CT Center for Patient Safety Newsletter

August 2014

In This Issue

An Appeal for Safe and Appropriate Imaging of Children

New Legislation on Safe Staffing and "duty of candor"

Some Generic Drug Prices are Increasing

Avoid Hospitalizations in...July and August

CU Letter to Congress

Hospital Mergers -...When is big too big?

Are Patient Satisfaction and Quality of Care Linked?

An Appeal for Safe and Appropriate Imaging of Children

Jean Rexford, along with Rosemary Gibson, Stephen Smith, John Santa and other supporters of national patient safety efforts, are contributors to an article recently published in the March 2014 JournalPatientSafety.com:

The Right Exam, The Right Way,

The Right Radiation Dose

The March, 2014 issue of JournalPatientSafety.com features an article on the overexposure of ionizing radiation to our pediatric population. This problem has urgency in that the findings are uncontroversial and patients cannot wait for changes to passively diffuse through the system. Through the engagement of patients, public organizations, and medical professionals in this movement, the authors of this commentary seek to bring about that accreditation of all American hospitals and advanced diagnostic imaging facilities require these 3 practices:

The Right Exam, The Right Way,

The Right Radiation Dose.

New Legislation on Safe Staffing and "duty of candor"

Health care providers who fail to provide safe care could face immediate prosecution and hefty fines. In Europe, England's Parliament is considering a new law that sets out 11 "fundamental standards of care" that all health and social care providers who are part of the NHS System must meet. Providers could face fines if they fail to protect patients from abuse, do not provide safe care, or if patients are harmed or put at risk by not getting enough to eat or drink. In addition, it will be an offence not to own up to mistakes that cause "significant harm" to patients. Speak Out Safely (SOS) is a campaign that aims to encourage NHS organizations and independent healthcare providers to develop cultures that are honest and transparent, to actively encourage staff to raise the alarm when they see poor practice, and to protect them when they do so. We would like to see the United States legislators look to our contemporaries "across the pond" and take cues from their approach to healthcare.

Some Generic Drug Prices are Increasing

Have you recently gone to the pharmacy to fill a prescription for a commonly used medication that has been available for years, only be told that now you need to get preauthorization? This happened recently to a number of patients taking the generic digoxin. The three companies selling the drug in the US doubled the wholesale price since late last year bringing the retail price up significantly. Until recently, generics have held down the rise of name brand drug prices. We saw this happen with the likes of Lipitor and Ambien which, when their patents expired, and generics entered the market, the prices dropped. But like with the generic digoxin, other generic drugs are also increasing and pharmacists want to know why and are asking Congress to conduct hearings. It may be due to the effect of a free market, but whatever the reason, it is hurting the folks who can afford it the least.

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Avoid Hospitalizations in July and August

Beginning in July of each year, newly graduated interns, residents, nurses and other new health care workers begin new first time jobs at

many hospitals. Data reflects that quality of care in hospitals decreases and medical errors increase during July and August. So, it is often recommended that you try to avoid hospitalizations in the summer months. Now, a NY Times article tells us about the weekend dangers in the ER..... A new study published in the July issue of The Journal of Pediatric Surgery suggests that emergency surgery done on children during the weekend results in more complications and deaths than similar surgery done during the week. This doesn't leave many safe options if you need hospital care in the summer. For ideas of things that you can do to stay safer in the hospital, we suggest that you look at the CTCPS website resource page.

CU Letter to Congress

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CTCPS has joined 33 other Patient Advocates and their respective organizations in sending a letter to certain members of Congress who sit on related committees. The letter urges the creation of a Congressional Committee on Patient Safety. It also urges the Congress to create a National Patient Safety Board, which would function much like the National Transportation Safety Board (NTSB). It goes on to remind our Representatives and Senators that harm to patients should be investigated just as airplane crashes are presently investigated. The NTSB, FAA and Congressional oversight have made the airline industry in the US the safest in the world. We should strive to make US healthcare the safest in the world. In Connecticut, the letter was sent to Senators Blumenthal and Murphy and to Representatives DeLauro and Courtney.

Hospital Mergers - When is big too big?

We are seeing big getting bigger again. First it was mom and pop stores being eaten up by retail giants. Then starting in 2007 we heard the phrase "too big to fail" going mainstream when referring to the banking industry. Now we are hearing of hospital mergers and of hospitals buying primary care groups.

As explained in the NY Times article, The Risks of Hospital Mergers, if we look back in history we can see that Massachusetts went through the merger experience in 1994 when its two most prestigious hospitals, Mass General and Brigham and Women's, both affiliated with Harvard, merged. The merger gave the hospitals so much market control that they were able to drive up local health care costs. Now the MA Attorney General is trying to slow down the continued growth of this conglomerate and control the increasing prices that are being charged with limited success.

One reason that we study history is so that the good things that occur will be replicated and perpetuated and the mistakes won't be repeated. On March 6, Yale New Haven Health System which includes Yale-New Haven Hospital, Bridgeport Hospital, Greenwich Hospital and Northeast Medical Group (who recently signed an asset purchase agreement with PriMed, a physician practice based primarily in Fairfield County)and Tenet Healthcare Corporation announced their partnership bringing even more hospitals together through the agreement. Then we have Danbury Hospital, New Milford Hospital, Norwalk Hospital and their affiliates who have joined together to create the Western Connecticut Health Network. The Hartford Healthcare System includes Backus, Hartford Hospital, The Hospital of Central Connecticut, Midstate Medical Center and Windham Hospital.

Are we seeing the beginnings of a repeat of what happened in Massachusetts? We are concerned and welcome your thoughts and comments.

Are Patient Satisfaction and Quality of Care Linked?

Patient satisfaction is a central feature of new pay-for-performance measures. High patient satisfaction ratings are now a goal for hospitals because Medicare plans tie a small percentage of reimbursement to "value-based purchasing" bonuses. Last year, 45 percent of a hospital's score was based on how frequently it followed basic clinical standards of care, Thirty percent of the score was based on how patients rate the way they felt they were treated in the hospital including topics such as pain control, cleanliness of rooms, whether the doctors and nurses communicated well and whether clinicians treated patients with respect. And the remaining 25% is based on a measure of a medical outcome, death rates of patients admitted for heart attacks, heart failure or pneumonia. They calculated these mortality rates, based on the number of Medicare patients who died in the hospital or within a month of discharge.

While we know that higher patient engagement leads to better health outcomes, it is still unclear as to the exact relationship between patient satisfaction and reduced medical harm and better medical care.

Are the right questions being asked of patients? We must first determine what is important to patients when they are receiving medical care. Do they want access to all of their records in real time? Do they have complete knowledge of their provider's disciplinary history as well as their standout strengths. Are patients being considered as an equal member of the team that is caring for them? We know that as patients, we are the only ones who have been there the whole time and we have the most complete picture. Do patients have enough information to make informed decisions about their care? If these questions, which do directly impact quality of care, were the ones being asked, might the results correlate more strongly with data that reflects real hospital safety?

Please let us know if there are any topics that you would like to see us address in future newsletters.

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