Weekly Must Reads in Patient Safety (Oct 10, 2014)

Unnecessary – that’s the word that best summarizes this week’s reads – unnecessary readmissions and unnecessary surgery.

And, then to round out “unnecessary”, new data recently published in the American Journal of Respiratory and Critical Care Medicine suggests unnecessary risk.

Unnecessary Readmissions

According to a recent report in Modern Healthcare, “2,610 hospitals in the U.S. will see their Medicare payments docked in fiscal 2015 for having excessive numbers of patients return to the hospital within 30 days of discharge.”

The risk of readmission is particularly high for stroke patients, who are “at high risk for a second similar event or other serious medical problems for at least five years”, according to data presented at the Canadian Stroke Congress.

At the recent Crittenden Medical Conference, essential factors for reducing hospital readmissions for the prevention and management of venous thromboembolism (“VTE” or commonly referred to as blood clots) were presented.

Unnecessary Surgery

Hats off to @JuanGrvas for asking “How did the C-section become America’s most common major surgery?” and pointing out this video by Chileshe Nkonde-Price, a cardiologist at the University of Pennsylvania, who wants to avoid an unnecessary C-sections.

According to Dr. Andra James, Professor of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Virginia School of Medicine:

“For pregnant women, the risk of VTE is 4-5 times higher than women who are not pregnant. Moreover, this risk is at least twice as much following cesarean delivery.”

Using the OB VTE Safety Recommendations could help reduce this risk and avoid possible death, as this new mother found out.

Unnecessary Risk

Sedation is often used for mechanically ventilated intensive care unit patients to reduce anxiety, provide comfort, and assist in providing optimal respiratory support. New data recently published in the American Journal of Respiratory and Critical Care Medicine suggests that there is an increased likelihood of death among these patients. The researchers encourage use of safer methods.

The “Keep It On” Campaign encourages monitors to be kept on, which can provide a useful safety net for patients on sedatives.

That said, the limitations of technology and monitoring need to be remembered. Thanks to @bhargavrajan for pointing out this insightful NY Times article.

Monitors can’t replace nurses, but together they are a powerful tool to increase patient safety, as Julianna Morath, RN, MS (then chief quality & safety officer, Vanderbilt University Medical Center) reminds us:

Human vigilance is required but insufficient; continuous electronic monitoring needs to be there to support and back up nurses, and allow them to visit a patient while monitors are continuously assessing other patients for various physiological parameters (such as, oxygenation with pulse oximeter or adequacy of ventilation with capnography).

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