Tag Archives: hospitals

Does Your Hospital Deliver Babies Too Early?

Delivering a baby before it’s ready is bad for everyone — for the baby’s health, the parents’ peace of mind, and the costs to the family and the health care system. Yet unnecessarily early deliveries (called early elective deliveries) have become more and more common in recent years despite evidence of the potential harm they can cause.

Photo by flickr user MammaLoves.

Now prospective parents have an easy means of comparing hospitals in their area to see which ones are more likely to deliver babies unnecessarily early, before 39 weeks of gestation. Babies need at least 39 weeks in the womb to fully develop the brain and lungs.

Because of the Internet, consumers have tools like never before to make comparisons between suppliers before purchasing a product or service. Those tools could be applied to many aspects of health care, if we had access to the raw data needed to make the comparisons.

The Leapfrog Group, a project of employers that buy health insurance for employees, gathered some of the raw data on early elective deliveries and put the results online for all to see, including naming hospitals and their rates of unnecessarily early deliveries. They surveyed 773 hospitals and found that rates of early elective deliveries varied more than 100-fold between hospitals. While there is no national benchmark for an acceptable rate of early elective delivery, Leapfrog’s panel of experts suggests that as of 2011 it’s acceptable for a hospital to have 5% or fewer of its deliveries be early elective deliveries.

Consumers may need to ask their preferred hospital to tell them the hospital’s rate of early elective deliveries, however, because not all hospitals were surveyed, and many of those that were did not respond. Nonetheless, this online report is a great start. The results showed that hospital practices vary greatly even at the local level. In Los Angeles, for example, rates of early elective deliveries ranged from 4% to 29%. In Boston, rates ranged from 1% to 27%.

Read more in my full story.

— Sherry Boschert (@sherryboschert on Twitter)

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Filed under Family Medicine, Hospital and Critical Care Medicine, IMNG, Obstetrics and Gynecology, Pediatrics, Practice Trends, Uncategorized

Family matters in cancer care

Family: can’t live with them, can’t live without them.

The upcoming holiday season calls the sanity of this adage into question, but when a member of the clan is diagnosed with cancer, there’s nothing like family to ease the way forward. Or is there?

 A team of Argentinian researchers evaluating the influence of family on the care of cancer patients found that 50% of physicians acknowledged at least one negative feeling for the relatives. Wrath, anger, rejection, and anguish were all noted, with women physicians more likely to feel anguish, and anger rising to the top of the list among male physicians. 

“Negative emotions must be considered since the above mentioned emotions may be an obstacle to the correct performance of the professional,” Luisina Ongania and colleagues reported at the European Society for Medical Oncology meeting in Milan. 

Before physicians cry foul, however, the survey showed that relatives had secrets of their own. 

"The Secret" by Edmund Blair Leighton, image in the public domain

 

 A stunning 95% of physicians said they had been asked by relatives to hide information of an adverse diagnosis or prognosis from the patient. 

Only 35% of the sample – made up of 50 oncologists, surgeons, pathologists, pulmonologists, and NIC providers – rejected this demand.  

Contrary to the image of women as chatterbox cream puffs, female physicians were more likely to snub a request for secrecy than men (40% vs. 32%), as were seasoned practitioners when compared with those with less than 10 years of clinical experience (40% vs. 32%). 

The influence of family can place doctors at an “ethical crossroads” in relation to respect for the patient’s autonomy, the researchers, from the Centro Médico Austral OMI in Buenos Aires, noted in their poster. 

Proponents of family centered care argue that engaging families in the hospital and even the ED can provide medical teams with valuable clinical and social information and calm patients who find themselves in a frightening and unfamiliar setting. Conversely, family members who witness the massive medical efforts launched to save their loved one are said to be more accepting of the outcome, even when the patient dies. (Click here for related story).

Exactly how hospitals, EDs, and clinicians should navigate these tricky waters is unclear, although all physicians in the survey argue that it’s important to receive information and training about how to work with relatives. Only 16% believed they’d received enough of this training.

Getting relatives to behave in the hospital, or even at the holiday dinner table, may be a harder nut to crack. 

By Patrice Wendling (on twitter @pwendl)

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Filed under Emergency Medicine, Hospice and Palliative Care, Hospital and Critical Care Medicine, IMNG, Internal Medicine, Oncology, Practice Trends, Psychiatry

Hospitals Moving “Moo” Off the Menus

(Courtesy NASA Goddard Space Flight Center)

Here’s a happy Earth Day item: Four hospitals in the San Francisco Bay Area reduced their meat purchasing for menus by 28% in a pilot study, thereby avoiding significant amounts of associated greenhouse gas emissions and saving hundreds of thousands of dollars in costs.

Most of the drop in greenhouse gases came from reduced purchases of beef, which is a notorious producer of gases that contribute to global warming.

The study is the first attempt to evaluate the “Balanced Menus” program, which was created by the San Francisco Bay chapter of Physicians for Social Responsibility and has been rolled out to 32 hospitals across the United States by the nonprofit organization Health Care Without Harm. The Johns Hopkins Center for a Livable Future partnered with Health Care Without Harm to conduct the study.

A hospital meal (not in one of the study hospitals) by flickr user VirtualErn (Creative Commons).

Two hospitals reduced meat (beef, pork and chicken) in its cafeterias or cafes, one hospital reduced meat in inpatient menus/meal services, and one hospital did both. The Balanced Menu program also had them try to replace the remaining meat on their menus with purchases from sustainable and grass-fed meat producers instead of industrialized meat sources.

The study estimated that in a year’s time, the reduced meat purchases would avoid a total of 1,004 tons of carbon dioxide-equivalent greenhouse gas emissions. That’s roughly equivalent to not using 102,454 gallons of gasoline, or growing 23,354 tree seedlings for 10 years. Although the study did not account for greenhouse gases associated with whatever food replaced that meat, no food makes gas like beef, so there’s no doubt the planet came out ahead.

They also calculated that the less-meat, better-meat program saved the four hospitals $21,080 per month in costs even after including increased purchases of fish and vegetable sources of protein. My calculator suggests that’s $252,960 per year.

What about the patients? No complaints there, only anecdotal reports of compliments. Plus changing the meat-heavy U.S. diet could help combat rising rates of diabetes, obesity, and some cancers. According to Department of Agriculture statistics, the U.S. food supply contains 58% more red meat and chicken (8.7 ounces per person per day) than is called for in dietary guidelines that cover meat, poultry, nuts, beans, and eggs (5.5 ounces per person per day).

One of the lessons learned in the pilot study, the investigators noted, is that hospitals should involve clinicians early in the process of menu development. If you’re a clinician who is looking for one small, achievable Earth Day action that could make a big difference, consider showing this study to your hospital team. They (and the planet) may thank you.

–Sherry Boschert (@sherryboschert on Twitter)
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