The incident occurred in 2010, when eight people were infected with the potentially deadly form of pneumonia. A recently published study found that all eight people had been infected after simply walking by the decorative water wall-style fountain in a hospital lobby. (None of the people had been admitted to the hospital at the time of their exposure.)

All of the infected victims were workers, visitors or outpatients who were simply passing through the building. But all eight did have pre-existing medical conditions or other factors that made them more prone to infection.

Legionnaires’ is transmitted through inhalation near contaminated water sources.

Water walls and similar decorative touches are popular in hospitals because they’re soothing and calming for patients and their families. But this incident, the second time a water wall has been the vector for disease transmission, is raising questions about the safety of these particular decorative flourishes in a health care setting where people with already compromised immune systems are at additional risk of contracting a variety of illnesses.

The hospital in question, Aurora St. Luke’s South Shore near Milwaukee, shut down the water wall as soon as it was suspected of being involved in the outbreak. It has since been turned into a planter. Although the water wall was cleaned frequently, the fountains make an ideal breeding ground for bacteria since they’re generally at room temperature or slightly higher. In addition, the walls often feature decorative touches such as rocks that provide nooks and crannies that allow bacteria to thrive — and are notoriously hard to keep clean.

The study was published in Infection Control and Hospital Epidemiology.

The highest penalty of $100,000 was assessed on two hospitals:  Mission Hospital Regional Medical Center, Mission Viejo, and  Scripps Memorial Hospital La Jolla. In both cases, patients needed to have second operations performed to remove retained foreign objects after staff didn’t follow proper procedures.

The rest of the penalties were for $50,000 or $25,000. Most were for failure to follow surgical procedure or failing to implement appropriate policies for the safe administration of medication.

You can read the news release — with links to the individual reports for each incident at the California Department of Public Health.

The National Labor Relations Board claims that Holy Family Hospital of Methuen, Massachusetts, part of Steward Health Care System, fired Mary Ramirez for her activity leading a union organizing effort. Ramirez, 61, has 40 years of nursing experience, 18 of them at Holy Family. NLRB also said that nurses at Holy Family weren’t allowed to wear buttons showing support for Ramirez.

Through a spokesperson, Steward has denied the allegations, claiming that Ramirez was fired for a variety of performance issues that were reported to management by a fellow nurse. The hospital claimed that Ramirez intentionally changed a doctor’s order, made an intentional medication error, and didn’t enter a morphine dose in a patient’s record. (Ramirez doesn’t deny that she administered a drug intravenously rather than injecting it, but said it wasn’t an intentional error. She also noted that the patient wasn’t harmed in any way.)

The hospital also said that the Board of Registration put Ramirez on probation for two year for diverting patient medication for her own use. Ramirez didn’t deny the allegation, but again pointed out that no patients were harmed by her actions.

Ramirez maintains that her union activity was the real (and improper) reason for her firing. She’s seeking reinstatement to her position and back pay.

Between 2000 and 2010, the number of doctors hospitals employ has increased by 32% — up to 212,000 physicians, according to the latest edition of AHA Hospital Statistics.

Of those, 27.5% are covered by either a group or individual contract, 17.3% are directly employed by the hospitals — the rest, more than half, of all hospital doctors, aren’t employed or under contract.

The report also looks at many other vital areas, including hiring patterns for registered nurses, how hospitals apportion revenue, and various community health measurements.

Hospitals’ incident reporting systems are only registering about 14% of patient injuries, according to a new study. 

That’s the conclusion of a new statement from the Office of the Inspector General. According to the report, hospitals investigate the patient harm events that are most likely to help them make safety or quality improvements and they made relatively few policy changes based on the events that were reported.

As for the other 86% of incidents, hospitals said 61% were events that the staff didn’t perceive as a reportable event. The rest were normally reported but not reported in that specific instance.

OIG noted that all the hospitals reviewed had incident reporting systems in place and that hospital managers say they rely on the systems to monitor quality of care and catch potential problems.

Because incident reporting is so vital to hospitals, OIG recommended that CMS take the following steps:

• collaborate with the Agency for Healthcare Research and Quality (AHRQ) to create a list of potentially reportable incidents that hospitals could use
• provide guidance to accreditors regarding their assessments of hospital efforts to track and analyze events
• suggest that surveyors evaluate the information collected by hospitals using AHRQ’s Common Formats, and
• scrutinize survey standards for assessing hospital compliance with the requirement to track and analyze events and reinforce assessment of incident reporting systems as a key tool to improve event tracking.

To see the full report as a downloadable PDF click here.

Will those steps actually improve incident reporting and make it easier for hospitals to improve overall patient care? Share your thoughts in the comments.

The College Station Medical Center recently finished a major upgrade and expansion that included the addition of 2,200 square feet in the ER, five new treatment areas and six “fast track” treatment areas which are designated to handle patients who need less extensive treatment.

A hospital spokesperson said College Station is the only ER in the region that publicizes its ER wait times and promises that patients will be seen by an ER doc within 30 minutes of arrival. A large part of the building redesign was intended to create spaces where medical staff could see those patients more quickly and better prioritize treatment and use of resources.

A typical example is Massena Memorial Hospital in Massena, New York. The hospital’s board of managers recently voted to spend about $20k for equipment including surveillance cameras, lock-down buttons, and pendants staffers can use to summon police.

Massena has experienced a series of violent incidents recently, including a man who committed suicide near the ER entrance and a visitor to the hospital who broke a window.

Massena’s far from the only hospital dealing with the issue of safety. In recent months there have been numerous reports of shootings, attacks on staff and other disturbances at hospitals around the country — a trend that seems to be on the rise.

While no one would argue against improving safety on hospital campuses, health care organizations do have a need to make sure patients and visitors feel not only safe, but welcome. There have been cases of over-reactive security measures that have resulted in violent incidents as well.

According to a recent survey by The Medicus Firm, national physician search firm, doctors with more than 16 years of experience (after their medical training) get much lower interest from recruiters and hiring managers than their younger peers.

Nearly 29% of candidates with 16 or more years of experience reported a zero response rate on applications to hospitals and direct employers. Just over 8% of candidates with 1-15 years of experience reported a zero response rate.

Even when they do get a response, it’s less enthusiastic. Oder doctors reported they only received an average of 2.12 job offers in a two year period, while younger doctors received an average of 7.88 offers. Both groups applied for approximately the same number of jobs.

http://healthexecnews.com./where-are-the-docs

The need for outpatient facilities in particular is expected to increase as the industry adapts to the ongoing health reform and a move toward accountable care organizations. Outpatient facilities generally provide more access at the local level, and at a lower-cost care overall.

Another driver behind that activity is an expected increase in mergers and acquisitions. The company said that the anticipated activity — of both hospital mergers and the acquisition of physician practices — will create real estate dilemmas for the organizations involved.

That’s the warning from a recent Joint Commission Sentinel Event Alert (downloadable pdf).

While fatigue certainly is never the only cause of adverse events, it’s a leading factor in many of them, as demonstrated by numerous studies.  Besides increasing the risk to patients, the Alert noted that it puts health care workers’ own safety in jeopardy as well.

In response, the Joint Commission made the following nine recommendations regarding the prevention and management of fatigue as well as creating a safety culture for all health care organizations:

1. Assess your organization for fatigue-related risks. This includes an assessment of off-shift hours and consecutive shift work and a review of staffing and other relevant policies to ensure they address extended work shifts and hours.

2. Since patient hand-offs are a time of high-risk – especially for fatigued staff – assess your organization’s hand-off processes and procedures to ensure that they adequately protect patients.

3. Invite staff input into designing work schedules to minimize the potential for fatigue.

4. Create and implement a fatigue management plan that includes scientific strategies for fighting fatigue. These strategies can include: engaging in conversations with others (not just listening and nodding); doing something that involves physical action (even if it is just stretching); strategic caffeine consumption (don’t use caffeine when you’re already alert and avoid caffeine near bedtime); taking short naps (less than 45 minutes).

5. Educate staff about sleep hygiene and the effects of fatigue on patient safety. Sleep hygiene includes getting enough sleep and taking naps, practicing good sleep habits (for example, engaging in a relaxing pre-sleep routine, such as yoga or reading), and avoiding food, alcohol or stimulants (such as caffeine) that can impact sleep.

6. Provide opportunities for staff to express concerns about fatigue. Support staff when appropriate concerns about fatigue are raised and take action to address those concerns.

7. Encourage teamwork as a strategy to support staff who work extended work shifts or hours and to protect patients from potential harm.20 For example, use a system of independent second checks for critical tasks or complex patients.

8. Consider fatigue as a potentially contributing factor when reviewing all adverse events.

9. If current policy allows for sleep breaks, assess the environment provided for sleep breaks to ensure that it fully protects sleep. Fully protecting sleep requires the provision of basic measures to ensure good quality sleep, including providing uninterrupted coverage of all responsibilities (including carrying pagers and phones, and coverage of both admissions and all continuing care by another provider), and providing a cool, dark, quiet, comfortable room, and, if necessary, use of eye mask and ear plugs.