Articles Posted in Medical Resources

It doesn’t necessarily represent the standard of care.  It is the place to begin, not end, your medical research.  But it is a great place to start.   Merck Manual

Many Americans are frustrated by the our health care system but quickly declare it to be the best in the world. 

A new study challenges that belief, pointing out that "the U.S. spends twice per capita what other major industrialized countries spend on health care, and costs continue to rise faster than income" and yet "the U.S. achieves an overall score of 65 out of a possible 100 when comparing national averages with U.S. and international performance benchmarks."

This is  an excerpt from the executive summary of the report in the issue of quality:

The November 2007 Annals of Surgery  has an interesting article on surgical errors.  The abstract of the article says that  the authors "analyzed 444 randomly sampled surgical malpractice claims from four liability insurers. Among 258 claims in which injuries due to error were detected, 52% (n = 133) involved technical errors."

They found that "[f]orty-nine percent of the technical errors caused permanent disability; an additional 16% resulted in death. Two-thirds (65%) of the technical errors were linked to manual error, 9% to errors in judgment, and 26% to both manual and judgment error. A minority of technical errors involved advanced procedures requiring special training ("index operations"; 16%), surgeons inexperienced with the task (14%), or poorly supervised residents (9%). The majority involved experienced surgeons (73%), and occurred in routine, rather than index, operations (84%). Patient-related complexities-including emergencies, difficult or unexpected anatomy, and previous surgery-contributed to 61% of technical errors, and technology or systems failures contributed to 21%."

So, what do they conclude?  "Most technical errors occur in routine operations with experienced surgeons, under conditions of increased patient complexity or systems failure. Commonly recommended interventions, including restricting high-complexity operations to experienced surgeons, additional training for inexperienced surgeons, and stricter supervision of trainees, are likely to address only a minority of technical errors. Surgical safety research should instead focus on improving decision-making and performance in routine operations for complex patients and circumstances."

Yesterday I wrote about tort statistics revealed by the 2006-07 "Annual Report of the Tennessee Judiciary."  Among the statistics I cited was that there were 584 medical malpractices cases filed in the state of Tennessee and a total of 15 medical malpractice trials.

To put that in perspective, remember that according to the National Institute of Health 98,000 people a year die in the United States from malpractice in hospitals alone.  Assuming that Tennessee is neither worse nor better than average, that means that 1986 Tennesseans die each year as a result of malpractice in a hospital setting (because we have about 2% of the nation’s population).

And yet only 584 malpractice cases were filed in the entire state for the fiscal year ending June 30, 2007.  Those cases presumably involved not only deaths in hospitals but also injuries in hospitals and deaths and injuries in outpatient settings, nursing homes and surgery centers.  They also include cases against pharmacies and home health agencies and outpatient physical therapy centers.

This post is taken from an email sent out by Janabeth Fleming Taylor at Attorney Medical Services:

ICD-9 codes (Think of it as "Diagnosis" Code)

http://www.cdc.gov/nchs/icd9.htm

Need to go to back to school on the neck and back?  Check out Spine University.

Click on the Spine Wizard, select the area of the spine that you are interested in, and read a detailed description of the various procedures that can be used to treat pain in that area.

There are also printable booklets on these subjects:

A professional liability insurer has posted this information on fetal monitoring for doctors.

The opening paragraph:  "Initially, the fetal monitor was developed for the intrapartum period to better evaluate the status of the fetus during labor. Earlier identification of pending acidosis and hypoxia would alert the obstetric team, leading to more timely intervention and thus a significant reduction in the incidence of neonatal morbidity and mortality. Though clinical trials have failed to demonstrate a significant impact on morbidity and mortality, fetal monitoring is now essentially universal."

This is interesting:

The Joint Commission on International Patient Safety has a website that it calls "Patient Safety Practices."

Here is the introduction to the site:  "Welcome to Patient Safety Practices, a new online resource for health care professionals and the public. Over 900 links to trusted patient safety websites are provided, with tips, tools and resources for addressing patient safety problems. The problem categories and topics have been culled from the Joint Commission’s Sentinel Event Database."

If you are looking for information on wrong site surgery, you will find links to a large number of sites, including this one from the American College of Surgeons.

The American Association of Pediatricians  has issued  "Guidelines and Levels of Care for Pediatric Intensive Care Units." 

The abstract: "The practice of pediatric critical care medicine has matured dramatically during the past decade. These guidelines are presented to update the existing guidelines published in 1993. Pediatric critical care services are provided in level I and level II units. Within these guidelines, the scope of pediatric critical care services is discussed, including organizational and administrative structure, hospital facilities and services, personnel, drugs and equipment, quality monitoring, and training and continuing education. "

The citation:  PEDIATRICS Vol. 114 No. 4 October 2004, pp. 1114-1125.

Author of a recent article published  in Medicine, Health Care and Philosophy have taken a hard look at the 1986 article in the New England Journal of Medicine by Karin Nelson and Jonas Ellenberg that led the medical community to sing in chorus that lack of oxygen was rarely a cause of cerebral palsey.

The new article finds that the central argument of the 1986 article relies on "straightforwardly fallacious statistical reasoning."  The author’s concern is that the 1986 article  improperly influences "how carefully fetuses are monitored during labor and delivery, expert testimony in malpractice cases, and public policy decisions."

(Remember my recent post on the birth-related injuries prevented by Seaton hospitals after they instituted various measures to provide more uniform care to expectant mothers?  If lack of oxygen is rarely a cause of cerebral palsey why did those (and other) injuries decrease by almost 90% when new procedures were adopted?)