A study in the New England Journal of Medicine found that hospitalized patients’ mortality increased proportionally with shortages in nurse staffing.

But another study published in Medical Care, found that effect was muted when looking at “safety net” hospitals that serve the poor, uninsured, etc. At non-safety-net hospitals, patients benefited from fewer deaths from heart failure, fewer incidents involving failure to rescue, lower infection rates and fewer patients who had to stay in the hospital longer than expected.

The researchers say more data is needed to determine what causes the discrepancy, but they suspect it’s related to overall poorer health of the populations using safety-net hospitals.

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In particular, those facing life-ending illnesses such as cancer, heart failure and dementia, are subjected to drawn-out procedures that may be counter-productive and create a miserable environment for patients in their final days. Consider:

• Hospitalizations during the last six months of life increased by more than 10% between 1996 and 2005.
• Average time spent in hospice care or other palliative treatment is shorter, because patients are getting aggressive treatment up until the very end. (One-third of hospice patients received it for less than one week, according to one study.)
• As many as 20% of cancer patients receive four or more sequential treatments of chemotherapy, even though  guidelines call for no more than three attempts if the tumors haven’t responded to treatment.

The reasons for this over-treatment are complex – but understandable.

Many doctors practice “exhaustion medicine” – trying any treatment regardless of likelihood of its success, until there are no options left. Doctors may revert to this out of a fear of lawsuits later on, or simply because it’s difficult to convince a patient in denial that his or her condition is simply not treatable and won’t improve.

Doctors don’t share all the blame for overtreatment. Patients may have little to hold on to besides the hope of getting better – and if a treatment has only a 1% chance of working, that 1% chance may seem preferable to waiting for death.

But overtreatment has numerous downsides: It not only saps the sorely needed resources of an already-strained health care system, it subjects patients and their families to unnecessary pain and discomfort – both physical and emotional.

Ethics experts and others in hospice and palliative care urge health care providers to make time with patients, especially those diagnosed with cancer, dementia and heart failure, to discuss the true pros and cons of aggressive treatment past a certain point. The earlier, the better.

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Three London hospitals started using eight “care bundles” to target common clinical issues (such as vomiting and surgical site infections) as part of the treatment for 13 specific diagnoses, ranging from senility and mental illness to COPD and heart failure.

Each care bundle consisted of a treatment checklist, space for medical notes, a way to flag affected patients and a tracer backing form. Each bundle was printed on one page, with a sticker to attach to the patient’s chart on the first day of treatment.

After a year of use, there were 255 fewer deaths at the hospitals than in the previous year — a 14.5% decrease. The targeted diagnoses accounted for 174 fewer deaths.

The study was published in the British Medical Journal.

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The survey, conducted by Health Intelligence Network, found 67% of respondents were using telehealth for either clinical or non-clinical purposes. Just under half (49%) use it to remotely monitor patients’ health.

For the most part, providers aren’t using hi-tech solutions: 72% cited the phone as the most used medium for telehealth. Another 39% said they offer broadband connections for telehealth services.

Other highlights from the survey:

• The biggest benefit of using telehealth was health care efficiency, cited by 73% of respondents.
• Just under 20% of respondents said their biggest headache in implementing telehealth was getting reimbursed for it.
• Most of those using telehealth made it available to their entire client base. Only 17% focused its use on the chronically ill; 8% primarily targeted rural patients.
• The condition most commonly tracked via telehealth was heart failure.

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