Has it really been 12 years since the Institute of Medicine released this report?

A study released in November of 2010 showed that one in three hospital patients experience adverse events and about 7% are harmed permanently or die as a result.

This study, published in April’s Health Affairs, was taken from two reports that showed rates of adverse events near 25% among hospitalized Medicare patients nationwide and at 10 North Carolina hospitals.

The study showed research estimating that up to 98,000 patients die each year due to preventable medical errors.

From a survey released March 31, patients are scared of medical mishaps. Almost 60% of adults polled by the Consumer Reports National Research Center feel that medical errors are common in hospitals, and nearly half said serious harm is common. Almost 80% of patients said they were afraid of contracting an infection in a hospital, 71% were worried about medication errors and 65% were scared of surgical mistakes.

Patient safety improvement remains uneven, said Mark R. Chassin, MD, president of the Joint Commission, which is the accreditation organization for hospitals and other health care organizations.

“What we have been doing for the last 10 or 15 years has produced some important progress, but it has not produced the kind of improvement that anybody wants to see.  The progress is not broad enough across the different services that are delivered in health care, and it’s not consistent within health care, whether at physician practices, hospitals or facilities of any sort. And it’s not deep enough,” he said.

According to Dr. Chassin, who co-wrote a separate article in the April Health Affairs, said physicians and hospitals should look to “high-reliability industries” such as commercial aviation to develop processes that identify systemic weaknesses before they result in harm.

A report being prepared by The American Medical Association’s new Center for Patient Safety will speak to the last decade of research in ambulatory patient safety. The report will be released this year and will focus on how organized medicine can help office-based practices improve quality in areas such as hospital readmissions.

The vast majority (93%) of the adverse events identified in the Health Affairs study required medical intervention but did not permanently injure or kill the patient. Most of them were medication-related or hospital-acquired infections. This study did not attempt to estimate how many of the adverse events could have been prevented.

The NEJM study said 63% of the adverse events that reviewers identified could have been avoided. A November 2010 report from the Dept. of Health and Human Services’ Office of Inspector General for Medicare patients estimated that 44% were preventable.

HHS Secretary Kathleen Sebelius announced on April 12 that the “Partnership for Patients” initiative is aimed at preventing 60,000 health care-related deaths and avoiding $50 billion in Medicare costs over 10 years.

The program will disburse $1 billion under the Patient Protection and Affordable Care Act to reduce hospital readmissions and cut hospital-acquired conditions such as pressure ulcers and catheter-related urinary tract infections.

Also in April (over objections from the American Hospital Assn.), the Centers for Medicare & Medicaid Services began reporting individual hospital performance on hospital-acquired conditions at its Hospital Compare website.

And yet…nurses are still overworked to the point of the impossible in terms of workload and accountability through documentation.  Nursing organizations such as the ANA are working through legislative efforts to help correct the nurse/patient ratios so that the ones at the bedside can have the time and energy that it takes to care for patients holistically, provide simple comfort measures and most importantly, avoid errors.

There is a better future ahead.  The key, in my opinion, has always been and will always be more nurses – with better incentives for new nurses to learn, and likewise for the more advanced nurses to be able to share the wealth of their time and experience.  Quality personnel, time, and pay scales can turn this mess around.

After a Medline search from 1966-2007, they reviewed 3,372 potentially relevant articles. In studies of women at or beyond 41 weeks of gestation, the evidence was rated as moderate due to of the size and number of the studies and consistency of the findings -higher rates possibly due to increased number of meconium-stained fluid and macrosomia?  The evidence regarding elective induction of labor prior to 41 weeks of gestation is insufficient to draw any conclusion.

Observational studies reported a consistently lower risk of cesarean delivery among women who underwent spontaneous labor (6 percent) compared with women who had an elective induction of labor (8 percent). Observational studies also found higher rates of cesarean delivery with elective induction of labor.

Interestingly, Obesity is found to have a higher rate of failure.  There are several studies which examined the association of body-mass index and cesarean delivery in the setting of induction of labor. When maternal BMI was dichotomized at 30kg/m², the authors found that those women with a higher BMI had higher rates of cesarean delivery in the setting of induction of labor. The presumed biologic plausibility behind this association includes higher rates of pregnancy-related complications such as preeclampsia, gestational diabetes, and increased birthweight with associated risks such as shoulder dystocia. These factors are associated with maternal obesity leading to higher rates of cephalo-pelvic disproportion and cesarean deliveries.

In summary, trusting your body to be physically at it’s best to prepare for the “marathon of labor” can decrease the amount of intervention and surgery in the long run…literally.

These sources may include:

1. Joint Commission on Accreditation for Healthcare Organizations (JCAHO) rules and regulations
2. Helathcare Professional Associations
3. Policies and procedures set forth by the institution
4. Job descriptions
5. Current medical literature
6. Opinions of experts within the field of question

This requires a writen specific response to each demand or category of items stating the following:

• The items are attached, or that the responding party will comply with specifics of the demand for production and inspection
• The responding party lacks the ability to comply with the demand.  Reason should be stated specifically, demonstrating that the responding party has made a due and diligent search for the requested items and why the party is unable to comply.
• While it is not necessary to produce priviledged documents, you must provide a list of all priviledged documents that fall within the scope of the request.

Being organized in production of documents is not only the corteous and professional way to respond, but in the long run it will help you keep track of what has been produced, and to whom.

When things start to go bad for a patient, there is a very compelling habit on the part of medical providers to hide their mistakes by failing to document their errors.

To the unpracticed eye the chart can often tell a different story than what actually happened to the patient and often with devastating gaps between what happened and what was charted.