CT Center for Patient Safety Newsletter

February 2016

In This Issue

Computers are in the way!

February Health Hint

Sen Blumenthal's Generic Drug Bill

What's All That Noise?

Problem Paying My bills

Computers are coming between patients and their doctors

In a recently published study in JAMA, the Journal of the American Medical Association, it was found that high computer use by clinicians correlated with lower patient satisfaction. Specifically, it pointed out that physicians who spent more time using a computer during a visit made less eye contact with patients and communicated negatively more often when they corrected patients regarding their medical histories or medications. These patients feel that the clinicians aren't really listening as carefully as they would like them to. Researchers have pointed out that when physicians are so wrapped up with their computers, they are missing an opportunity to make an "emotional connection" with their patients. This is something that many reports say is desired by patients. After all, regardless of the medical reason for the visit, patients are people first, who happen to be at an office visit or in a hospital for a medical condition. They do not want to be defined by the medical condition that they have at that time.

Technology certainly offers benefits. It can enhance transitions of care, keep accurate records of medications and conditions, and provide helpful alerts but unless it is used effectively, it can create a barrier between a patient and their clinician. For this reason, it is recommended that a computer monitor not be placed so that the clinician's back faces a patient, but rather between and off to the side of the clinician or somewhere where the patient and clinician can view it simultaneously. If done in a smart way, technology does not have to come between a patient and his or her clinician, literally and figuratively.

February Health Hint

Just before our big snow a couple of weeks ago, Tara Parker-Pope published in her NY Times blog a piece that was a collection of their favorite winter health stories including:

Her compilation can be found titled, Wintry Wellness. If you haven't seen it already, I hope that you enjoy reading it. There may yet be some winter weather coming our way!

Blumenthal: Bill would speed generic drug approval, reducing costs

Senator Blumenthal is intending to cosponsor and introduce legislation that will allow for generic drugs to go through the FDA approval process faster. His bill would also curb the rapidly rising costs of generics as well. During a panel where he announced this initiative, he also spoke about the need for more transparency in the cost of drugs and stronger enforcement of antitrust laws. In speaking about the cost concerns, Dr. Peter Schauer of Hartford Hospital said that one of the issues is the increasing disparity between the value of new medications and the cost of them. In part, this was attributed to the slower process now in place for the FDA approval of generic drugs. Blumenthal said that the bill "will enable more drugs to come to market - generic drugs - more quickly at lower prices." A similar bill, the

Fair Access for Safe and Timely (FAST) Generics Act,

was introduced in the House last year. That bill will be reintroduced and has bipartisan support.

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Dear Members,

Over the past seven months, the Connecticut Center for Patient Safety has been fundraising to take advantage of a matching challenge donation. I want to thank everyone who contributed to this drive providing us a greater opportunity to make a real difference. I want to proudly share that we received over $40,000 in donations that will now be matched by the Coverys Community Foundation. Their donation will support our educational outreach to medical residents and medical students, nursing and other health science students. Our expectation is that through our education curriculum, we can improve patient safety and the quality of care to Connecticut's residents. We strongly believe that by bringing the patient experience in health care, through our stories of medical harm and of our positive experiences, and by sharing the facts and strategies aligned with avoiding harm and improving care, we can impact these students and newer doctors so that they will make a difference to patient who they care for.

Our first � day workshop, "Patients as Partners: The Value of an Enhanced Relationship", took place on January 29^th at Quinnipiac University Frank H. Netter MD School of Medicine. It was designed as an interdisciplinary program and conversation between students from each of their medical and health science schools. The program began with a keynote by Natalie Augustin, who shared her experiences as a patient and a two-time cancer survivor. She spoke about what was important to her and other patients in health care. She was followed by Dr. Allison Hong from the Connecticut Hospital Association who spoke about the importance of effective communication between the various clinical staff and also between the staff and patients. The remainder of the program, emceed by our own board vice president, Alan Manning, involved smaller group discussions on a number of topics ranging from the difference between "safe patient" and "patient safety" to how clinicians can make sure to hear the voice of the patient and how will that impact their practice?

The attendees "really enjoyed this presentation & conversation amongst patients & receivers of care." Adding, "It put into perspective the other side of the care we give & points out things we can work on." Many expressed that "the speakers were excellent and had great stories that should be heard by all healthcare providers." They found that this program "was an incredible and informative workshop" and "enjoyed all stories and conversations shared." What the Connecticut Center for Patient Safety is doing is making a lasting impression and providing tools, strategies and perspectives that are often not present in the classroom.

Lisa Freeman

What's All That Noise?

When walking into a healthcare facility have you ever wondered what all the chaotic noises are? One might hear multiple types of beeps, rings, bells and whistles. After being on a floor for a while with a loved one or being a patient yourself, do you ever just tune them out? Well that's just it, studies show that as many as 90% are false alarms or don't require immediate action and there are doctors and nurses who are ignoring them, just turning them off, or they just stop "hearing" them because of "alarm fatigue."

From 2010 through June of 2015 there were 138 reported deaths from alarm system failures in hospitals. Do you wonder how this can happen? These system failures occur, for example, when a nurse turns off an alarm on one patient while caring for another or when alarm parameters are set to off. Staff members become desensitized from "alarm fatigue" and can overlook the critical needs of patients. Not only were these deaths preventable, but according to the Joint Commission, requirements to improve safety policies and procedures around alarm issues and related deaths and patient harm are now mandatory will be considered when determining a hospital's eligibility to participate in Medicare and private health plans as well. This requirement also includes hospitals developing programs to educate their staff about alarm signals including when they can be disabled, when settings on monitors can be changed and who has the authority to change parameters on the monitor.

Ronald M. Wyatt, the Joint Commission's medical director for health-care improvement states, "This is a preventable issue that is killing people, and every year we see the number go up because of something related to alarm management." He encourages families and patients to familiarize themselves with the monitors in use and to learn which alarms are the most important to their medical situation.

A professor of medicine, Barbara J. Drew Ph. D. in nursing from the University of California, San Francisco feels that hospitals are over-recording data and that monitors may be over-sensitive. In a very large study, it was found that 88% of the alarms for arrhythmias were false alarms and of 12,671 alarms that went off, only 17 patients were in true cardiac arrest. Studies found that by adding a 20 second delay, there were significant reductions in certain monitoring processes, and no adverse outcomes.

Patients need to be safe, false alarms or not. Hospitals must find better ways of using the alarms. By setting parameters on the alarms based on a patients' true baseline, and by further tailoring the alarms for the condition of each patient, alarm fatigue can be reduced and life-threatening crisis' can be averted. There are solutions being studied and with the new Joint Commission requirements, there will hopefully be improvement in the use of this technology.

1 in 5 people with health insurance have problems paying their bills

It seems that even with health insurance, a large number of people have problems paying their medical bills.

To pay their bills it was reported that those with financial challenges postpone vacations, reduce their spending on food and clothes, take on a second job, and use up much of their savings just to mention some of the impact. A recent Kaiser report states that "62 percent of those who had medical bill problems say the bills were incurred by someone who had health coverage at the time" and that three quarters of them felt that the basic co-pays, deductibles, coinsurance and the premiums themselves were more than they could afford.

What is really concerning is how people are coping with these unaffordable charges. They are skipping appointments, medications and dental care. These are the very things that insurance reform was put in place to change. The intent was to make healthcare more affordable and accessible to all people. It seems that now some people are spending money on the premium so that they have the required insurance, but they are still unable to access the care. What is even more concerning is that many of these people are having trouble paying their other bills too - such as those for basic needs including food, heat, or housing.

Surprise billing is one of the more frequently mentioned problems with high medical costs among insured Americans. A quarter of those surveyed said that denied claims were a problem and nearly a third said that they were surprised by non-covered charges from out-of-network providers.

A 2014 study found that Massachusetts was the only state where medical debt was not the leading cause of personal bankruptcy and, in fact, the amount of medical individual debt there was lower than elsewhere. This is significant because Massachusetts made health insurance mandatory in 2005. The 2014 study found that 18 to 24% of US bankruptcies were due to medical debt whereas in Massachusetts the figure is 3 to 9%. The author's conclusion was that healthcare reform was behind the difference and he pointed out that the bankruptcy rate is now falling nationally. To the person struggling between paying for food or their medication, this doesn't offer too much comfort today.

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