Monday night, rescheduled from earlier in March: #ConjoinedTwins: At the Crossroads of #Surgery, Medicine and Ethics.”

In order to separate these two babies, who were joined at the chest, one had to die. The doctors told their story to   a group of health writers last year. One detail stood out: when the babies were rolled into the operating room, each one was holding a rattle.

Free, but registration required. 

 

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Why does Partners cost more than other #Massachusetts #hospitals? Price variation revealed in new report.

The Commonwealth of Massachusetts tracks not only what it spends on Medicaid, but total  health care spending.  Modern Healthcare reports on the variation in care spending recently identified by the in Massachusetts Health Policy Commission. 

The highest-cost providers in Massachusetts spent nearly a third more per patient than their lowest-cost peers, mirroring the widespread cost variation found in markets throughout the country. 

Massachusetts’ largest and highest-cost organization, Boston-based Partners HealthCare, spent 32% more per patient annually than Reliant Medical Group, after adjusting for treatment severity, according to a new report from the Massachusetts Health Policy Commission that analyzed the 14 largest providers in the state. That variation amounted to more than $1,500 per patient.

varaiation in speanding

 

ICYMI: The #Boston Globe series on race included a look at our #hospitals, where “the color line persists.”

Hospitals story, quoted below,  here. Entire series here. 

CapturePatients fly in from all over the country to get care at Massachusetts General Hospital. Yet, most black Bostonians don’t travel the five to 10 miles from their neighborhoods to take advantage of the hospital’s immense medical resources. Just 11 percent of Bostonians admitted to the city’s largest hospital are black, far less than its peers.

The picture is similar at Dana-Farber Cancer Institute, one of the world’s top oncology centers. Nearly 2 in every 5 white Boston residents diagnosed with cancer are treated there, but, among black residents with the disease, it’s 1 in 5.

Across town, meanwhile, white residents of the South End are more likely than black residents to leave the neighborhood for inpatient care rather than go to nearby Boston Medical Center, once a public hospital. Blacks account for half of Boston patients at the former Boston City Hospital — by far the most of any hospital in the city.

Though the issue gets scant attention in this center of world-class medicine, segregation patterns are deeply imbedded in Boston health care. Simply put: If you are black in Boston, you are less likely to get care at several of the city’s elite hospitals than if you are white.

 

BI: Partner’s #security chief warns:”You can do a lot with the information contained in a #healthrecord,” including get a credit card.

partners gatewayBusiness Insider quotes MGH Chief Medical Officer O’Neil Britton who spoke at Hub Week on hospital cybersecurity.

We have 72,000 employees with credentials to log into our computer system,” says O’Neill. “Our network has many components, including a financial clearance system and an electronic health records database. Not all 72,000 employees can get into each component, but having this number of people can make it easier for criminals to access our network with a phishing attack, for example.” (He emphasized that his organization has implemented some robust anti-phishing training for employees.)

Despite enabling great convenience, technology can also increase the potential for harm. “You can do a lot with the information contained in a health record: get a mortgage, file insurance claims, open a credit card, get a mortgage,” says Jagar Kadakia, Chief Information Security and Privacy Officer of Boston-based Partners HealthCare. “It’s way more valuable than a credit card number.” To steal a few thousand paper records would require a truck. To steal the social security numbers, addresses, and driver’s license data for 136 million Americans would only require a USB drive. I

Should hospitals be #compounding #IVfluids? Logistics and safety concerns could make it prohibitive.

Commonhealth, WBUR’s health blog, reports on a potential shortage of IV fluids at MGH. One approach to deal with it: compounding.  But, a 2014 story in Health Leaders Media quoted pharmacists who believe “Logistics and safety concerns would make it prohibitive.”

Saline Compounding a Poor Option for Hospitals

Nov. 12 2014

By Tinker Ready

For Health Leaders Media

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Hospitals are learning how to stretch their limited supplies of IV fluids and are unlikely to resort to compounding saline for routine use, pharmacists say.

Three times in the past year, the Food and Drug Administration responded to the ongoing shortage by allowing three top US suppliers—BBraunFresenius Kabi USA and Baxterto distribute supplies from European plants. While there is some hope that the shortage may clear up in 2015, the once plentiful and much-in-demand product remains in short supply.

Bona E. Benjamin, director of medication use quality improvement with the American Society of Health-System Pharmacists (ASHP), says she is unaware of any hospitals that are routinely compounding their own solutions. Logistics and safety concerns would make it prohibitive, says Benjamin, who spent roughly 30 years working in hospital compounding services.

Because hospitals use saline for both rehydration and drug delivery, any in-house compounding effort would “approach the scope of manufacturing,” she says. And the volume of saline solution needed by a hospital would overwhelm a hospital- based compounding service.

“As an IV person , I would not want to be tasked with doing that,” she said. “You would need a lot of space, a lot of people, and a lot of equipment, and you would have to run it 24/7.”

State Regulation
A survey by the AHSP earlier this year found that 6% of the responding hospitals reported a shortage of IV saline. “While conservation strategies are working for 53% of respondents experiencing this shortage, 29% of respondents reporting a shortage have a supply inadequate to meet all patient needs,” the group reported.

Compounding of saline would fall under the same regulatory rules as other compounding activities. While the FDA regulates commercial compounding companies, state pharmacy boards oversee hospital pharmacy operations. In-house compounding efforts must comply with the rules set by the United States Pharmacopeia (USP), a federally recognized standards-setting organization. Compliance is also reviewed as part of Joint Commission accreditation process.

David Jaspan, director of pharmacy and materials management at Union Hospital of Cecil County in Elkton, MD says he’s beginning to see “some loosening up ” of the supply, but noted that it’s still a problem. Hospitals are getting limited allocations based on their past routine use.

“If we routinely use 100 bags a week, and I’m given 60, after a period of time it is gong to be a problem,” he says.

He sees compounding as a last report that his staff members use on occasion to produce half-normal saline, which Jaspan says is also currently unavailable. Both Jaspan and Benjamin cited another downside of using concentrated sodium chloride for compounding – it too is in short supply too and there is no substitute. 

Hospital Compounding Discouraged
The non-profit Association for Safe Medication Practices also defines compounding as a last resort. A January “safety alert”issued by the group’s website notes that: “We can’t stress enough the importance of exhausting all other alternatives before compounding IV sodium chloride solutions.”

One major safety concern is labeling, Benjamin says. Bags of saline come from the manufacturers with labels. If the hospitals were to reuse bags, they would have to be re-labled, which raises the risk of medication errors.

So, hospitals are finding ways to conserve. But, the shortage can have an impact on patient services and budgets. With scarcity, comes price increases.

At Union Hospital, that means a greater awareness of a product that many once took for granted.

“For every patient who comes into the emergency department, they used to hang a liter of normal [saline] and now maybe they hang a 500cc bag because if they don’t use it all, they throw it away after the patient is evaluated,” Jaspan said.

Benjamin says that efforts like these have kept the shortage from having a visible impact on care. She encourages hospital administrators to be sure they are monitoring the shortages and giving staff the resources they need to cope.  

“It’s only by of a lot of dancing behind the scenes and just-in-time management that patients are not feeling this worse than they already are,” she says.

Tuesday, Globe series targets racial disparities in health care. Conclusion: The color line exists in sickness as in health.

CaptureThe Boston Globe’s series on race focuses on health disparities on Tuesday.

Though the issue gets scant attention in this center of world-class medicine, segregation patterns are deeply imbedded in Boston health care. Simply put: If you are black in Boston, you are less likely to get care at several of the city’s elite hospitals than if you are white.

Also, check out the paper’s Q&A from 2014 between Kate Walsh , the chief executive of Boston Medical Center, and Dr. Paula Johnson , executive director of the Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital.

Walsh: What would you say are the biggest health issues facing the minority community in Boston?

Johnson: There are a number, and they really occur across th

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e life span. For example, black infants are 1.5 to 4 times more likely to die prematurely in the first year of life. If we looked at those likely to die below the age of 74, blacks are twice as likely to die.

Then you look at the disparities in chronic disease. They are pretty significant. Heart disease, stroke, cancer. And there also are a lot of inequities in people being able to make the right choices. That is a very significant health issue for minorities. For example, being able to make healthy food choices, being able to let your children out on the playground and get adequate exercise.

 

 

Two babies, two rattles, one heart. The complicated decision to separate conjoined twins when only one will survive

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by Nora Valdez. Used by Permission.

Oscar J. Benavidez, MD, the MGH pediatric cardiologist  involved in a difficult separation of conjoined twin girls, remembers a painful moment on the day of surgery. When the joined babies were rolled into the OR, each was holding a rattle.

He and the others knew: only one of them would leave the operating room alive. And even that wasn’t certain.

Benavidez and two others recalled the case at a Tuesday gathering of members of the Association of Health Care Journalists. It was a case the described rather clinically in an article behind the paywall in  The New England Journal of Medicine  and more conversationally in STAT. The Globe’s sister health site hosted the event in their new downtown offices.

The twins had separate brains, lung and hearts, but only one heart was functioning.

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Ethicist Brian M. Cummings, MD,  was also at the event  along with pediatric surgeon Allan M. Goldstein. In Cummings’ contribution to the NEJM article, he noted  “In this case, to do nothing would most likely result in the death of both girls but to intervene could save only one child. Can observation of both of their deaths be defended? Can an interventional killing be rationalized?”

The decision was left to the parents, a couple from rural Africa.  Their voices, in English, come in at the  end of the NEJM article. Life for them had been “very unpleasant. Conjoined twins are not seen frequently, and because of the stigma associated with this condition, it was very difficult to seek treatment or even just to go out in public.”

They agreed to the surgery and, as expected, one twin survived.

Writing in Stat — The Boston Globe’s sister health news site  — Cummings described how he felt after the surgery.

“…Twin B arrived in the intensive care unit. I felt a profound mixture of relief and sadness, suddenly feeling the burden of facilitating this emotional process. Even though it had become clear what we needed to do, it had been harder than I thought. I had only a few moments to say my own goodbye to Twin A and I could not hold back my tears. I wasn’t alone.”