In an unusual move, the Food and Drug Administration has ordered all producers of a popular category of artificial hip to undertake studies of the implants, which have been linked to high early failure rates and severe health effects in some patients. Under the order, producers of "metal-on-metal" hips will have to conduct studies of patients who received the device to determine, among other things, whether the implants are shedding high levels of metallic debris. Some patients have encountered that problem, including soft tissue damage that has disabled them. In a telephone interview on Tuesday, William H. Maisel, MD, the deputy director for science at the FDA's Center for Devices and Radiological Health, said the order marks the broadest use of the agency's authority to conduct studies of devices after approval for sale.
New Jersey doctors who illegally dump medical waste would get their license suspended for three years, in addition to a fine, under legislation unanimously approved in the state Assembly. Increasing the penalty to include the license suspension would serve as a deterrent for potential dumpers who gamble on fines being cheaper than the cost of proper medical waste disposal, said the bill's sponsors, Assemblymen Matthew Milam, Nelson Albano and Louis Greenwald. "If you fine a doctor making a lot of money for beach dumping, he or she can do a mental cost-benefit analysis to see if the fine is enough of an incentive to stop," said Greenwald (D-Camden). "However, if you take away their license for dumping, you take away their ability to make money, which is a much more effective deterrent."
Given the growing cost of malpractice suits from missed or delayed diagnoses in the emergency department, hospitals and their liability insurers are mining resolved claims for lessons on how to reduce such errors, the Informed Patient column reports. In one of the more ambitious efforts, Crico/RMF, which insures Harvard-affiliated hospitals, last year convened an emergency medicine leadership summit with insured hospitals and clients of its risk-management strategies business to identify the key factors contributing to missed or delayed diagnoses in the ER. Their main finding: physician-nurse communication breakdowns often happen at a critical juncture in care. The participating hospitals field-tested strategies to improve communication, and compiled a list of best practices that hospitals can use to prevent such snafus.
An 18-year-old man with fever and chills is sent home from the emergency room with Tylenol and later dies of sepsis, a blood infection. A 42-year-old woman with chest pains is discharged, only to suffer a heart attack two hours later. A 9-year-old girl's appendix ruptures after doctors rule she's just got a bellyache. Hospitals are drawing on lessons learned from these worst cases of missed or delayed diagnosis to overhaul emergency departments, where errors, oversights and a lack of teamwork between doctors and nurses can harm or kill patients. They are adopting new triage systems to ensure doctors and nurses jointly see at-risk patients soon after they arrive, requiring physicians and nurses to huddle to make sure no information is overlooked, and using time-outs at discharge to prevent patients with unresolved problems from leaving the ER.
Using CT scans to diagnose head injuries in children may needlessly expose them to radiation. And the scans also don't catch minor injuries any better than observing the child, according to a new study in the latest issue of Pediatrics. But good luck getting your local emergency room to back off of them. They've become the go-to test for quickly diagnosing soft-tissue injuries, like bleeding on the brain, that won't show up in an X-ray. And half of all children who go to an emergency room with a head injury now get CT scans, according to Lise Nigrovic, an attending physician in the emergency room at Children's Hospital Boston who led the study.
A colonoscopy isn't something you get just for giggles. Beyond the obvious unpleasantness, there's the small but real risk of complications that in rare cases can lead to hospitalization or even death. That's why the American Cancer Society and other groups recommend that people screened for colorectal cancer using a colonoscopy wait a decade in between tests if no polyps or other signs of potential cancer are found. Polyps are slow-growing, and the benefits of being screened more frequently than that don't seem to outweigh the risks. A new study, however, suggests that a significant percentage of Medicare patients are having screening colonoscopies more frequently than that, for no apparent medical reason. Researchers at the University of Texas Medical Branch found that among 24,071 Medicare enrollees who had a negative screening colonoscopy between 2001 and 2003, almost 24% were re-examined within seven years "with no clear indication for the early repeated examination."