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.

Routine testing discovered she had diverticulitis, and a follow-up CT scan showed she had a foreign body in her stomach. It turned out to be a pen.

The woman told her doctor that about 25 years earlier, she had been poking at a spot on her tonsil with the pen when she slipped, fell and accidentally swallowed the pen. At the time, both her husband and her doctor dismissed the possibility and said she must have been mistaken. (X-rays taken at the time showed no pen in her gut.)

On this most recent visit to the doctor, the pen was removed — and found to still work. Her symptoms have gone away, and the hospital is using the case as a teaching example of two rules: 1) Abdominal X-rays don’t show every single foreign object, and 2) Even if a patient’s story sounds unbelievable, it may just be true.

According to the report, of people in the U.S. infected with HIV, about 80% know their diagnosis. Of those, more than 75% start receiving treatment for the disease within four months. But only half of them stay in treatment.

The treatments to manage HIV and its related illnesses are expensive, often have serious side effects and require rigorous adherence to a schedule of pill-taking. Combined with a still-active social stigma and the fact that many patients are uninsured, those barriers may keep many HIV patients from sticking with their treatment plans.

The good news: When patients do stick with the treatments, they work well. Of those who maintained the most common treatment plan, antiretroviral therapy, 77% showed that their viral load was completely suppressed.

The CDC report also showed that what treatment is prescribed for patients with HIV can vary significantly based on their demographics. Antiretrovirals are more likely to be prescribed for people over 55 (92% of patients), whites (84%) and men (90%).

A group of nurses in New Jersey recently filed suit against the University of Medicine & Dentistry of New Jersey regarding the hospital’s September announcement that nurses would be required to help with pre- and post-op care of abortion patients. That was a reversal of the previous policy that exempted employees who had religious or moral objections to the procedure. The nurses, all of whom work in the hospital’s same-day surgery unit, claim the requirement to help patients before and after the procedure is a violation of various state and federal laws.

In a statement, the hospital said that “no nurse is compelled to have direct involvement in, and/or attendance in the room at the time of, a procedure to which she or he objects based on his/her cultural values, ethics and/or religious beliefs.” The statement went on to say that the university is in compliance with all applicable laws.

The suit was filed Oct. 31, and on Nov. 3, a judge granted a temporary restraining order that bars the hospital from requiring nurses to be trained on caring for abortion patients. A hearing is scheduled for Dec. 5

New Jersey, like many states, has laws allowing health care providers with moral or religious objections to abortion to refuse to participate in the procedure. Federal law also requires health-care organizations that get taxpayer money to exempt workers from the procedure.

The topic hits several hot button issues, including the morality of abortion and patients’ right to treatment plans which health providers don’t agree with.

The hospital maintains that the pre- and post-op care abortion patients receive is the same as any other less controversial procedure. The hospital also said that nurses were putting patients at greater risk since they refused to care for them even in emergency situations.

Several women’s health advocates said that being exempt from performing actual abortions didn’t give the nurses the right to pick and choose which patients they would work with regarding pre- and post-op care.

“If it’s directly participating in an abortion, then the law says they should be able to refuse without being penalized,” said Susan Berke Fogel of the National Health Law Program. “It can’t be just, ‘She’s there to have an abortion’ therefore the person can refuse to even talk to her, refuse to look at her chart or, say, let visitors come up to see her.”

Michigan’s Department of Licensing and Regulatory Affairs is investigating two nursing homes after two female patients were found in deplorable states of neglect. And it’s raising more questions about the care nursing home patients receive — and the kind of oversight these facilities are given.

The incidents came to light as part of a survey of nursing homes in the state by the Michigan Protection and Advocacy Service (MPAS). (Warning: Some Some details below may be hard to stomach.)

The most disturbing finding of the survey: At least two patients were discovered by staff to have active maggot infestations.

In one case, a patient had been refusing showers due to pain and wasn’t receiving regular bed baths. Eventually a staffer found maggots in and around her catheter. Corporate staff directed a nurse at the facility to document it in the patient’s medical records as “debridement” of dead tissue. The woman didn’t get a shower until several hours later, and was sent to a local hospital where she was also treated for a previously undiagnosed hip fracture.

In the second case, a woman was experiencing severe coughing far worse than usual for her condition, but staff didn’t check on her for awhile because they were busy with other patients. Eventually, the coughing became so severe that EMTs were called. The EMTs found an active maggot infestation in the woman’s throat.

The agencies say the conditions were, unsurprisingly, the result of serious neglect and abuse.

The two nursing homes involved were not named due to medical privacy laws. A policy that’s most likely baffling to anyone who has a loved one in a nursing home in the state. Both facilities have been cited for multiple violations each; one of them was also fined. Both facilities have submitted correction plans as required by the law.

The executive director of MPAS cited not only staffers’ neglect in allowing the women’s conditions to degrade to such a point, but noted that multiple levels of regulation and patient safeguards had failed as well.

What needs to change to ensure cases like this stop happening? Share your thoughts in the comments.

Matthew Scheidt, a 17 year old, talked his way into Osceola Regional Medical Center as a physician assistant student from a local hospital. He spent the better part of the week working in the emergency department. By all accounts, he had a real learning experience: In that week, he performed CPR on a patient in cardiac arrest, performed an unknown number of exams on undressed patients and had reviewed patient’s confidential medical files.

Scheidt had previously worked in the billing department of a local surgical group. He got a hospital ID by telling workers at the hospital that he worked as a PA for a physicians practice and needed a new badge since the medical group had changed its name. Twice in that week, Scheidt tried to get a doctor’s ID card which would have given him additional access to sensitive areas of the hospital, but the request was denied.

At one point, someone from the surgical group questioned Scheidt’s story. He claimed that he was working in the ER on a special “top-secret” assignment for the county’s sheriff’s office, and that’s why they couldn’t find the right paperwork to back up his claims.

Eventually, someone at the hospital got suspicious and called the police. And shortly thereafter, Scheidt’s new “job” was terminated.

He now faces five charges of impersonating a physician’s assistant and is being held in a facility for juvenile offenders.

It’s unclear at this point what the fall-out will be for the hospital.

The cause of the shortage is a trend toward smaller production runs of less profitable generic injectable drugs as well as manufacturing problems such as contamination that have removed large lots of some drugs from the market.

Vital drugs used in chemotherapy, critical care and treatment of several life-threatening illnesses have been in short supply. The shortages have inspired some middle-market suppliers to essentially scalp the meds, by buying back-stock where they can and offering it to hospitals at jacked up prices.

It’s a steep price difference, too: The Associated Press found that one medication for high blood pressure was being sold for $1,200 a dose instead of the usual $25.90 per dose.

Some hospitals are forced to postpone purchases to either save money or because the supplies simply aren’t available to them at any price. But when those drugs aren’t available, patients have to delay surgeries or other treatments — which leads to extra pain as well as avoidable complications, and in some cases, even death. Patients who receive the drugs bought from the so-called gray market suppliers aren’t necessarily safer. Sometimes hospitals end up unwittingly buying medications that have been stolen and may or may not have been handled and stored properly.

Besides the cost to patients’ health, hospitals are absorbing huge losses on these drugs — an estimated $415 million per year — which they won’t be able to do for much longer.

Ruphard went back to the hospital, Provena St. Joseph Medical Center, a few weeks later to have a perforation repaired. On Thanksgiving morning, she started to feel pain and tingling in her legs.

Her medical chart shows that Ruphard’s toes had turned cold and blue and that she eventually lost feeling below her knees. Her lawyer claims that the hospital waited far too long to offer the correct treatment and contact a surgeon. He also said that once the surgeon was called, he was upset and asked staffers why he wasn’t brought in sooner.

Ruphard’s laywer indicated that inadequate staffing over the holiday might have been a factor in Ruphard’s care.

Whatever the cause, by the time a surgeon did see her, 36 hours later, it was too late to save her legs.

Ruphard is now suing the hospital, claiming it didn’t monitor her condition adequately and didn’t administer proper care, since she had a pre-existing clotting disorder.

Provena St. Joseph Medical Center wouldn’t discuss this specific case, citing privacy issues, but said in a statement that gastric bypass surgery carries known risks and that its patients are properly monitored and treated.

There are a few easy steps patients can take before, during and after their appointments to make it easier for both sides to get the information they need. Here are five tips to make your appointments more productive and efficient — and give your doctor the info he or she needs to give you the best care.

1. Be open to other diagnoses — Few of us are immune to the paranoid pleasure of making a self-diagnoses based on thigns we’ve read online. Sometimes that diagnosis is even right! But doctors say too often, patients come into the exam room convinced their symptoms mean one thing — and then they’re skeptical when the doctor offers an alternative diagnosis or treatment.
2. Be honest — Don’t be shy  about sharing your sexual history, assume the joint you smoke when you go hiking “doesn’t count” or forget to mention the half dozen nutritional supplements you take. Or if you haven’t been taking a medication that was prescribed, or working out like you had been, let your doctor know that too. They don’t want you to tell them what they want to hear — they want to know what’s actually going on in your life so they can offer the best advice
3. Come prepared — A prepared patient is a healthier patient. Writing down even apparently minor symptoms or questions that have come up since your last visit gives your doctor a better idea of your overall health and saves time for both of you. This is one time where the axiom that there’s no such thing as a stupid question is really true.
4. Take notes, and ask questions — Any good doctor understands that some medical terminology or explanations will go over the heads of patients. Take notes of any advice or recommendations your doctor makes. And if you need something explained again — or in a different way — let them know. Any doctor who isn’t willing to take the extra few minutes to make sure you fully understand what s/he is telling you isn’t a doctor you want to go back to. 
5. Keep your follow-up appointments — They don’t exist just to pad doctors’ coffers. While they often seem like time-wasters to patients, those follow-up visits help doctors keep tabs on how your treatment or condition is progressing. Doctors said they were the most important part of a solid preventative health plan.

The advice doctors give you isn’t necessarily what they themselves do when faced with a medical situation.  That’s the takeaway from a recent article in the Archives of Internal Medicine.

Researchers asked physicians how they would handle two medical situations that required them to weigh the likelihood of a cure against the expected side effects of treatment. In the first hypothetical situation, doctors were presented with a diagnosis of cancer and asked to choose between a treatment that:

• would cure 84% of patients, but leave 4% with complications such as infections and chronic diarrhea, or
• would cure 80% of patients with no complications.

More doctors recommended the first option for their patients than for themselves.

In the second hypothetical, 63% of doctors said they would opt out of a potentially life-saving treatment for avian flu to avoid side effects — but only 49% would advise their patients to do the same.

That’s not to say doctors are giving out bad, or hypocritical, advice to patients. The researchers believe that doctors have a natural bias toward recommending the most logical choice (i.e. the treatment most likely to cure them). But when making their own medical decisions, they’re more likely to consider more emotional issues, such as the effect of long-term complications on quality of life.