Risk Watch e-column
August 2005
A monthly update of risk management news, issues and items of interest
Bush Signs Medical Error Database Bill Into Law
President George W. Bush has signed into law landmark legislation that would establish a national patient safety database intended to encourage voluntary reporting of medical errors.
The Patient Safety and Quality Improvement Act, sponsored by Sen. Jim Jeffords, I-Vt., authorizes the Department of Health and Human Services to certify independent “patient safety organizations” to compile a national database of medical errors reported by healthcare providers. The organizations will analyze the findings and make recommendations on ways to reduce the errors.
The data will not identify specific patients, healthcare providers or individuals who report errors. Disclosure of such information is subject to a $10,000 fine per violation. In addition, the information cannot be used as evidence in malpractice lawsuits or other litigation, nor can it be used by an accrediting body or regulator to take action against a provider.
The one exception is if a judge in a criminal proceeding determines the information “contains evidence of a criminal act and that such patient safety work product is material to the proceeding and not reasonably available from any other source.”
The law does not bar patients or their families from using other medical records as evidence in malpractice lawsuits. It also prohibits employers from taking retaliatory action against whistleblowers.
(Source: Business Insurance)
15 Million in U.S. Abuse Prescriptions
The number of U.S. residents who abuse prescription drugs exceeds the number who abuse cocaine, hallucinogens, inhalants and heroin combined, according to a study released July 7.
Researchers at the National Center on Addiction and Substance Abuse at Columbia University in New York estimate that 15.1 million U.S. residents — or 6% of the national population — abused prescription drugs in 2003. That represents a 94% increase from 1992. The study also found that 2.3 million residents ages 12 to 17 — or 9.3% of the total population in that age group — abused prescription drugs in 2003. That figure is an increase of 212% from 1992.
The most-abused prescription drugs included the following:
- opioids such as OxyContin, Vicodin and Percocet
- depressants such as Valium and Xanax
- stimulants such as Ritalin and Adderall.
Four in 10 doctors surveyed by the center said they received no training on prescribing controlled substances, and more than half said they had not been trained to identify prescription drug abuse or addiction.
In addition, about four in 10 pharmacists surveyed said they had not been trained in dispensing prescription drugs since pharmacy school, and nearly half said they had received no instruction in identifying prescription drug abuse or diversion of prescription drugs since pharmacy school.
(Source: The Washington Post)
Study Traces Errors to Physicians’ Speech
A new study has found that physician dictation often is responsible for medication errors.
The study, based on a sample of 220 dictated medical records totaling 9,726 lines of transcription, found that 27% of the 96 more-serious flaws were attributed to the speaker — typically a physician — and not the transcriptionist. Twenty of 38 critical flaws (53%) and six of 58 major flaws (10%) were traced to the speaker.
Critical flaws included patient misidentification, medical word misuse and omitted dictation. Major flaws include misspellings and inappropriate blanks. Minor flaws included punctuation, grammar and formatting errors.
(Source: Modern Healthcare)
Bariatric Surgery Fast-Growing Procedure
The number of weight-loss surgeries in the United States grew by more than five times in five years, according to a report released in the July 12 Health Affairs. The number of bariatric surgeries performed jumped from 13,386 in 1998 to 71,733 in 2002.
The trend is expected to continue because less than 1% of clinically eligible patients in the United States underwent bariatric surgery in 2002, according to the study by the Agency for Healthcare Research and Quality.
Among patients ages 65 to 69, an estimated 395,000 will be clinically eligible for the surgeries this year. That number is projected to grow to 475,000 by 2010. If Medicare, which covers the elderly and disabled, expands coverage of bariatric surgeries, the potential demand will grow even more, researchers concluded.
(Source: The Washington Times)
Study: Quality Gap Persists Despite Best Practice Awareness
The gap between the best possible care and the healthcare that patients actually receive remains large, despite an increased focus on evidence-based practice guidelines, according to a report in the June 27 issue of the Archives of Internal Medicine.
Researchers at Stanford University School of Medicine found that the percentage of visits during which patients received appropriate care improved significantly in only six of 23 areas measured when comparing results from 2002 to those gathered in 1992. These were:
- treatment of depression (83.4% from 46.7%)
- statin use for hyperlipidemia (36.9% from 9.6%)
- inhaled corticosteroid use for adults with asthma (42.2% from 25.4%)
- inhaled corticosteroid use for children with asthma (35.8% from 10.9%)
- avoiding routine urinalysis (72.8% from 63.4%)
- avoiding inappropriate medications in the elderly (94.6% from 91.8%).
Improvements were seen in 11 other categories, but the researchers classified these gains as "modest" or not statistically significant.
There is a commonly held belief that it takes 17 years for medical practices to go from research to widespread practice, and the study's findings lend evidence to this theory, said the report's coauthor, Jun Ma.
(Source: Modern Physician)
Study: Financial Woes Mean More Medical Errors
In a new study, two senior economists from the Agency for Healthcare Research and Quality found that hospitals in financial trouble make more mistakes.
According to the study, which appeared in the spring issue of Inquiry, hospitals that are unable to maintain healthy profit margins are less able to invest in their facilities to improve patient safety, leading to more medical errors.
The study concluded that patients face significantly greater odds of having adverse events from major surgeries in hospitals where profit margins have eroded.
(Source: Modern Healthcare)
Medicare Shares Electronic Records System Free
This month, Medicare will give physicians—free of charge—software to computerize their medical practices. The software is called Vista, a version of an electronic health record system that has been used for two decades by Veterans Affairs hospitals, doctors and clinics.
Medicare has not estimated what its software giveaway is worth, but as a rule, an office with five doctors could save more than $100,000 by choosing the Medicare software rather than buying similar software elsewhere. Other systems can cost $20,000 to $25,000 per physician to install, while installing Vista would cost $10,000 to $12,000 for an entire medical practice, officials said. Medicare will provide physicians with a list of companies that have been trained to install and maintain the system.
The federal government uses Vista in the Veterans Administration’s 1,300 inpatient and outpatient facilities, which maintain more than 10 million records and treat more than five million veterans a year.
Currently, only 20-25% of the nation's 650,000 licensed doctors—outside the military and the Department of Veterans Affairs—use electronic medical records.
(Source: Kaiser Daily Health Policy Report)
