The Leapfrog Hospital Survey, which Arizona medical malpractice lawyers, health care personnel and patients rely on for information about the best healthcare in the country, has released its annual Top 10 Hospitals list.

A total of 65 hospitals around the country feature on the list, a record that matches the one set in 2010. According to Leapfrog, the ‘Top Hospital’ designation is meant to recognize those hospitals that have delivered the highest quality of healthcare measurable by certain yardsticks, like the prevention of medical errors, reduction of mortality for high-risk procedures and reduction of hospital readmissions.

Several organizations release hospital ratings every year, but the Leapfrog Hospital Survey has been widely recognized as one of the most reliable and accurate indicators of top quality healthcare. According to Leapfrog, its surveyors base their ratings on several parameters -how patients fare in the hospital, the kind of resources that are used to care for patients and the kind of management practices that are utilized in order to promote patient safety. Approximately 55% of America's hospitals report to Leapfrog on standardized measures, so that patients can rate hospitals based on how they fare in the rankings. Some names, like Cleveland Clinic, are missing from the list, because they have stopped reporting to Leapfrog.

The 2011.hospital rankings include university teaching hospitals, children's hospitals and community hospitals in rural and urban environments. The 65 hospitals in the list this year included several Kaiser Permanente facilities in California. The number one position was taken by the Kaiser Permanente Medical Center in Antioch, followed by several other Kaiser Permanente hospitals. Hospitals from Florida, Illinois, Massachusetts, Maryland, Michigan, Minnesota, New Jersey, North Carolina, New Mexico, New York, Ohio, Tennessee, South Carolina and Pennsylvania also made it to the list.

Healthcare personnel who wear latex gloves may be exposing themselves and patients to the risk of infection. According to a study reported in the New York Times, medical personnel who wear latex gloves are less likely to wash their hands after removing the gloves. This is a dangerous practice because germs can be transmitted through the latex gloves.

The results of the study have been published in the Infection Control and Hospital Epidemiology Journal. Researchers looked at 7,000 doctor-patient interactions in hospitals in England and Wales. The researchers found that the overall handwashing rate was 47.7%, regardless of whether gloves were worn or not. However, when the medical personnel were wearing gloves, the hand washing rate dropped to about 41%.

Doctors and nurses wear gloves when they're working with people with infectious diseases, and the bodily fluids from such patients can contain deadly disease-causing germs. These germs can seep through the gloves, and when these people fail to wash their hands after removing the gloves, they place themselves and patients at risk of infections. Additionally, medical personnel may be at risk of having the germs transmitted to their hands when they remove the gloves. That's why it's necessary that these people wash their hands thoroughly after removing the gloves.

Arizona medical malpractice lawyers find that proper handwashing procedures are some of the simplest steps that doctors and nurses can take to reduce the risk of hospital -acquired infections. Unfortunately, these basic steps are often ignored. In fact, many infection control strategies in hospitals around the country are now focusing on compliance with handwashing and hand hygiene procedures. Hospitals are also experimenting with cameras installed at wash areas to encourage staff to wash hands before and after handling patients.

A new study finds that several factors, including the location and type of health care worker, determined hand hygiene compliance rates among healthcare personnel in an emergency room. The results of the study have been published in the November issue of Infection Control and Hospital Epidemiology.

The study confirms to Arizona medical malpractice attorneys the role of several factors in crowded hospital emergency rooms that increase the risk of infections. For instance, the study found many healthcare personnel in hospital emergency rooms preferred to wear gloves instead of washing hands after seeing each patient. This practice does NOT minimize infection risks, and may actually enhance them.

Additionally, the study found that hand hygiene education leaves out several types of workers, increasing infection risks. For instance, workers responsible for transporting patients from an emergency department to a room or another department, were much less likely to receive training in hand hygiene compliance. These people were therefore, much less likely to wash their hands after taking care of a patient, compared to other types of workers. The researchers also found that providers taking care of a patient in a hallway bed had lower hand hygiene compliance rates.

This is believed to be the largest such study into hospital emergency departments, and involved data from 5,800 patient encounters in an emergency room. Researchers found that overall, appropriate hand washing practices were in place about 90% of the time.

Considering that one out of every five American residents can expect to visit an emergency department this year, Arizona medical malpractice lawyers believe that it's important to focus on infection prevention and control in these departments. The risks in emergency rooms are especially high because of overcrowding, which is common in many Arizona hospitals.

Many healthcare professionals, including doctors and nurses, may be carrying more than just their stethoscopes and trays around the hospital. The study shows that their clothing may contain deadly infection-causing organisms, like MRSA.

A group of Israeli scientists swabbed the white coats and uniforms worn by doctors and nurses. What they found on the clothing was staggering. They found that more than 60% of items of clothing contained clusters of potentially dangerous bacteria. Doctors uniforms tended to be slightly cleaner than nurses, but only just. Approximately 60% of doctors clothing contained bacteria, while 65% of nurses clothing were contaminated.

What Arizona medical malpractice lawyers find even more alarming is the presence of potentially deadly, antibiotic-resistant bugs like MRSA on the clothing. Antibiotic resistant strains were found on 14% of the nurses’ uniforms, and about 6% of the doctors clothing.

However, the Association for Professionals in Infection Control and Epidemiology believes that there is no reason for concern, because there is minimal risk of infections spreading through doctors’ clothing. Most hospital-acquired infections spread through poor hand washing practices by healthcare professionals. Even the researchers note that patients may not be at risk of infections through the germs on the nurses or doctors clothing. However, any infection risks still exist when you consider that the people coming in contact with these doctors and nurses with contaminated clothing are in a fragile state, with weakened immune systems.

Changing clothing everyday seems to dramatically reduce the risks of contamination. Only 8% of doctors and nurses who changed their clothing daily were found to have germs on their uniforms, while 29% of professionals who did not change clothes every day, were found to have germs on their clothing.

Surgical errors, including wrong site surgeries and wrong patient surgeries, occur even more frequently in American hospitals than Arizona medical malpractice lawyers have feared. According to the results of a new analysis, these kinds of errors occur as many as 40 times a week in the country.

That makes it about 40 incidents a week involving surgeries on the wrong body part, on the wrong patient, or even the wrong surgery. The results from a Joint Commission Center for Transferring Healthcare analysis found that there were at least 29 areas which are prone to errors that can lead to wrong site surgery. The data focused on eight hospitals. The mistakes that were made ranged from incomplete documentation and lack of timeout to surgical room errors.

This indicates to Arizona medical malpractice attorneys that wrong site surgeries continue to remain a major patient safety issue in the United States years after the Joint Commission Center for Transferring Healthcare released protocols to deal with these safety issues. The Joint Commission protocols involve the use of a simple checklist to prevent wrong site surgical errors. The checklist encourages doctors to mark the site to be operated on before beginning the surgery. It also calls for doctors and nurses in the operating room to take a timeout before the surgery, and to carefully determine whether the patient to be operated on is scheduled for that surgery.

However, in spite of widespread promotion of these protocols, and the fact that many hospitals use them, there still far too many wrong site surgeries occurring in the country. Also, while it may seem like wrong site surgeries are widespread, the fact is that these are rare, and many doctors and surgeons don't have experience with these. These doctors, therefore, may not be equipped to avoid wrong site hazards. Wrong site surgeries may be rare, but that doesn't change the fact that these can be devastating.

It is probably the first patient safety institute of its kind in the country.  John Hopkins has announced that it will use a $10 million gift to set up a patient safety institute.  The goal of the institute would be to study the prevention of hospital- acquired infections, improper treatment, misdiagnosis and other kinds of medical errors that contribute to thousands of deaths every year.  Arizona patient safety lawyers believe that it's high time we had a center like this. 

The institute will be known as the Armstrong Institute for Patient Safety and Quality.  The institute will conduct research into infection prevention and control, misdiagnosis, mistreatment and other common patient safety problems in the United States.  The $10 million gift has been given by C. Michael Armstrong, who is the chairman of John Hopkins Medicine's Board of Trustees as well as a former chairman of Comcast, AT&T and IBM World Trade Corporation. 

According to Armstrong, in spite of the fact that there is an intense focus on patient care at John Hopkins, every year he would come across several cases of patients injured due to medical errors.  He felt the need to establish a center that would focus exclusively on the prevention of such errors, thereby enhancing patient safety.

A recent study published in the journal Health Affairs found that as many as 1/3^rd of patients suffer a medical error.  The rates of such errors have remained more or less constant over the years, in spite of increasing concerns over the injuries and deaths from such errors every year.  Hospitals have been under pressure to share data about infections and mistakes in their facilities, and to raise the focus on quality reporting and analysis. 

John Hopkins has a special place in patient safety - one of the doctors, Peter Pronovost, a professor of anesthesiology at the center, developed a checklist aimed at the prevention of medical errors.  The checklist is currently being used by thousands of hospitals and facilities across the country.  In some states, there has been a substantial reduction of hospital errors by as much as 10% from the use of the checklist.

A study indicates that a number of factors, including lack of research into pediatric health, and the lack of quality measures to gauge pediatric safety, may expose these young patients to a higher risk of hospital-acquired infections.  There are many differences between pediatric and adult patients, but unfortunately, Arizona medical malpractice lawyers see that many hospitals choose to overlook these differences.

The study was conducted by two Cleveland Clinic Children's Hospital physicians, and the results have been published in the Journal of the American Medical Association.  According to the study, the rates of central line-associated bloodstream infections and surgical site infections and other hospital-acquired infections rates differ for both children and adult patients.  For instance, pediatric patients have a higher susceptibility to central line-associated bloodstream infections and viral respiratory tract infections than adult patients.  However, adult patients are more susceptible to catheter-associated urinary tract infections, surgical site infections and ventilator-associated pneumonia.  In spite of these differences, the surveillance of infections continues to be the same for both groups.

The higher incidence of central line-associated bloodstream questions and pediatric patients poses a special challenge to hospitals and facilities caring for these patients.  For instance, preventing central line-associated bloodstream infections in pediatric patients is very important, because in these patients, there may often be the need to draw blood.  Besides, there is poorer vascular access to pediatric patients.  Catheters are often maintained for a longer period of time in child patients, and this often increases the risks of central line-associated bloodstream infections. 

Unfortunately, there is little solid research that can help us to understand how hospital-inquiry questions can be prevented in children.  We need more rigorous research into the prevention of hospital-acquired infections in child patients, and verification of the best practices for preventing these infections.

The Milbank Quarterly has published a report that defines aviation safety initiatives that can also be used in the healthcare field, to enhance patient safety and reduce costs.  The report is titled Counterheroism, Common Knowledge and Ergonomics: Concepts from Aviation That Could Improve Patient Safety.

The report discusses 15 examples of measures to reduce the possibility of aviation safety errors, which are not currently being used in the healthcare sector.  The safety initiatives that are currently being used in the field of aviation safety to reduce the possibility of crashes include the use of checklists.  Airline pilots have been using electronic checklists to tick off items that have to be completed before takeoff and while the flight is in operation.  Pilots use different types of checklists including read and do checklists, challenge and response checklists and aide memoire checklists like pre-departure briefings.  Similarly, surgical safety checklists developed by the World Health Organization can be used to enhance patient safety.

Airline pilots also routinely use a training program called Cockpit Resource Management or Crew Resource Management.  The program emphasizes the importance of using people, information and equipment in order to ensure a safe flight.  The researchers believe that a program called Threat and Error Management that is currently used in the aviation sector can be used in the healthcare sector too. 

Before every flight, commercial aircraft crews gather together for a joint safety briefing.  Arizona medical malpractice lawyers believe that these practices can be carried over into the healthcare sector, by having joint briefings before the start of clinics, ward rounds and handoffs as well as at the beginning of every day.

Besides, commercial aircraft pilots also follow sterile cockpit rules, requiring pilots and cabin crew to abstain from all non-essential talk.  Aviation safety rules also place all authority for important flight decisions with the captain.  An airline cockpit has a standardized layout, which allows pilots easy and quick access to the instrumentation controls.  Similar concepts can be used in the healthcare sector to streamline safety procedures and enhance patient safety.

According to a report by the Government Accountability Office in 2009, the average wait time in an emergency room in the US in some cases was almost double the recommended time. That same year, Press Ganey Associates found that patients who were admitted to a hospital had to wait an average of six hours in the emergency room. Approximately 400,000 patients had to wait 24 hours or more.

Arizona medical malpractice attorneys are familiar with the serious risk to patient lives and safety when they have unreasonable wait times in a hospital emergency room. However, there are some things that you can do to avoid long wait times.

Don't wait for an emergency to find out that your hospital ER is always cramped. Find out the average wait times of hospital emergency rooms closest to you. Many hospital emergency rooms now post their average wait times on their websites to inform patients about wait times.

Visit an ER on these days only if it’s a real emergency. If possible, avoid visiting a hospital emergency room on high-traffic days like Mondays. Mondays can typically be very busy for emergency rooms, because many people who fall sick over the weekend walk into ERs on a Monday.

Be proactive, and coordinate your own medical care. It's always a good idea to call your physician on the way to the ER, and recount your symptoms. The physician can then contact the ER, and explain your symptoms, so you can expect better care.

When faced with a long line at the hospital emergency room, it doesn't pay to be rude or angry. Be cooperative, but persistent.

Even as you're waiting, inform others or someone else about any changes in the patient's symptoms. Even a slight change in temperature or persistent weakness should be brought to the attention of nursing staff.

If you still have not been attended to after a certain period of time, ask for the charge nurse or the shift supervisor. Use words like “emergency” and “needs to be evaluated right away” to have your concerns taken more seriously.

This is not a study that will contain surprises for Arizona medical malpractice attorneys. A study in Canada shows that patients who are in private ICU rooms, have a vastly reduced risk of contracting hospital infections than those who are put up in shared rooms.

The study conducted by researchers in Montréal analyzed more than 19,300 hospital admissions over a period of five years at the McGill University. They analyzed admissions at the ICUs before the general intensive care facility was transformed into private rooms, after renovations. They found that the infection rate for patients in the private rooms was 54% lower than before the renovation. According to the authors of the study, private intensive care rooms may enhance infection control practices, and reduce the risk of transmission of infections from patient to patient. The researchers in fact are recommending conversion of general intensive care facilities into private rooms, to reduce the risk of contracting hospital-acquired infections.

As mentioned, none of this is exactly rocket science. When patients are in isolation, the chances of contracting dangerous infections decrease substantially. In fact, other researchers have called for changes in the hospital design that allows for private rooms in intensive care. However, there are far too many health facilities that still haven't implemented this enhanced hospital design, with the result that patients are still crammed into general intensive care rooms with a higher risk of infections.

No one is suggesting that having private rooms is a one-step solution for soaring hospital infection rates. Besides, there will be space and other constraints that prevent hospitals from moving to a private room design. In such cases, hospitals can use other methods like using separate and private washrooms, targeted screening of patients and enhanced infection control methodologies and training to prevent infections.