Guns in hospitals? MGH guards go with pepper spray

579 mill tower MGH

MGH 2010

Deep into a disturbing  New York Times story on hospital guards who shoot patients, find a passing reference to Massachusetts General Hospital’s security program.

(More on guns in hospitals here.  It has been about a year since the son of a patient walked into the Brigham and fatally shot a doctor. 

From the Times:

To protect their corridors, 52 percent of medical centers reported that their security personnel carried handguns and 47 percent said they used Tasers, according to a 2014 national survey, more than double estimates from studies just three years before. Institutions that prohibit them argue that such weapons — and security guards not adequately trained to work in medical settings — add a dangerous element in an already tense environment. They say many other steps can be taken to address problems, particularly with the mentally ill.

Massachusetts General Hospital in Boston, for example, sends some of its security officers through the state police academy, but the strongest weapon they carry is pepper spray, which has been used only 11 times in 10 years. In New York City’s public hospital system, which runs several of the 20 busiest emergency rooms in the country, security personnel carry nothing more than plastic wrist restraints. (Like many other hospitals, the system coordinates with the local police for crises its staff cannot handle.)

“Tasers and guns send a bad message in a health care facility,” said Antonio D. Martin, the system’s executive vice president for security. “I have some concerns about even having uniforms because I think that could agitate some patients.”

The persistence of low-value services

CaptureAnalysis from Health Leaders Media:

Turns out, it’s not so easy to make wise choices about healthcare. Several new studies find that, even with urging, doctors and patients are having a hard time passing on low-value services, including many identified in the Choosing Wisely campaign.  

Not that it should be a surprise. You don’t need an MD to know that change is difficult.

The specialty societies of the Choosing Wisely campaign have offered up a menu of low-value services they suggest patients can live (well) without. The trick is to convince providers and patients to abandon superfluous old-reliables and “might-as-well” tests. They waste money and can do more harm than good.

Somehow, the message isn’t getting through…

And this release today on the ACOG meeting mentioned in the story:


Breast Cancer Screening Conference Addressed Mammography Guidelines

Washington, DC – More than 50 stakeholders in women’s health convened on the 28th and 29th of January, 2016, at the headquarters of the American College of Obstetricians and Gynecologists (ACOG) to discuss recommendations on mammography for breast cancer screening. Participants reviewed current data and provided perspective on the interpretation of the data and resultant recommendations for breast cancer screening.

 

The primary issues addressed at this conference included when screening should be initiated, how frequently mammography should be performed, and if there is a point in a women’s life at which mammographic screening may no longer be beneficial. Although clearly important, other aspects of breast cancer screening – including the role of clinical breast exam and screening for high-risk women or those with dense breasts – were determined to be beyond the scope of this conference.

 

Participants in the conference included representatives from the United States Preventive Services Task Force (USPSTF), the American Cancer Society, the National Comprehensive Cancer Network (NCCN), the American College of Radiology, the American College of Surgeons, the American Academy of Family Physicians, the American College of Physicians, and ACOG. In addition, representatives from more than 22 other organizations representing women’s health care providers, radiologists, patient advocate organizations, and allied women’s health professional communities participated in the conference. Furthermore, patient representatives also provided valuable input.

 

The participants will continue the efforts at addressing breast cancer screening recommendations. It is hoped that the outcome of these conversations will help to improve informed decision-making among women and their health care providers.

 

 

 

 

 

Lown Institute seek trainees’ stories of dangerous “medical overuse”

From Lown:

The first author must be a trainee who is a professional student, intern, resident, fellow, masters or doctoral student, or post-doctoral student.logo

More here

 We are seeking clinical vignettes written by trainees that describe harm or near harm caused by medical overuse. In particular, we want to hear about medical interventions that are commonly performed and seem acceptable, rather than errors or obvious malpractice.

Applications should include a clinical vignette that provides an engaging story with pertinent clinical and historical findings. Vignettes must also include a succinct summary of the clinical issues that describes the evidence for medical overuse and suggests an alternative approach going forward.

The top two vignettes will be eligible for scholarships to participate in the fourth annual Lown Institute Conference, April 16-17, 2016 in Chicago. 

Surgeons, MGH react to to Globe story on surgery scheduling

ss2 (2)Reaction to the Globe’s Spotlight series on simultaneous surgeries — where a surgeon has two operations going at the same time — continues in the paper and beyond

In late December, the paper reported:

 

The American College of Surgeons plans for a roughly 10-member committee — which includes both critics and supporters of concurrent surgeries — to craft a consistent approach to keeping patients safe and informed when doctors run two operating rooms, according to Dr. David Hoyt, executive director of the organization.

“We are going to move as quickly as we can on this,” Hoyt said. “This is a priority.”
A Globe survey of 47 hospitals nationwide found that it is common for surgeons to start a second operation before the first is complete, often after the surgeries were deliberately scheduled to overlap briefly. However, some surgeons have operations that run simultaneously for longer periods. And few hospitals call on doctors to explicitly tell patients when their operations are double-booked.

The paper also ran an editorial cartoon — a surgeon on RollerBlades –with a super long disclosure statement.

MGH got a lot of space in the Sunday “Ideas” section to offer their unfiltered take on the matter, as did this doctor:

When I handle concurrent procedures, I have to carefully design the schedule around when I can and cannot be absent from an operating room. Surgical procedures have “critical” and “noncritical” portions, and this changes on a case-by-case basis depending on the patient and his or her unique problem as well as the team I’m working with. For instance, if I’m working with a brand-new intern, then every moment, from preparation to wake-up, is critical. If I’m working with a seasoned fellow with five years of operating experience, then the critical portions are much more focused.

From the Jan. 10 piece  by Dr. Peter L. Slavin –president of Massachusetts General Hospital  and Dr. Thomas J. Lynch chairman of the Massachusetts General Physicians Organization ran in the Sunday “Ideas” section of the paper

Overlapping surgery occurs at MGH and hospitals throughout the country for a variety of reasons. Overlapping surgery saves lives in certain clinical situations, such as after the Boston Marathon bombings and the Rhode Island Station nightclub fire, when multiple critically ill patients need rapid access to surgical care. Overlapping surgery enhances access to care, helping meet the high demand for certain specialties and specialists.

Partners has also posted detailed comments on its own web site.

 

HLM: Berwick, newest member of Mass. #Health Policy Commission, on link between #costs and #quality

imagesDonald Berwick, MD, president emeritus and senior fellow at the Institute for Healthcare Improvement, has worn a lot of hats — head of the Centers for Medicare and Medicaid Services, candidate for Massachusetts governor and, more recently, an advocate for single-payer health insurance and member of the Massachusetts Health Policy Commission.

So, he has a lot to say and said some of it to Health Leaders Media. During  this Q&A, he elaborated on the point he made in his recent keynote at the IHI conference — we’re overdoing in on quality measures. He also described why he thinks quality will lead to lower costs.

Berwick: My plea is to take the spotlight off finance and profit as the primary responsibility or activity of senior leaders because I believe we will never solve the problem of cost and finance by focusing cost and finance. We’re going to have to solve that problem by focusing on the design and redesign of healthcare and the improvement of its quality.

As long as executives are leaning in on revenues and profits, they will not have the energy; they are not evincing the confidence to work on care as the route to success.

I promise healthcare leaders that if they will focus on quality as their central agenda, on the needs and desires of the people they serve, if they focus on waste and its continual reduction, if they focus on the experience of the workforce, they will be financially successful.

Maybe that sounds paradoxical. But the route to financial success in healthcare in the future is not in the study and management of finance. That’s the wrong agenda. It won’t succeed.

 

Partners’ Kvedar’s new book on “The Internet of Health Things”

Joseph  Kvedar, the VP of Partners’ Connected Health Program was on to  “The Internet of Healthy Things” way before any of the rest of us.  Now he’s collected his thoughts — aimed a “business executives” — in a new book.

More video from this year’s connected health conference here.

 

Health care in Massachusetts: Affordable or not?

Not affordable: From this week’s paper

Rising health care costs have outpaced the incomes of Massachusetts families over the past decade, despite efforts by the state to control medical expenses, according to a report released Wednesday.

Affordable: Two weeks ago.

Despite concerns about rising health care costs, the head of the state’s largest and most expensive network of doctors and hospitals said Thursday that health care is “very affordable” in Massachusetts.partners

Partners HealthCare chief executive Dr. David Torchiana, in remarks to the Greater Boston Chamber of Commerce, acknowledged that health care costs are higher here than in other parts of the country, largely because Massachusetts is home to several large teaching hospitals whose training and research programs make them expensive to run.

But considering the high incomes in Massachusetts, it’s not so bad, Torchiana said: “Health care is very affordable in Massachusetts.”

To help make sense of this and other health policy debates, check out the latest Health Wonk Review.

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