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October 2012 Archives

Emergency Care Threatened By Readmission Reduction Program

Emergency care leading to hospital readmission rates within 30 days of a prior discharge will be penalized by Medicare and Medicaid in the form of reduced payments. The costs associated such readmission penalties will likely run into the millions of dollars. Two thirds of U.S. hospitals (2,211hospitals) will be penalized starting in 2013. Two hundred seventy eight (278) facilities have already been told that they will receive the maximum penalty of a 1% reduction in payments, which means millions less in payment to penalized hospitals. For example in Tennessee, Vanderbilt University Medical Center expects to be penalized between $500,000 and $1,000,000 a year, and Saint Thomas Health Hospital expects to lose about $1.2 million dollars a year in payments. Because every dollar lost hurts hospital operations, there will be increased pressure on Emergency Room physicians to not readmit recently discharged patients who need care.

Study Finds MRI More Reliable Than ECG in Diagnosing Heart Attacks

A recent study reveals that electrocardiograms (ECG) are failing to diagnose heart attacks in many cases. Failure to diagnose a heart attack on time can lead to delayed or no treatment, which can result in a subsequent heart attack-and even death.

Patient Safety Requires High Index of Suspicion For Errors

To improve patient safety, doctors, nurses and all healthcare personnel must have a high index of suspicion for errors, reports a recent Medication Safety Alert in the Institute for Safe Medication Practices. Each person on the team must anticipate and investigate the possibility when any member of the healthcare team, regardless of experience or rank, expresses concern about possible errors or when patients are not responding to treatment as expected. Often the discovery of an error is begun when someone asks a question just because something doesn't seem right. Unfortunately, there is a hierarchy of rank amongst healthcare professionals that creates a culture where even the slightest questions about possible problems with patient care are not treated seriously and dismissed without any follow up. Outright intimidation and disrespect of medical subordinates are rare, but over-deference to "more experienced" providers is common. Subordinate staff who do speak up are easily convinced that their concerns are unfounded. As a result, opportunities to catch errors before harm occurs are lost.

Specialty Radiologists Improve Pediatric Care

Specialty radiologists improve pediatric care and disagree with the interpretations of critical imaging studies by community general radiologists in about 40% of cases. A study in the American Journal of Roentgenology examined the imaging reports of all pediatric patients at a major medical center, and compared the interpretations by community radiologists with those of pediatric radiology and neuroradiology specialists. Major disagreements between the general radiologist and the specialty radiologist reads were found in 22% of the studies, or 170 of the 773 examinations. Most major disagreements concerned the presence of fracture and hemorrhage, two conditions that often require emergent diagnosis and treatment.

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