Booster Shots

Oddities, musings and news from the health world

Category: hospitals

For hospitals too, beauty is in the eye of the beholder

July 8, 2010 |  5:51 pm

Last year, the good folks at Soliant Health – a healthcare staffing firm – took it upon themselves to rank the 20 most beautiful hospitals in the country. The list was subjective, of course, but the judges clearly put some thought into their selections. Check out the Cinderella-castle quality of No. 1 pick Johns Hopkins Hospital in Baltimore; the one-acre rooftop garden at No. 6 St. Louis Children’s Hospital; the lodge motif at No. 10 Mat-Su Regional Medical Center in Palmer, Alaska; and the hotel feel of No. 17, Sacred Heart Medical Center in Springfield, Ore.

Greys This year, Soliant asked readers of its blog to nominate and vote for the country’s most beautiful hospitals. More than 10,000 votes were cast, but the 2010 contest winners are decidedly less beautiful.

Take the winner, Sharp Memorial Hospital in San Diego. This glassy, boxy building was nominated for an onion award in the San Diego Architectural Foundation’s annual Orchids & Onions contest. (Hint: only the orchids are meant as a compliment.) Here’s what an anonymous commenter had to say about the design:

This building is a monstrosity. I have to look at it every day. … There's a big post there holding things up - and blocking the door entryway. The sign is silver type on orange - practically unreadable. It's the ugliest most prominent nightmare of a building, plopped into the most incoherent assemblage of parking, clinics, etc.

Soliant acknowledged that its winner is “not without controversy.” You can click here to take a virtual tour of the hospital and decide for yourself whether it deserves to be called the most beautiful hospital in America.

Coming in a close second was Michigan’s Henry Ford West Bloomfield Hospital. This is another boxy building, but Soliant notes that its food menu is beautiful, with about 3,000 selections that are “99% organic” and “designed to boost patients’ immune systems and keep their spirits high.”

Overall, only two of the hospitals on last year’s list were selected by voters this year – Sacred Heart Medical Center (mentioned above) and Dixie Regional Medical Center in St. George, Utah.

-- Karen Kaplan

Photo: The fictional Seattle Grace Hospital on "Grey's Anatomy" wasn't on the list of most beautiful hospitals, but L.A.'s Sepulveda Ambulatory Care Center -- whose exterior doubles as Seattle Grace -- was No. 2 last year. Credit: Karen Neal/ABC

California program helps people record wishes at end of life

July 2, 2010 |  6:00 am

Oldage A program used in California to help nursing-home and terminally ill patients express their wishes regarding treatment at the end of life results in the type of care patients want and expect, maintains a new study.

The program is called Physician Orders for Life-Sustaining Treatment and has been adopted in many nursing homes, hospitals and long-term-care facilities in California beginning in January 2009. The program involves an innovative medical form, that is signed by a doctor, allowing patients to specify what kind of care they want at the end of life, such as feeding tubes and other medical interventions. The form was designed 20 years ago in Oregon because of concerns that traditional "do not resuscitate" orders and advanced directives did not fully communicate patients' wishes for many situations and types of treatments.

The multi-state study, published Friday in the Journal of the American Geriatrics Society, found that patients with the Physician Orders for Life-Sustaining Treatment forms had much less unwanted hospitalization and medical interventions. For example, 98% of people with the forms had orders about medical interventions in addition to resuscitation -- compared with 16% of residents without these forms.

The form "allows patients to tell their health care professionals exactly what they want, so providers know patients' wishes no matter what level of treatment they are seeking," Dr. Susan Tolle, a co-author of the study and director of the Center for Ethics in Health Care at the Oregon Health & Science University, said in a news release.

Efforts to increase awareness about the program are being led in California by the Coalition for Compassionate Care of California and the California HealthCare Foundation. Information and opportunities to learn about the program can also be found at this website.

-- Shari Roan

Photo: Justin Sullivan / Getty Images

Feds propose new rules to expand hospital visitation rights to same-sex partners

June 25, 2010 |  3:53 pm

Hospital visitation policies are about to get more inclusive, thanks to a rule change announced this week by the Centers for Medicare & Medicaid Services (CMS).

same sex domestic partners hospital visitation rights Under the proposed rule, patients may decide who is allowed to visit them during their hospital stays. Furthermore, patients can elect to give these hand-selected visitors the same bedside access that is normally reserved for immediate family members.

The new rule is designed to give same-sex domestic partners the same visitation rights as spouses who are legally married. CMS drafted the rule in response to President Obama’s April 15 memorandum to the Department of Health and Human Services, titled “Respecting the Rights of Hospital Patients to Receive Visitors and to Designate Surrogate Decision Makers for Medical Emergencies.”

The proposed rule will apply to hospitals that receive Medicare and Medicaid funding. The Department of Health and Human Services said it expects to publish the rule in the Federal Register very soon, and it will go into effect after a 60-day public comment period. (Until it appears in the Federal Register, it can be viewed online here.) However, HHS Secretary Kathleen Sebelius urged major hospital trade groups to voluntarily implement the rules right away – if they haven’t done so already.

“Your actions could spare many patients the pain of being separated from a loved one during an admission to a hospital – often one of the most anxious times in their lives,” Sebelius wrote.

-- Karen Kaplan

Photo: Same-sex domestic partners should have the same visitation rights as legal spouses, the Obama administration says. Credit: Spencer Weiner/Los Angeles Times

Heart failure patients are often readmitted to the hospital

June 2, 2010 |  6:00 am

Wheelchair Treatment for older people with heart failure has improved by several measures. Patients today have shorter hospital stays and lower rates of death while in the hospital. However, the rates of hospital readmission have increased, which may signal that care for this serious illness isn't as good as it could be.

Researchers analyzing Medicare data from 1993 to 2006 found that the average length of a hospital stay for heart failure declined from 8.8 days in 1993 to 6.3 days in 2006 while in-hospital death rates declined from 8.5% to 4.3% during the same time period.

However, the patients may be sicker when they leave the hospital. The study, released Tuesday in the Journal of the American Medical Assn., found that deaths occurring within 30 days of discharge rose from 4.3% to 6.4% over the 14 years studied. Readmission to the hospital within 30 days increased from 17.2% to 20.1% Moreover, the ratio of patients who were discharged from the hospital to skilled nursing facilities increased from 13% to 19.9%.

It's troubling to see an uptick in patients who have to be readmitted or go to skilled nursing facilities, the authors of the study noted.

"Although we cannot demonstrate that the shortened hospital stay caused these changes, it is certainly plausible that the effort to discharge patients quickly has led to transfers to nonacute institutional settings and occasionally sent patients out of the hospital before they were fully treated," they wrote.

-- Shari Roan

Photo credit: John Moore / Getty Images

More women are refused healthcare due to hospital ideology, report says

May 27, 2010 | 12:27 pm

Contraceptives and abortion may be denied at Catholic hospitals; nun was excommunicated for approving an abortion in Phoenix A Phoenix-area nun was recently removed from her job as a senior administrator of a Catholic hospital and was excommunicated by the Catholic church because she was part of a hospital board that approved an emergency abortion last year for a woman -- a mother of four children -- whose life was in danger due to complications of the 11-week pregnancy.

That the nun, Sister Margaret McBride, should be punished for providing what is considered standard and appropriate medical care has led to a huge national outcry. But the issue goes further, according to a report released this week by the National Health Law Program, a national public-interest group that seeks to improve care for the working class, poor and minorities. The report claims that a growing number of patients are encountering hospital policies that deny some types of medical care -- such as abortion or contraceptive services -- due to ideological or religious beliefs. One in six Americans is seen in hospitals that have some restrictions, according to the report "Health Care Refusals: Undermining Quality Care for Women."

"When people go to the doctor, they should be able to expect that the care they receive meets prevailing medical standards," Susan Berke Fogel, the lead author of the report, said in a news release. "We reviewed policies at hospital systems representing more than 650 facilities across the U.S. and have documented the conditions and circumstances where that is not happening. We found a disturbing number of case studies where patients ended up far worse off either because their healthcare providers refused care or because their hospitals prohibited the care they needed for ideological or religious reasons."

This issue is typically framed as a moral contest between health providers' rights of conscience versus patient autonomy, Fogel writes in the report. But that narrow framework overlooks the most important factor in the debate: an evidence-based analysis of what constitutes the best medical practice.

-- Shari Roan

Photo: Daniel Hulshizer  /  Associated Press

Hospital gowns that match skin tones could help detect symptoms

April 29, 2010 |  3:10 pm

Who doesn't love a hospital gown? They're so comfy and flattering. But they may not be doing the job they could be, according to researchers.

Kz37yfnc Scientists Mark Changizi and Kevin Rio believe the venerable hospital gown needs a makeover -- at least the color, anyway. In a study published recently in the journal Medical Hypotheses, they argue that the typical hospital gown colors -- usually a solid blue or green or a print on a white background -- may not help health professionals see if skin tones are changing, signaling a serious condition such as cyanosis. Cyanosis produces a blue or purplish color to the skin and mucous membranes, signifying that there may be less oxygen in the bloodstream. Pale or yellow-tinged skin can signal other health problems.

One solution, they suggest, is to give patients gowns and sheets that are close in color to their skin tone. "If a doctor sees a patient, and then sees the patient again later, the doctor will have little or no idea whether the patient's skin has changed color," Changizi said in a news release. Changizi, assistant professor in the department of cognitive science at Rensselaer Polytechnic Institute in Troy, N.Y., added, "Small shifts in skin color can have tremendous medical implications." This, he said, applies to all skin tones.

The researchers also recommended using biosensor color tabs, matched as well to the patient's skin tone and placed at several locations on the body. Those, too, would allow physicians or clinicians to notice any changes in skin color.

Although pulse oximetry is already available (that's a non-invasive way of tracking how oxygenated a patient's hemoglobin is), the authors believe that noticing a skin color change may be a faster method of telling if something is wrong.

-- Jeannine Stein

Photo: Constantina Guzman, lying next to her son, wears a standard-issue hospital gown. Photo credit: L.M. Otero / Associated Press

A better way to judge hospital quality

April 22, 2010 |  8:00 am

If you judge the quality of a hospital, one of the first things you’d want to know is the mortality rate of its patients, right?

Hospital Wrong, according to a new study in the British Medical Journal.

Only 5% of deaths that occur in U.S. hospitals could have been prevented, according to researchers from Johns Hopkins University School of Medicine and the University of Birmingham in England. Hospitals shouldn’t be dinged for taking care of patients who were already beyond saving when they were admitted, the researchers say.

People who put together hospital rankings surely rely on data reporting all deaths because it’s easier than figuring out which of those patients could have survived if they had received better care. But they should shift their focus to other statistics that get at whether the doctors, nurses and other caregivers are sloppy or careful, according to the researchers.

One suggestion: Tally the number of patients in the intensive-care unit who wind up with bloodstream infections, a life-threatening mistake that kills 31,000 hospital patients in the U.S. each year. Another option would be to focus on deaths of patients who are admitted for elective surgery, since all of them would be expected to survive.

-- Karen Kaplan

Photo: Hospitals shouldn't be penalized for taking in patients who are beyond saving, researchers say. Credit: Mark Boster / Los Angeles Times

Those patients clogging up the ER? They're not all who you may think they are

March 19, 2010 |  5:17 pm

The patients that emergency room docs call "frequent fliers" -- regular visitors to the Emergency Department -- are predominantly white, have insurance and tend to be sicker than most patients who visit the ER less often.

Those findings are among many in a study published this week in the American College of Emergency Physicians' journal, Annals of Emergency Medicine. The study combs through 25 previously published studies that identified the demographic characteristics of patients who visited a hospital's emergency department four or more times in a given year. Such patients represent 4.5% to 8% of all emergency department patients, but account for 21% to 28% of total yearly visits to the ER.

First off, the uninsured represent 15% of frequent ER users (though they account for 16% of American adults). And among all uninsured adults, only 2% use the ER four or more times in a year. 

African Americans and women are disproportionately represented in the group with heaviest use of the ER, and patients who are insured by Medicare or Medicaid represent 60% of the ER's frequent fliers. But 60% of those who turn up in an emergency room four or more times in a year are white. And most of the regulars fall into two age groups: patients 25 to 44 years old and those over 65. Frequent ER users were also sicker: They were consistently more likely to be admitted to the hospital during a visit than were less regular patient visitors.

In the decade leading up to 2006, emergency department use rose 36%, leading to crowding that has caused ambulances to have to divert to other hospitals, increasing wait times and boosting the cost of care in the United States. Lawmakers and others have suggested that the steep increase was the result of the uninsured seeking care in emergency rooms and a growing use of the ER by people with non-urgent medical problems.

The authors of the study suggested that efforts, including a recent one in California, to restrict use of the ER by the uninsured and those who are not urgently sick will save little. Bigger savings, the authors suggested, could come from diverting patients with chronic illnesses from frequent ER use.

"The data from these studies challenge the assumption that frequent ED use is a problem of uninsured, ethnic minority patients inappropriately seeking primary care in the ED," concluded the study's authors.

--Melissa Healy 

Washing hands is a smart preventive; so is washing trauma patients

March 15, 2010 |  5:29 pm

Ambulances Swabbing down trauma patients with disposable, antiseptic-laced cloths appears to pay off in terms of infection control. 

Doctors at Harborview Medical Center in Seattle found that patients given a daily antiseptic wipe down were much less likely to develop a catheter-related bloodstream infection than patients who received a daily, non-antiseptic wipe down. They were also much less likely to develop either a MRSA or Acinetobacter infection.

Here's more on those catheter infections, MRSA and Acinetobacter from the Centers for Disease Control and Prevention.

The full study results, released online Monday, were published in the March issue of Archives of Surgery. Here's a news release from Infection Control Today, plus the abstract. And here's the Reuters health story with a disturbing twist at the end.

If you're interested in the antiseptic used, here's information on chlorhexidine from Mayo Clinic. For at-home use, soap and water should suffice.

-- Tami Dennis

Photo: The trauma's bad enough, but then can come the infections...

Credit: Allen J. Schaben / Los Angeles Times

Move over, Cosmo! The Joint Commission has its own quiz

March 5, 2010 |  2:45 pm

LegsAmericans do so like a good quiz, assuming it carries no penalty for wrong answers. Witness the popularity of those ever-fab Cosmo questionnaires: "Are You Enough of a Bad Girl?" "Do You Ace a First Date?" "Are You an Oversharer or Mysterious?" Now comes a quiz that even the most painfully modest, prudish or uptight can enjoy! The Patient Safety IQ Quiz!


Let's take a look at the first question:

"Which of the following statements is true?

a. Hand washing helps prevent infection.
b. Using hand sanitizer (liquid, gel or foam) helps prevent infection.
c. Getting a flu shot helps prevent disease and infection.
d. All of the above."

Perhaps "enjoy" was too strong a word.

All the questions are like that. They're taken from the Joint Commission's Speak Up patient safety program. And they're fun... interesting?... educational? -- let's go with educational -- in their own right. (Though if you miss any of them, you've been spending way too much time flipping through magazines at the checkout stands, and far too little time reading the fun ... interesting? ... educational? -- let's go with educational -- posts on Booster Shots.)

The commission accredits healthcare organizations in the U.S., and it has a vested interest in persuading consumers to take more responsibility for their own safety.

Not to brag, but I got a perfect score. On that quiz. 

To test yourself, go to the agency's website. Look in the top right corner for Take the Patient Safety IQ Quiz.

-- Tami Dennis

Photo: Consider this photo a cheat sheet for question No. 7.

Photo credit: Los Angeles Times


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