When New York City Mayor Michael Bloomberg instructed five hospitals to evacuate their patients from Hurricane Irene's path, one replied it couldn't follow his order. Administrators from New York University-Langone Medical Center explained that six patients in the intensive care unit were so sick that moving them might kill them, and so the mayor's office gave permission to keep them in the hospital throughout the storm. It then fell to Elaine Rowinski, nurse manager of the intensive care unit, to find seven nurses willing to stay at the hospital, right in the hurricane's predicted path and just 100 yards from the East River, which many feared would overflow. It turned out she had nothing to worry about. "I could have had 20 nurses if I'd needed them," she said. "That's how many called me up to volunteer." Rowinski stayed at the hospital all weekend as the doctors and nurses who also stayed listened to the wind and the rain through the boarded-up windows."I had no qualms about staying, no fears at all," she said. "We train for these disasters."
Expensive technologies like proton beam therapy and hot chemo baths are among the reasons America's health care spending is rising at an unsustainable clip and making the federal deficit so hard to tame. But two of the nation's top healthcare economists are expressing doubts that accountable care organizations -- one of Obama administration's most-hyped mechanisms to save money -- will be able to overcome the medical system's lust for the new new thing. Established through last year's health law, ACOs are networks of doctors and hospitals that would collaborate to provide quality care at lower cost, with the motivation of keeping a share of the savings they deliver to Medicare and private insurers.
A Madison, WI, clinic is contacting 2,345 of its diabetic patients to determine whether a nurse may have exposed them to blood-borne illnesses, including HIV and Hepatitis B and C, over the past five years. "An internal review found that a former Dean Clinic employee was inappropriately using these devices during some patient visits between 2006 and 2011," the clinic said in a statement. In teaching patients how to administer finger sticks and insulin shots to themselves, the nurse changed the needle with each patient but reused the rest of the device, which could put patients at a slight risk of blood transfer from one person to another. The practice devices she used were not even intended for to be tried on people, the hospital said. "That demonstration pen is intended to be used not on people but rather into an inanimate object, such as a pillow or an orange," Mark Kaufman, MD, Dean's CMO, told ABC's affiliate WKOW. The clinic, which is part of a larger medical system in southern Wisconsin, reported that each patient who received insulin training by this nurse would receive a phone call or letter explaining the wrongdoing. The hospital said it would provide the necessary blood tests, follow-up care and support free of charge.
The number of medications on the Food and Drug Administration's shortage list keeps growing. And while calcium chloride and potassium phosphate aren't drug names the average American would recognize, they're critical to patients visiting the emergency room every day. "It seems more and more frequently that we're being alerted to some shortage of a medication that really has been a staple in the emergency department," according to Dr. Bill Frohna, the chairman of Emergency Medicine at Washington Hospital Center. The shortage hasn't yet adversely effected patients at his hospital, the largest private hospital in Washington, D.C. But, like nearly every other hospital in the United States, it's struggling to come up with workarounds for the shortage list.
Over the past year, the ICU at my hospital has been field-testing a more open approach. We are not the first to do so. Geisinger Medical Center in Danville, PA, went to an open ICU policy nearly a decade ago, found it extremely disruptive and soon reverted to only 30 minutes of visiting six times a day. On a second attempt, however, Geisinger developed an extensive communication program for both families and staff, and open ICU visitation has been successful since 2003. A 1997 study found that open ICU visitation practices had a beneficial effect on 67% of patients and 88% of families. I am surprised by how well the open policy at our hospital has worked over the past six months. I have become comfortable seeing family members stretched on recliners in the ICU during my early-morning visits. They update me on how the night went for the patient. One ICU specialist said, "I don't have to chase down families to update them on what is happening." Some ICUs are also inviting families to participate when a team of a dozen professionals, including doctors, nurses, pharmacists and social workers, decide on the plan for the patient.
A new report scrutinizing the risks of eight common vaccines is over 600 pages long, combs through more than 1,000 research papers, and is the best analysis of suspected vaccine-caused medical problems that's ever been done, says the high-powered committee that wrote it. Even so, it's not likely to end the contentious debate about vaccine safety in Washington state, which has the highest rate in the nation of children who enter school without the required vaccines. A hotly contested law passed this year bars parents from simply signing to exempt their children; starting this fall, they must include a doctor's certification that they've been informed of vaccines' risks and benefits. Ideally, worried parents would be able to turn to such a report for answers. In some cases, the committee, convened by the Institute of Medicine of the National Academy of Sciences, delivered the goods. In 14 cases the panel examined, it found convincing evidence some vaccines can cause rare adverse events in certain people, including seizures, brain inflammation and fainting. Those problems were, in most cases, experienced by people with immune-system deficiencies. The committee also found the evidence doesn't support any connection between autism and the MMR vaccine for mumps, measles and rubella (German measles).