication two days after the transplant surgeries on Aug. 24, Chang said.

The hospital has been in contact by email with the Taiwanese-American inventor of the AIDS cocktail therapy, David Ho, who endorsed the medication the patients are receiving as the best drug combinations in their case, Chang added.

"We will decide whether to adjust the drug regimen in the future in terms of whether the current treatment has caused any side effects and whether the virus has shown signs of drug resistance," said Chang, who is an infectious disease expert.

He further said the patients have to take the drug combination for three months, at which point the medical team will then assess whether the drug regimen should be continued or can be stopped.

"As HIV infection cannot be confirmed until six months after the end of drug therapy, the condition of the transplant recipients cannot be confirmed until at least May 25, 2012," Chang explained.

The flawed transplants -- four at NTUH and one at National Cheng Kung University Hospital (NCKUH) -- were performed on Aug. 24. The hospitals only realized two days later that the donor of five organs was an HIV-carrier.

Prior to the operations, the NTUH transplant team relied only on a phone communication to get the results of HIV tests on the organs, and it thought it was given a green light when in fact the organs had tested positive for the virus.

NCKUH took the NTUH transplant team's word that the organs were clean and went ahead with its heart transplant.

NTUH admitted on Aug. 27 that its medical team did not follow standard operating procedures in the case and should have checked for the test results on the computer before proceeding.

The incidents marked the first time in Taiwan that organ transplants have left recipients at risk of acquiring HIV/AIDS. ... 1109030028

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