Across the nation, patients are frustrated by lack of access to their doctors and are going to drug-store clinics for basic care. Primary care doctors are so harried that they are abandoning their practices. The "medical home" being created at Union Square Family Health in Somerville, MA, and at many doctors' offices across the nation is an attempt to provide an alternative. The doctor or nurse-practitioner-led team practices are designed to offer patients care when and where they want it and to give the team the money, the tools, and the time to do more than triage.
Over the past three years, some 7,000 M.D.s have flooded into Texas, and experts say Tort reform is the main reason. In 2003 and in 2005, Texas enacted a series of reforms to the state's civil justice system. Texas Medical Liability Trust, one of the largest malpractice insurance companies in the state, has slashed its premiums by 35% and saved doctors approximately $217 million over four years. There is also a competitive malpractice insurance industry in Texas that drives rates down. The result is an influx of doctors so great that the State Board of Medical Examiners recently could not process all the new medical-license applications quickly enough.
The Service Employees International Union and the California Nurses Association, two of the nation's biggest nurses' unions, are engaged in a slugfest over workers. The two unions are seeking to spoil each others' organizing drives with tactics such as ad campaigns, lawsuits, and infiltrating job sites. CNA says nurses would be better represented by a registered-nurses-only union that could focus on issues including nurse-to-patient staffing ratios. SEIU says nurses are better off in a bigger union that would also fight for other hospital workers and improve hospitalwide standards.
For years, lawyers and insurers have counseled doctors and hospitals to "deny and defend" during malpractice cases. Many still warn clients that any admission of fault, or an expression of regret, could invite litigation and imperil careers. But now that healthcare providers are choking on malpractice costs and consumers are demanding action against medical errors, a handful of prominent academic medical centers are trying a different approach. By promptly disclosing medical errors and offering apologies and fair compensation, they hope to restore integrity to dealings with patients, make it easier to learn from mistakes, and dilute anger that often fuels malpractice lawsuits.
Timeouts to wash hands and put on hairnets, a checklist to ensure that precautions are taken, and advertising campaigns directed at doctors and patients have been credited with reducing the number of serious infections at New York City's public hospitals. Since 2005, central-line bloodstream infections have fallen 55% in adult intensive care units at the city's 11 public hospitals, according to new statistics. Ventilator-associated pneumonia declined by 78%.
To keep up with growing patient demand, the University of Kansas Hospital is expanding its emergency department through an $800,000 project. The expansion will add seven beds to the emergency room for a total of 32, and is expected to be completed by the end of the summer. KU Hospital had 41,000 emergency room visits in its latest fiscal year and expects to have about 44,000 this year. Like other emergency departments in its area, the KU Hospital emergency room frequently must divert patients because the department fills up.