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Entries in Hospitalizations (5)

Tuesday
Jul102012

More Stroke Patients Die After Weekend Hospital Admissions

iStockphoto/Thinkstock(NEW YORK) -- Patients who are hospitalized over the weekend for strokes fare worse than those who come into the hospital during the week, according to new research published in the Archives of Neurology.

The study found patients who were hospitalized on the weekends for stroke were less likely to receive urgent treatments and had overall worse outcomes.  Dubbed "the weekend effect," other studies have shown similar results with a variety of medical conditions, but none have specifically looked at admission days and their effect on mortality rates after stroke, according to the research.

"The scale of the issue is substantial, with approximately 350 potentially avoidable in-hospital deaths within seven days, and an additional 650 people could be discharged to their usual place of residence," said Will Palmer of the Imperial College and the National Audit Office in England, and lead author of the study.

Palmer noted that the results are representative of a population that is one-sixth the size of the United States.

"The results are consistent with previous studies in the U.S., which have suggested a weekend effect in stroke care," said Palmer.  "However, to date, there has not been such a comprehensive study in the U.S."

The study included more than 90,000 U.K. patients over a one-year period in 2009.  Researchers analyzed the day in which a person was admitted for stroke and compared six indicators of stroke care, including the availability of brain scans and clot treatments, 30-day readmission rates, complications, seven-day mortality and hospital discharge.

Researchers found that there was an 11 percent in-hospital death rate for Sunday admissions, compared to an average of 8.9 during the weekdays.  The availability of same-day brain scans showed the largest disparity, with 43.1 percent on the weekends, compared to 47.6 percent on weekdays.

They also found that strokes that occurred over the weekend were also more likely to be classified as emergencies than those during the week.  Of note, emergency readmission rates within 30 days did not differ between weekend versus mid-week patients.

The scientists suggested that a lack of staff, particularly among specialty staff, along with lack of access to urgent treatments, are responsible for the weekend outcomes.  But these are areas that can be addressed "through better management of the existing resources and, where necessary, some additional investment," said Palmer.

Copyright 2012 ABC News Radio

Wednesday
Jan042012

Hospital Readmission Rate Among Heart Attack Patients Higher in US

Pixland/Thinkstock(DURHAM, N.C.) -- Heart attack patients in the U.S. are more likely to be readmitted to the hospital within 30 days of surgery than patients in Canada, Australia and several other European countries, a new study revealed.

The research, published in the Journal of the American Medical Association, analyzed data from more than 5,700 patients in more than 15 countries.  Duke researchers found that 14 percent of American patients who experienced a ST segment elevation myocardial infarction (a severe type of heart attack that occurs when a coronary artery becomes at least partially blocked by a blood clot) were readmitted to the hospital, as opposed to an average of 9 percent in other countries.

There were two strong predictors of these results, said Dr. Manesh Patel, senior author of the study at Duke University Medical Center. Patients with multi-vessel disease were more likely to be readmitted because they were higher risk patients. The second strong predictor for any reason was if the patient was being treated in the United States.

“This isn’t telling us to stay in the hospital longer, but it does open up a conversation about how other countries perform differently,” said Patel.  “This will be important as we move forward with health care reform and figure out ways to provide sufficient care.”

“We do a great job of opening up a patient’s artery, but we need a more coordinated system in place that helps patients follow lifestyle changes, instead of the episodic nature of U.S. health care,” continued Patel.

American doctors are more aggressive in treating patients, said Dr. Christopher Cannon, professor of medicine at Harvard Medical School.  If patients experience any ischemia (reduced blood supply to the heart) post-surgery, doctors tend to want to readmit the patient to the hospital.

“I think also that U.S. patients demand top level care, so if there is a question of chest pain following a [heart attack], they get readmitted for evaluation just to be safe,” said Cannon.

Copyright 2012 ABC News Radio

Wednesday
Sep072011

Want a Lower Medical Bill? Just Ask

Comstock/Thinkstock(YONKERS, N.Y.) -- The economy has left millions unemployed and mounting medical costs have put millions in debt. With financial hardships in mind, a new Consumer Reports column suggests ways to become a savvy health care buyer and haggler.

"I have become impressed with how often American households are unable to afford their medical bills and medications, and they're doing various things, like not taking their medications or taking someone else's, because they can't afford them," said Dr. John Santa, director of the Consumer Reports Health Ratings Center and author of the column.

Because of this, Santa noted that the best time to talk to doctors about medical bills and financial limits is before a patient has incurred any costs.

"It helps to know from folks the degree to which financial issues are a stress for them, especially related to health," Santa said.  "This works best if the physician is aware of this from the start.  If you're struggling to keep your head above water, tell the doctor anything he can do to moderate cost is appreciated."

For many medical conditions, there is a wide range of ways to diagnose and treat the problem and the treatments can vary "enormously" in cost, experts said.

"This recommendation makes sense to me in today's world," said Alan Sager, professor of health policy and management at Massachusetts Institute of Technology.  "In a more reasonable world, of course, all patients would be insured and all would pay the same price for the same care.  And doctors and hospitals would be financially neutral, liberating them to recommend care in light of its clinical value."

When an unexpected exorbitant bill gets handed to a patient, Santa recommends speaking with the doctor who recommended the procedure or treatment to understand why the costs are so high.

And don't ever assume the price on the bill is set in stone.  On average, the hospitals' total charges to patients and insurers are triple the average cost of actually delivering hospital care to the patient, Sager noted.  Uninsured patients are usually charged the highest price, which is the hospital's list price for different treatments and tests.

"That's because no big insurance company or Medicare plan is available to negotiate a lower price," Sager said.  "Hospitals usually offer to discount their initial bill by 10 to 20 percent from those very high charges when the patient simply asks.  That can be offered by the billing or patient accounts department."

For patients hit with an extremely high bill, Sager recommended bypassing the billing department and calling the hospital CEO's office directly.  Explain the problem and ask for help, he said.

Copyright 2011 ABC News Radio

Tuesday
Sep062011

Hospitalized Kids Are Overmedicated, Study Finds

Keith Brofsky/Photodisc/Thinkstock(PHILADELPHIA) -- Many children receive multiple medications while they are hospitalized even though there may be safety concerns about some of the drugs, according to a new study.

Researchers led by Dr. Chris Feudtner of the Children’s Hospital of Philadelphia analyzed 2006 data from more than 580,000 pediatric patients from 463 hospitals across the country.

The number of different medications a child typically received varied depending on age, length of hospitalization and whether they were at a children’s hospital or a regular hospital.

“[A] large proportion of hospitalized children were exposed to five or more drugs and therapeutic agents during each day of their hospitalization,” the authors wrote.

Some children, they found, received as many as 13 different drugs throughout their hospital stays.  After a week-long stay, a number of children received 35 different drugs.  Children with rare conditions were more likely to receive a greater number of medications.

Among the drugs children most often received were acetaminophen, albuterol (often used for asthma) and antibiotics.  A number of drugs the children received were used for off-label indications.

While there have been studies on multiple medications in adult populations, the authors say their data suggests the need for more research into the safety of these drugs as well as certain drug combinations in children.

“[P]olypharmacy … has been shown to be associated with an increased risk of adverse drug reactions in adult patients in intensive care units and other settings,” they wrote.

Copyright 2011 ABC News Radio

Monday
Jul112011

July Hospitalizations: Inexperienced Doctors Make Them Riskier

Ryan McVay/Thinkstock(SAN FRANCISCO) -- Most doctors will tell you to stay out of teaching hospitals when the new crop of inexperienced medical school graduates begins their training. A new analysis of existing studies adds to the evidence that medical trainee turnover makes July a more perilous time for hospital patients, with more deaths, longer surgeries and longer hospital stays -- not to mention higher hospital charges.

However, Dr. John Q. Young, lead author of the review article, said he doesn't want the findings about the "July effect" to scare sick men and women into staying home.

"Patients should definitely seek the care they need, but beware of the July turnover and know that there's always an experienced attending physician overseeing the care of a trainee. Patients shouldn't hesitate to speak with the supervising physician if they feel anxious about the resident."

In the article, appearing in Tuesday's online edition of the American College of Physicians' Annals of Internal Medicine, Young and his co-authors suggested that potential harm to patients treated in July by newbie physicians could be lessened by more gradually increasing their responsibilities and by pairing the inexperienced interns and residents with veteran physicians.

Young said he and his colleagues systematically reviewed 39 studies published since 1989 because of "a common perception that July is the worst month to be admitted to the hospital." The July effect, he noted, is called "the August killing season" in Great Britain. The enormous variations in the designs and quality of the various studies meant Young and his fellow researchers couldn't quantify the risk to patients hospitalized in July. Nor, he said, could they conclude "which hospitals are doing better and which are doing worse."

According to the article, the departure of experienced trainees and influx of new trainees at U.S. teaching hospitals creates a turnover of 100,000 jobs; the turnover in Europe is 32,000. "As a result, the average experience of the teaching hospital's workforce abruptly declines, established teams are disrupted and many of the remaining trainees are promoted and assume new roles in the care delivery process," Young and his co-authors wrote.

In an accompanying editorial, Dr. Paul Barach, a specialist in perioperative and emergency medicine at the University Medical Center in Utrecht, the Netherlands, and Ingrid Philibert, a top official of the Accreditation Council for Graduate Medical Education in Chicago, which recently implemented changes in medical training, called the new study "superb." They said it highlighted potential dangers to patients who enter hospitals during the July changing of the guard.

The new review "clearly traces the worsening in patient quality and safety by new interns and residents as they advance toward mastering patient care," Barach and Philibert wrote. They suggested that "patients would not consent to care if they knew that the opportunities for residents to learn come at the expense of their welfare."

Earlier this month, U.S. teaching hospitals implemented new regulations from ACGME, which included limiting interns to no more than 16 hours of continuous duty, and requiring direct supervision of interns "until they demonstrate competency that allows them to be supervised indirectly," Young said.

Young said additional studies need to be done to determine which techniques can increase patient safety and mitigate the risks posed by teaching hospitals' July turnover.

Copyright 2011 ABC News Radio







ABC News Radio