Pennsylvania Malpractice Numbers Ignored?
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I composed a polite letter to the editor of our local paper, the Patriot-News. It went something like this (exactly like this, actually):
"Title: Is Pennsylvania's Malpractice Crisis Solved? Maybe for trial lawyers.
Dear Editor,
Data just published by the non-profit, non-partisan Kaiser Family Foundation at http://www.statehealthfacts.org/ provides facts to consider in our discussion of health care reform in Pennsylvania.
Based on data from the National Practitioner Databank, Pennsylvania ranks third in the nation in the number of paid malpractice claims per thousand physicians (http://tinyurl.com/22mppw). Pennsylvania ranks second only to New York in total payments for claims made during 2006--over $300,000,000 (http://tinyurl.com/26hh9p).
Please consider passing these facts on to your readers so that they may form their own conclusions about the state of Pennsylvania's malpractice system. I submit that being ranked second and third in the nation in two objective measures of malpractice payouts does not support those who contend that our malpractice crisis is 'over.'"
Was it published? Nope. Oh, well.
It WAS published on Sunday, April 29th, 2007,
PA Ranks Second in Total Dollars Paid in Malpractice Claims
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At the same website mentioned in the preceding post one can find information on total dollars paid in malpractice cases in 2006. Pennsylvania ranked second with $308,781,000 paid (second only to New York). See for yourself.
Vermont looks pretty good to me right now...
PA Ranks Third in Paid Malpractice Claims
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The Kaiser Family Foundation maintains StateHealthFacts.org, a site "designed to provide free, up-to-date, and easy-to-use health data on all 50 states". The site just published Number of Paid Medical Malpractice Claims, 2006. Pennsylvania ranks third among all states in number of malpractice claims paid per thousand physicians. See for yourself.
Acoustic Respiratory Monitoring: What Is It?
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An intriguing press release last week from Masimo (known for their motion artifact-resistant pulse oximeters) begins as follows:
"Masimo, the inventor of Pulse CO-Oximetry and Read-Through Motion and Low Perfusion pulse oximetry, reported that three new independent studies, including one presented the recent International Anesthesiology Research Society (IARS) Clinical & Scientific Congress in Orlando, concluded that Masimo Acoustic Respiratory Monitoring technology (ARM) is "at least as accurate as capnometry" and "significantly more reliable" for monitoring respiration in spontaneously breathing patients."
The release then refers to "an adhesive bioacoustic sensor applied to the patient's neck and connected to a breathing frequency monitor prototype" which in turn accurately monitors respiratory rate.
If this device does what I think it does, it will become the standard of care for post-surgical patients very rapidly. We've been looking for a way to reliably monitor respiratory rate on the floors, once patients are discharge from the recovery room. For example, a patient may receive pain medications from multiple sources, with unpredictable onsets. How do we know their maximum respiratory depression won't happen after they've been delivered to their hospital room?
A patient can receive oxycontin and celebrex orally from a surgeon before their knee replacement surgery, then more fentanyl, morphine, and versed from us (anesthesia). The surgeon may then inject bupivicaine and morphine into the joint at the conclusion of surgery (without necessarily telling the anesthesiologist). I might also do a femoral nerve block to further reduce post-op pain. All of us are trying to do right by the patient but, given the right set of circumstances, are setting them up for significant respiratory depression post-op. The ability to reliably monitor respiratory rate with this new Masimo monitor would be a huge patient safety advance.
The Society for Technology in Anesthesia abstract is here.
Skim for OS X
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A new application called Skim has been released for Mac OS X and I mention it here for readers who stuff their hard disks with pdf files of articles they have heretofore been unable to annotate electronically:
"Skim is a PDF Reader and note-taker for OS X. Skim is designed to help you read and annotate scientific papers in PDF."
[Michael McCracken]
Do Specialty Hospitals Call 911 to Save Their Patients, or Transport Them?
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The New York Times has an article titled Some Hospitals Call 911 to Save Their Patients which details two cases of patients having surgery at a specialty surgical hospital, experiencing complications, and then being transferred to a medical center (where they ultimately died). The whole article is written, and certainly the title was chosen, to suggest that 911 emergency services were called in order to treat a deteriorating patient as no physicians routinely stay in-house overnight.
Although I am not familiar with the particulars of the two cases mentioned in the New York Times article, it should be known that 911 would be called for any intra-facility transfer and does not necessarily imply they were called to render care in an emergency or that care was unavailable from other professionals already there.
Isn't it interesting, though, that a patient who is has no objection to getting their care from a CRNA, nurse practitioner, physician's assistant, or other 'health care provider' (after all, it's cheaper, right?) suddenly deems it essential to have a doctor there when things start to go south? Of course they do. I would, too!
If you're flying a commercial flight and the landing gear won't deploy, you feel better knowing the pilot is a former military pilot with years of experience in 'heavies.' If your child's safety is threatened by a stranger, you feel better knowing that highly trained and qualified officers are there to protect you. If you're having surgery and things start to go bad, you want an anesthesiologist, a physician, a smart, independent thinker who doesn't get flustered or do whatever the surgeon says to do. You want me. Not someone who is cheaper, less highly trained, less experienced, someone who will do in 99% of cases.
