Hospital Death Rates

[paramedicmike]

This is sort of "non-EMS" but it may, potentially, affect what we do and how we do it. It is interesting reading, to say the least.

-be safe

[web:d99a2c2e59]http://www.usatoday.com/news/health/2008-08-20-hospital-death-rates_N.htm?se=yahoorefer[/web:d99a2c2e59]

[itku2er]

Wonder if this will cause any potiential long term effects on the hospitals that you can compare? Think about it would you take your love one to a hospital with a high death rate or would you choose a hospital with a low death rate? Could cause some good hospitals to loose money and clients. Good topic paramedicmike.

(now I want my cookies back!)

[VentMedic]

This is already having a huge effect on different procedures and transport which directly or indirectly affect EMS.

Medicare will no longer pay for hospital acquired infections. In the past hospitals had let the field IV slide through and laxed their policy on restarting in the ED. That is again being examined. If there is a central line done by anyone, flight or ground, there will be documentation and follow up. There are also studies being done at some hospitals acrosss the country on VAP and what percentage of the ETTs were started in the field. We also use a different ETT in the hospital and if a patient is going to be on a vent more than 24 hours, we may switch tubes in the ED.

For the past few years hospitals have also started to participate in the 100,000 Lives Campaign and establish emergency or Rapid Response teams (RN/RRT) to respond to a patient inside the hospital before they do code. This gets the pt a higher level of care while the transfer is being made.

Hospitals are also establishing their own CCT teams with their own equipment to have a better handle on training and infection control. Infection control is still something EMS skims and does not fullly address when it comes to protecting the patient as well as the provider. Some CCT/EMS crews still do not even filter their transport ventilators properly or even do adequate cleaning between transfers.

The CCT team formed by hospitals will also help in that some EMS teams still take MIs to little general hospitals and not the Cardiac hospital a few blocks down the street.

[VentMedic]

If you want more interesting reading about a hospital's awareness now for every procedure done. :

The Check List

http://www.newyorker.com/reporting/2007/12...fa_fact_gawande

[itku2er]

Thanks Vent another good story there great reading. Its amazing how far medical history has advanced with all these new machines and bells and whistles, but honestly why can't we come up with a cure for all these diseases with all the advances we have made so far?

[Just Plain Ruff]

I think anytime that a hospital is revealed to have higher than industry norms in death rates. length of stays, and other items they become beter at that specific thing.

You've all heard of the 30 minute or less guarantee - that was directly a result of the focusing on the waiting times for patients in the ER's.

No hospital wants the spotlight shined on them. Things get changed when admin's get their faces shined on.

[VentMedic]

This problem is a little more complex with many variables. Insurance and availability of medical care also plays a large part. People are ending up in the hospital sicker because they don't go to doctors for routine checkups. There is a waiting list for uninsured women for a routine mammogram for some places in this country of almost 18 months if there is even a program for them. Most do not know their colesterol level. Factor in all the patients that have abused their bodies with drugs and alcohol.

Even the 30 minute guarantee ran into some problems and many hospitals no longer emphasize that. It was a quick fix resulting from some media stories but was not always thought through thoroughly before implementing it.

We can fix a lot of problems but each fix may require more invasive procedures or medications that lead to other problems. Look at the treatment course of a cancer patient of almost any type. PNA is another example of what can be done but the invasive procedures and antibiotics use set the patient up for more potential problems.

The reason why nurses do call the doctors in the ICUs for more orders even if there are protocols in place is there may be signs of another body system or organ failing and that bears some responsibility of determining if another course of treatment may have to be taken or if it is necessary to continue even with the possibility of permanent damage to another organ or at least temporarily enough to where more treatment will be needed to counteract those problems stemming from that damage.

There are also budget issues as staff and services are cut. If CNAs, EKG techs and Phlebotomists are cut, the RN may be doing primary with complete care on no less than 10 patients for 12 hours on a med-surg floors. Many more than that if you count admissions and discharges. In some places ICU RNs take 3 - 4 patients while others may have 2 but of a very high acuity. In either place, that is less eyes watching the patients to intervene when something does happen or to prevent it from happening.

This problem is not new and hospitals have been aware of it for many years. There are just some many human variables that can not always be controlled. One could look at the deaths that resulted in the field from poor RSI techniques and the poor oversight of Paramedics to intubate. However, if one also looks across the country at the varying levels of EMS coverage, there is less emphasis placed in that area. San Francisco and other cities' media are taking the response time thing to the max for being just a minute off their target times. What they have not emphasized is what type of services and quality from medical oversight that is done once the ALS ambulance gets to the patient. Trying to fix one problem quickly may also have required them to take shortcuts to free up ambulances quicker. That could impact patient care either directly or indirectly.

[VentMedic]

There are other factors also that contribute to the statistics. Patients are living longer and hospitals are able to save patients or prolong their lives longer dispite to over all prognosis. The subacutes are full of vegetative patients on ventilators. Last weak I had 3 med-surg codes in 2 shifts with pts older than 95. 2 of them made it to the ICU. Was it the hospital's fault they coded or was their age a contributing factor? When should we say enough is enough and let some commonsense come into the medical profession?

The expense of keeping a patient along is astronomical and I am always amazed at what we can do as we seem to get more, new and improved technology every week.

Just the cost for training staff on all the technology is incredible. Then, to continue proficiency in updating educating and skills along with all of the regular education/training updates requires a lot of didication from staff as well as expense.

Here an article on today's business wire:

http://www.insidebayarea.com/business/ci_10256926

Heart device pumping new life in patients, firm's bottomline

By David Morrill

Contra Costa Times

Article Last Updated: 08/20/2008 06:38:04 PM PDT

PLEASANTON — The heart of Chula Vista resident Debra Kinney was down to its last beats.

Medication that served as her savior battlling back her congestive heart failure for 25 years suddenly didn't work anymore. In 2006, her doctors said she had probably a month to live.

"My life turned from being very active to basically coming to a grinding halt," she said.

Her doctor said there was nothing more that could be done and sent her to San Diego for more help.

That's where she was told of one last option. An experimental device called the HeartMate II manufactured by Pleasanton-based Thoratec. Four days later she had it implanted, and it saved her life.

"They put it in, and within a month I was up and running around doing stuff I had done in the past," she said. "It was a miracle."

The HeartMate II is a left ventricular assist device implanted into the body that delivers a continuous flow of blood through the body using a propeller-like mechanism. Because it's a steady flow, a pulse on a patient is hard to find.

Not only is the device giving patients a new lease on life, but it's been a financial boost for Thoratec's bottom line as well.

Earlier this month, Thoratec reported its second quarter earnings had risen almost sevenfold largely because of the success in sales of this pump, which received government approval in April to be used to treat patients as a bridge to a heart transplant. Its revenue rose 44

percent, to $82.6 million from $57.3 million. The cost of the device is about $80,000. The devices are also benefiting from more acceptance by Medicare and other insurance companies.

Shares of Thoratec closed at $24.44 Wednesday,. Its 52-week range is from $12.92 to $25.87.

Jayson Bedford, an analyst with Raymond Rames & Associates, called the HeartMate II "one of the more exciting new product launches in our medical device universe."

The larger market in the future for the HeartMate II is in "destination therapy," or patients with end-stage heart failure who are too ill for a transplant, said Ryan Bachman, analyst with RBC Capital Markets. An official approval from the Food and Drug Administration for the HeartMate II and destination therapy could come by mid-2010.

The HeartMate II is Thoratec's follow up to its previous assist device the HeartMate XVE which is currently approved for destination therapy.

more at:

http://www.insidebayarea.com/business/ci_10256926