Consumers and Arizona medical malpractice lawyers who have always turned to Consumer Reports for the most trustworthy safety ratings for booster seats and toaster ovens, can now turn to CR for ratings before choosing a heart bypass center.  Consumer Reports will soon carry such ratings in its print version and on its website.

In fact, the magazine published ratings of 221 surgical groups on its website this week.  These ratings will be printed in the October issue of Consumer Reports.  Consumer Reports is using a one, two and three star rating to rate heart bypass surgery groups.  A one-star rating would denote a below average facility, while a three star rating would denote an above-average facility.  The ratings consider the rates of complications at these facilities, survival rates, use of the best surgical techniques and likelihood of being discharged with recommended medications that help in patient recovery.

Out of the 221 groups that have been rated, only five are rated below average.  The criteria that Consumer Reports takes to rate a facility are valid.  For instance, at one of the centers that is rated below average, patients at the hospital had only a 24% chance of receiving the right medications when they left the hospital.  At an above-average rated facility, a patient had a 92% chance of receiving the right drugs at the time of discharge.

Currently, the ratings are available only to Consumer Reports subscribers.  However, they will be available soon for free on the website of the Society of Thoracic Surgeons.

A majority of Americans currently have no access to ratings for doctors, and even the Consumer Reports rating will only include a small percentage of the total number of surgical groups in the country.  However, this is a good beginning, and it shows that Consumer Reports is willing to give patient safety the attention that it has to consumer and auto safety.

The New York Times is reporting on a growing trend towards acclimatizing hospital and healthcare staff to the needs of increasingly diverse patient populations.  The Times article talks specifically about New York hospitals, but considering Arizona's diverse culture, it might as well have been written for the state.

Hospitals that cater to a heavy immigrant, non-English-speaking population are beginning to find that it's not nearly enough to throw their hands up when they have a foreign born patient, drag an interpreter in, and consider their job done.  With such a large number of diverse cultures represented in Arizona, it is becoming very necessary that our hospitals also step up and get attuned to dealing with different peoples from different cultures.  Whether it's recommending the correct diet plan for a Mexican immigrant, or dealing with cultural mores about breast-feeding among Asian cultures, hospital staff are getting new information on how to deal with these challenges.

While many of the cultural challenges can involve food, religious rituals, clothing and customs, there are other more serious issues that can impact patient safety.  For instance, the New York Times illustrates the example of a doctor who could not understand why a patient's blood pressure levels continued to remain high in spite of a change of diet.  She had recommended banning white bread altogether, but hadn't bargained for the fact that she ate tortillas every day.  These may seem like small issues, but can have an adverse effect on a patient's health.  As the United States becomes increasingly diverse, it is becoming more necessary that doctors, nurses and other hospital staff make an effort to go beyond charts and BP readings to really understand where their patients are coming from.

There are other areas where cultural mores could impact patient safety.  For instance people from some African cultures are more likely to miss follow-up appointments, or may not follow instructions carefully, because of a shaky belief in man-made medicine.  Other times, immigrants who have had little access to health care in their home countries, may find the prospect of visiting a doctor regularly, intimidating.  It's important for doctors to consider these factors, and deal with their patients accordingly.

A new study by Arizona State University shows that if you visit a hospital with advanced electronic medical records systems, you're likely to be treated and discharged quicker than if you arrive at a hospital with manual record filing systems. 

A study conducted by Arizona State University's WP Carey School of Business, shows that patients visiting a hospital with electronic medical records systems were likely to spend approximately 22.4% less time in the ER than in other hospitals that do not have electronic medical records.  These people could expect a much shorter overall stay in the emergency room, and a much shorter treatment time. 

The researchers examined data from the 2006 National Hospital Ambulatory Medical Care survey.  The data included more than 30,000 patient visits to 364 hospitals nationwide.  The researchers considered three categories:

• Hospital emergency rooms with little or no electronic medical records
• Emergency rooms with only basic electronic medical record systems
• Emergency rooms with highly sophisticated medical record systems

The researchers found that hospitals that had the best and most sophisticated medical record systems had treatment times that were 13% shorter. ER stays for patients who were eventually admitted to the hospital were approximately 23.5% shorter, and ER stays for patients who were treated and discharged were approximately 21.3% shorter.  Hospital emergency rooms that had only basic electronic medical record systems did not perform well in many areas.  They had a wait time for patients dealing with urgent or semi-urgent medical issues, that was 47.3% longer.

This proves to Arizona medical malpractice lawyers that hospitals that rush to have a basic electronic medical record system in place to benefit from promised federal funding, are likely to see no benefits from the systems.  In fact, these systems may actually negatively impact the hospital's capacity to respond quickly to patients.  The lesson to take home from this, is that it's not adequate to have only a basic electronic medical record system in place in a hospital.  It's important to have a full-fledged, comprehensive and fully established electronic medical system, in order to see the benefits of these systems.

Surveillance data from at least nine metropolitan areas in the US shows that between 2005 and 2008, there was a substantial decline in the number of methicillin-resistant Staphylococcus aureus (MRSA) infections in American hospitals. The data is not based on nationwide statistics, but researchers at the Centers for Disease Control and Prevention who announced the findings, say that there is enough reason to believe that these results are similar throughout the country.  According to the researchers, in 2005, methicillin-resistant Staphylococcus aureus bacterial infections sickened approximately 95,000 Americans and killed more than 18,500 people.

The CDC researchers considered 1.5 million people in nine metropolitan areas. These were people who had suffered an infection in otherwise sterile parts of the body. The researchers found that approximately 75 percent of these people had been hospitalized recently, or had been in close contact with a healthcare setting.

During the four-year study period, the researchers found that the appearance of severe methicillin-resistant Staphylococcus aureus infections during hospitalization, dropped by approximately 9% every year. Among patients who were not hospitalized but contracted the infection, the infection rate dropped by approximately 6% every year.

Obviously, that's good news, but Arizona medical malpractice lawyers would caution against over-optimism at these rates. It's important to remember that MRSA is just one type of Staphylococcus bacteria that is responsible for hospital infections. In fact, MRSA accounts for less than one in 10 hospital infections.

Even so, being able to stem these deadly infection rates is no mean accomplishment. At this point, all that we know is that these rates have declined, but we don’t know why yet. Infection control strategies could be working, but it's hard to tell at this point what kinds of measures are working best.

More and more hospitals are relying on checklists, and are advising proper handwashing procedures for healthcare professionals before they insert catheters into a patient. Other hospitals are actually testing patients for MRSA when they are admitted into the facility.  These practices could have played a significant factor here.

The American culture of treating doctors as demigods, who cannot be questioned at any cost, could be contributing to hospital infections, injuries or deaths.  That blunt observation comes from medical safety innovator, Dr. Peter Pronovost, who is the quality and safety research group medical director at John Hopkins University Center for Innovations in Quality Patient Care.

According to Dr. Pronovost, little progress has been made in enhancing patient safety in hospitals, in spite of numerous programs and a great deal of media and legislative attention to the problem.  Part of the problem, according to Doctor Pronovost, is a culture of not questioning doctors.  This means that many doctors tend to get arrogant about their skills, and this can have detrimental effects on patient safety. 

Dr. Pronovost made his views clear in a piece that he wrote for the Journal of the American Medical Association. In the article, Dr. Pronovost gives examples of the kinds of doctors that you come across, who might be toxic to patient safety.  One doctor for instance, refused to change his gloves even though he obviously had a latex allergy.  He only relented when Dr. Pronovost threatened to report the matter to a higher authority.  There are other examples that Dr. Pronovost gives of such arrogant doctors.  Doctors who do not accept that they are human and therefore, can make mistakes, and dismiss the inputs and thoughts of other staff members, endanger patient safety.  Dr. Pronovost doesn't mince words, saying that many physicians tend to be over confident about the quality of care they provide patients, and this prevents them from catching errors.

Often, nurses and other staff don’t correct errors the doctor has made, for fear of angering the doctor. This fear of doctors is not a new phenomenon to Arizona medical malpractice attorneys.  In fact, the New York Times has published reports discussing how this awe of doctors seems to be a vital - and potentially dangerous component - in our medical care system.  However, it does make a difference when someone as accomplished as Doctor Peter Pronovost also voices these opinions. 

In spite of a focus on the prevention of catheter-related bloodstream infections in hospitals, a new survey shows that these infections are still as prevalent as ever. 

Catheter-related bloodstream infections or central line infections, are those that are transmitted through the central lines that are used to transmit food and drugs to patients.  The central lines help deliver medications and nutrients much quicker.  However, when the lines are contaminated because of unhygienic, non-sterile practices, an infection can also be transmitted much quicker to the patient.  These are some of the deadliest infections in American hospitals, and frequently lead to complications like sepsis.

There has been much focus on the prevention of such infections in hospitals, but a new survey commissioned by The Association for Professionals in Infection Control and Epidemiology, found that almost half of healthcare professionals believe that central line infections are still a major problem at the hospital they work for.  The respondents included more than 2,000 infection prevention specialists in hospitals.  According to the Association for Professionals in Infection Control and Epidemiology, there are about 30,000 central line infections-related deaths every year, and almost all of these are preventable. 

Approximately 40% of respondents in the survey said that their facility had an active focus on the prevention of central line and dialysis line-related infections for at least five years.  71% of the respondents said the facility had a formal written policy for these preventions.  However, even with these measures, 48% of the respondents said that the infections are still at least a somewhat major problem at the hospital where they work.  Only about 12% said that the risk of these infections was low.

The survey also questioned respondents about the causes of these infections.  29% of the respondents said that improper maintenance of the ports or lines was the main cause of the infections, while 21% said the main factor was the failure to remove lines when necessary.  Improper prep was a factor, according to 20% of the respondents, while poor hand hygiene practices were a factor for 19% of the respondents.  Very few of these infections seem to be related to equipment failure, with only 4% of the professionals admitting that this was a factor.

For Arizona medical malpractice lawyers, it is disconcerting that even with all the hype over patient safety and targeted focus on central line infection prevention, there has been little progress made in minimizing these infection rates.

A growing epidemic of obesity across the country has also meant that obstetricians, nurses and other healthcare professionals need to be extra careful while dealing with obese pregnant women. The New York Times has a report on how more and more numbers of overweight pregnant women are turning up at maternity clinics, and the kind of challenges these pose to medical care professionals.

According to the Centers for Disease Control and Prevention, approximately one in every five women is obese when she becomes pregnant. With rates like these, it has become important that hospitals and staff adjust to the unique medical needs of these patients. For instance in low-income neighborhoods, hospitals have begun investing in longer surgical instruments, enhanced fetal testing machines, as well as larger beds to accommodate obese patients. Even something as simple as a hospital bed can create dangerous conditions for a pregnant woman, if there is a danger that the bed could break under her weight. Hospitals are also investing in training staff to deal sensitively with these situations and counseling women about their options for losing weight.

As Arizona medical negligence lawyers see, there are plenty of complications that a pregnant obese woman faces. There may be complications from high blood pressure and the development of diabetes. There can be difficulties in administering anesthesia, as well as the formation of blood clots during pregnancy. Pregnant women can suffer strokes or hemorrhage.

According to the New York Times, five hospitals in New York City have formed a group in order to be able to better care for overweight pregnant women. One of the possibilities they're considering is having specialized centers for obese women. Obese women are more likely to deliver their first babies through Cesarean sections than women of normal weight, and these specialized centers would accommodate these factors as well as other unique challenges in delivering an obese woman's baby. Typical complications that may arise in an obese woman's pregnancy include fetal distress, delayed labor and birth complications.

Unfortunately, because obesity is so widespread in our society, there may be a sense of complacency about the issue. It's hard to determine that a person is obese simply by a visual inspection. That's why many doctors are now recommending determination of the BMI of an obese woman at the beginning of the pregnancy.

African-Americans seem to be at a higher risk of contracting deadly blood stream infections called sepsis in hospital settings. Not only that, these patients also have a much higher incidence of dying from these infections, compared to white persons.

Sepsis is a potentially deadly bloodstream infection that leads to the breakdown of blood processes, and causes clots in the blood. If not treated in time, the person can suffer organ failure, and ultimately die. Sepsis infections in hospitals are typically contracted from the contamination of the central lines that are used to deliver nutrients and drugs to a patient.

Researchers at the University of Pittsburgh studied hospital discharge data between 2000 and 2005. The data came from the National Hospital Ambulatory Care Survey. They studied a total of 8.6 million hospitalizations, and identified more than 2.2 million infections. 70% of these infections involved organ failure or organ damage, which is usually seen in cases of severe sepsis. The study showed that black patients had a 67% higher risk of being hospitalized for sepsis, compared to white patients. Among black patients, the incidence of hospitalization for sepsis was approximately 9.4 persons per 1,000 blacks, and for whites, it was 5.6 per 1,000 persons.

Blacks are not only more likely to acquire sepsis and require hospitalization for it, but they also have an 80% higher chance of dying from the infection. The blacks in the study, the researchers found also had higher incidences of kidney disease and diabetes. Researchers are concluding that the presence of these two conditions among blacks could possibly increase their risk of contracting a deadly sepsis infection.

So, what lessons does this hold for medical care professionals and Arizona medical malpractice lawyers? A black patient’s risk of contracting sepsis can be reduced through better care and better management of his diabetes and kidney disease. Also, blacks seem to have a higher rate of infections, like respiratory infections, that contribute to sepsis in the first place. Perhaps modifications could be made to existing vaccination schedules for blacks to reduce the risk of such infections, and consequently, sepsis. Better infection control in hospitals could also reduce their chances of contracting sepsis.

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