Pearson: Whether measured relative to its population or its economy, the United States spends by far the most in the world on health care.
They use a common fee schedule so that hospitals, doctors and health services are paid similar rates for most of the patients they see. They are flexible in responding if they think certain costs are exceeding what they budgeted for.
Pearson: Spending on almost every area of health care is higher in the United States than in other countries. As we have previously said, many OECD countries use strong regulation to set prices that hospitals can charge for different services, and some of them even set budgets for how much hospitals can spend. Such an approach still leaves room for differences in prices across regions and states, but it could help smooth out some of the huge differences you see in prices paid for the same services delivered in the same hospital, depending on whether a patient is on Medicare, Medicaid or their own health insurer. Pearson: The table below gives some examples of the prices of some common procedures in the United States compared with some of the countries with the best quality health systems in the world. A coronary bypasses costs between nearly 50 percent more than in Canada, Australia and France, and are double the price in Germany. These procedures and the use of expensive diagnostic tests are all subject to physician opinion on whether they are desirable or not. Payments that mean that physicians get paid more if they do more interventions, regardless of medical necessity.
It is often argued that differences in testing could reflect differences in patients’ needs between and within countries.
In terms of health care services, the biggest areas of concern are the quality of primary care services and coordination of care for long-term conditions. A similar picture emerges for chronic obstructive pulmonary disease (230 admissions per 100,000 population compared to an OECD average of 198, 2009).
PBS NewsHour allows open commenting for all registered users, and encourages discussion amongst you, our audience. The Rundown offers the NewsHour's unique perspective on the important events of the day with insights from the journalists you trust. This website is archived for historical purposes and is no longer being maintained or updated. Each year, nearly 900,000 Americans die prematurely from the five leading causes of death a€“ yet 20 percent to 40 percent of the deaths from each cause could be prevented, according to a study from the Centers for Disease Control and Prevention. The five leading causes of death in the United States are heart disease, cancer, chronic lower respiratory diseases, stroke, and unintentional injuries.
The numbers of preventable deaths from each cause cannot be added together to get an overall total, the authors note. Heart disease risks include tobacco use, high blood pressure, high cholesterol, type 2 diabetes, poor diet, overweight, and lack of physical activity.
Cancer risks include tobacco use, poor diet, lack of physical activity, overweight, sun exposure, certain hormones, alcohol, some viruses and bacteria, ionizing radiation, and certain chemicals and other substances. Chronic respiratory disease risks include tobacco smoke, second-hand smoke exposure, other indoor air pollutants, outdoor air pollutants, allergens, and exposure to occupational agents.
Stroke risks include high blood pressure, high cholesterol, heart disease, diabetes, overweight, previous stroke, tobacco use, alcohol use, and lack of physical activity. Unintentional injury risks include lack of seatbelt use, lack of motorcycle helmet use, unsafe consumer products, drug and alcohol use (including prescription drug misuse), exposure to occupational hazards, and unsafe home and community environments.
Southeastern states had the highest number of preventable deaths for each of the five causes.
A Chicago-style hot dog, Chicago Dog, or Chicago Red Hot is an all-beef frankfurter on a poppy seed bun, originating from the city of Chicago, Illinois.
Although less well known than a surgery performed at the a€?wrong sitea€?, retained surgical instruments is actually more common. Retained surgical instruments (needles, scalpels, clamps , sponges, etc ) occurs due to poor counting systems, fatigue of one or more members of the surgical team, difficult operations, or sponges a€?sticking togethera€?. Sponges should be counted on all procedures in which the possibility exists that a sponge could be retained.
There are many dangers as a retained surgical instrument can results in infections or a fibrinous response which may require another surgery to remove the retained surgical instrument.
Gossypiboma is the name given to a retained surgical sponge, pad, or towel (gossypium (Latin), cotton; + plboma (Swahili), place of concealment).
The hospital where the surgery took place may have legal responsibility as well since it is often the case that operating room nurses employed by them must undertake sponge and needle counts and it may be their error which produces the mistake even more directly than the surgeon. What are the legal ramifications of a retained surgical sponge or retained surgical instrument? Medical malpractice sometimes involves unique provisions of the law and procedure further complicated by the medical-legal issues present. US Department of Health and Human Services, Agency for Healthcare Research and Quality, Chapter 22. Important: Please do not consider anything contained on this website legal (or medical) advice to you for your particular case.
In Japan, if spending in a specific area seems to be growing faster than projected, they lower fees for that area. In running their business, private health insurers continually face a choice between asking health care providers to contain their costs or passing on higher costs to patients in higher premiums. It is often comforting to feel that medical problems are being diagnosed or treated, regardless of whether they are medically necessary.
When medication errors arise due to inaccurate or unknown patient weights, the dose of a prescribed medication could be significantly different from what is appropriate. Thata€™s because prevention of some premature deaths may push people to different causes of death. Others are due to disparities due to the social, demographic, environmental, economic, and geographic attributes of the neighborhoods in which people live and work. The study authors suggest that states with higher rates can look to states with similar populations, but better outcomes, to see what they are doing differently to address leading causes of death.
Retained surgical instruments simply means that the surgeon forgot to remove needles, scalpels, clamps , sponges, etc after the completion of the surgery.
The retained surgical instrument can cause local or systemic symptoms that can lead to major illness or death.
One study reported that 55% of retained surgical sponges were found after abdominal surgery and 16% occur after vaginal delivery.
It occurs when a surgical team fails to remove all surgical sponges, pads or towels from a patient. In the case of a retained surgical sponge or instrument, there is such a strong inference of negligence that it is considered below the standard of care for surgery. As a patient you want and need quality medical care and treatment, particularly for those injuries which are serious or may become so in the absence thereof.
Even where liability seems reasonably clear insurance companies obligated to pay damages on behalf of those they insure often vigorously defend such claims. Norway, the Netherlands and Switzerland are the next highest spenders, but in the same year, they all spent at least $3,000 less per person. This means that health care services can choose patients who have an insurance policy that pays them more generously than other patients who have lower-paying insurers, such as Medicaid. Similarly, in France an organization called CNMATS closely monitors spending across all kinds of services and if they see a particular area is growing faster than they expected (or deem it in the public interest), they can intervene by lowering the price for that service.
What are some successful models other countries are employing to keep costs down in those areas? As these services are often paid for by insurance policies, the immediate cost of extra treatment for a patient is often zero or very low. They found that the rate of coronary bypass was five times greater in certain hospital referral regions in the United States than others between 2003 and 2007. Relatively fewer patients (just 20 percent) wait more than four weeks for a specialist appointment or more than four months for elective surgery (7 percent).
OECD Health Data shows that the five-year survival rate for breast cancer is higher in the U.S.
Along with the FDA’s comparatively shorter drug approval processes, this means that cutting-edge drugs and treatments are available more quickly to American patients than elsewhere. Innovative centers such as the Mayo Clinic and Johns Hopkins that bring laboratory research and clinical practice together have also benefited patients enormously.
Examples that the world is watching at the moment include Accountable Care Organisations, which seek to better manage risk-sharing by giving providers flexibility to coordinate and deliver health care while holding them accountable for costs and outcomes and the Medical Home model, which seeks to coordinate care and better engage patients and families, using health coaches, care transition pathways and other interventions to reduce expensive re-hospitalizations.
While many states are making efforts to reduce smoking, there are fewer policies to tackle the harmful use of alcohol in the U.S. In a Commonwealth Fund survey of seven nations (Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States), 16 percent of American patients reported delays in being notified about an abnormal test result (the highest proportion reported) and only 75 percent of primary care physicians reported often or always receiving correspondence from specialists after referral suggesting systemic problems with care coordination. For example, a person who avoids early death from heart disease still may die prematurely from another preventable cause, such as an unintentional injury.
The study authors note that if health disparities were eliminated, as called for in Healthy People 2020, all states would be closer to achieving the lowest possible death rates for the leading causes of death.
This is supposed to be avoided by counting all instruments used during surgery and being sure they are all accounted for at the completion of surgery.
The risk of a retained surgical instrument or sponge increases in emergency situation, with unplanned changes in procedures or in obese patients. As a injured party seeking financial compensation along with a measure of justice, the importance of medical documentation is the primary tool which your lawyer may use to accomplish this. As a result, there are some situations where presettlement funding may be appropriate to provide a vital lifeline in order to obtain important related medical care or to stay financially afloat. The average spending on health care among the other 33 developed OECD countries was $3,268 per person.
Not only does this cut down on medical errors, it is also thought to save 1-2 hours of work by the pharmacists per day.
Groups of insurers and hospitals across different regions then use the national government’s ranking to negotiate what prices they ought to pay across the board. More generally, with so many different kinds of insurance, no one organization has a strong incentive to cut out wasteful practices and ensure that all Americans get value for the very high levels of expenditure incurred when they are sick. Similarly, regional variations in hip and knee replacement are substantial, with the rates four to five times higher in some regions compared with others in 2005-06. Adult overweight and obesity rates are the highest in the OECD, and have kept growing even in the last couple of years, while they have nearly stabilised in some other OECD countries, such as England, France and Italy. The report, in this weeka€™s issue of CDCa€™s weekly journal, Morbidity and Mortality Weekly Report, analyzed premature deaths (before age 80) from each cause for each state from 2008 to 2010. A 2008 study indicated that 1 in 8 surgical cases involves an intraoperative discrepancy in the count of surgical sponges or instruments resulting in a retained sponge and instrument (RSI). For example, they monitor how many generic drugs a physician is prescribing and can send someone from the insurance fund to visit physicians’ offices to encourage them to use cheaper generic drugs where appropriate. When we look across a broad range of hospital services (both medical and surgical), the average price in the United States is 85 percent higher than the average in other OECD countries.
This means that hospitals have an incentive to treat patients as quickly as possible and it also demonstrates how broader reform in the U.S. Child overweight and obesity rates are also very high, but they have been relatively stable over the past 10 years. The authors then calculated the number of deaths from each cause that would have been prevented if all states had same death rate as the states with the lowest rates.
Another 2008 study indicates they occur a€?more frequently than expected from literaturea€?.
Breakdowns described in reports most frequently involved failures to obtain accurate patient weight measurements. They are often statutory and Medicare cannot change the rates without approval by Congress. Strategies to address these problems include providing all units with the necessary equipment to weigh patients, weighing every patient during triage or admission to facilities, and weighing patients and documenting patient weights only in kilograms. Both height and weight are needed to use nomograms to determine body surface area and body mass index.
A Look at the NumbersThere is little information in the literature that specifically mentions medication errors that result from missing or inaccurate patient weights. Top Five Medication Error Event Types Associated with Wrong Weights (n=448) Table 2 lists events by the top five units in which the event occurred, representing 54% of all reports. A national survey of EDs shows that more than 50% of all patients admitted to a hospital came through the ED. Units Commonly Involved in Medication Errors Involving Wrong Weights (n=259) A review of the medications commonly reported reveals two key attributes.
Second, 5 of the top 10 medications involved, representing 236 (49%) of all reports, are high-alert medications.
High-alert medications are drugs that bear a heightened risk of causing significant patient harm when they are used in error.6 Table 3.
Top 10 Medications Involved in Wrong-Weight Medication Error Reports (n=304) Further AnalysisThe second step in the analysis process included a review of each report’s description of the event to determine what specifically went wrong in these reports. There are times when patients arriving at hospitals may not be weighed; for example, if a patient is admitted for an emergency, is not ambulant, or is unable to communicate his or her weight. The study results showed that staff members’ estimation of weight was poor, with 47% of estimates at least 10% different and 19% of the estimates were at least 20% different from the measured weights.11Another prospective study of adult patients presenting to an urban ED assessed the accuracy of estimations of patients’ weight by the patients themselves, physicians, and nurses in the ED.
The authors concluded that when a patient is unable to be weighed, the patient’s own weight estimate should be used.12In a third prospective, descriptive study of trauma patients, healthcare practitioners (physicians, trauma residents, and trauma bay nurses) estimated patients’ weights. The patient was never weighed prior to starting the weight-based heparin nomogram.A patient presented to the ED after having taken an overdose of Tylenol PM. The patient’s initial acetaminophen level [about 100] and an acetylcysteine (Mucomyst®) infusion was ordered based on the established pharmacy protocol. When the patient reached the floor and was actually weighed, [his or her] weight was found to be 23 kg less than originally stated.
The pharmacist was notified, and the infusion rate adjusted based on this knowledge.A report was given to ICU nurse from the ED.
This weight was only documented in [the computer system] under the Diprivan® (propofol) medication calculation. Upon transfer to the bariatric bed, the patient’s weight was confirmed at 250 lb and not 419 lb. According to the ED, the patient’s weight was an estimate because the ED could not weigh the patient prior to administration of the medications. The patient was unable to be weighed due to [his or her] critical status to stand on scale in ED. After the patient arrived to the floor, [personnel] were able to weigh [the patient, whose] weight was recorded as 91 kg.
For example, when patients are transferred from facility to facility or within a facility between units, practitioners often assume that the weight documented in the medical record is accurate and up-to-date. One such scenario was reported to the Authority.A patient was admitted through the emergency room.
The demographic sheet obtained from the nursing home, which was used to determine the patient’s weight, listed [the weight] at 253 lb. The error was corrected based on correct weight of patient.Although there are studies that show that a patient’s own weight estimate can be more accurate than a healthcare practitioner’s, problems can occur when solely relying on a patient’s stated weight.
One example reported to the Institute for Safe Medication Practices (ISMP) involved an ED patient with deep vein thrombosis who purposely understated her weight as 160 lb because she did not want her husband to know that she actually weighed 180 lb. A short time later, a pharmacist working in the unit asked the patient to step on a scale and an error was averted.
While a 20 lb difference in an adult may not cause a problem, larger discrepancies between a patient’s stated weight and a measured weight have been reported to ISMP (up to 100 pounds).14Finally, the patient’s weight may not be communicated to appropriate healthcare practitioners. For example, the weight, especially an accurate weight, may not be provided to pharmacy, either on paper or electronically, to calculate or double check weight-based drug doses. In a survey performed by ISMP and the Pediatric Pharmacy Advocacy Group to determine what medication safety practices were in place for pediatric patients in both critical care and noncritical care units, only about half of all respondents reported that the patient’s weight is always entered into the computer before processing orders to allow the system to warn practitioners about drug doses that exceed safe limits.15Errors with Documenting WeightsMost patients are weighed in pounds, both in their home and in the healthcare organization. But weighing and documenting patients’ weights in pounds introduces the need to then calculate the weight into kilograms, an error-prone process,16 for weight-based and other dosing.
However, the greater problem is obtaining the weight in pounds then failing to convert and document that weight in kilograms, resulting in more than two-fold dosing errors.
In fact, more than 25% of the 479 reports mention breakdowns that occurred when the patient’s weight, measured in pounds or kilograms, was erroneously documented as the patient’s weight in kilograms or pounds, respectively.
Reports submitted to the Authority illustrate that this can occur with weights documented in a paper-based patient record or computerized order-entry systems, as well as weights entered into infusion pumps.A patient’s weight was inaccurately reported to the pharmacy using pounds instead of kilograms. Another nurse did not convert the patient’s weight from pounds to kilograms.A patient’s weight was estimated at approximately 180 lb. The nurse did not convert the pounds into kilograms when drawing up the Lovenox® injection.
The nurse administered 180 mg of Lovenox.A patient in the ED was ordered “fosphenytoin IV stat” for break-through seizures. The resident entered the patient’s weight into the CPOE [computerized prescriber order entry] system in pounds instead of kilograms (44 lb versus 20 kg). The patient received an overdose of the medication that resulted in toxicity.Upon checking IV pump settings, both the weight and kilograms were incorrectly programmed into pump. Once the correct weight was programmed into the pump, the dose of dopamine was decreased, which decreased patient’s blood pressure, resulting in need to increase dopamine and increase monitoring.Ideal versus Actual Body WeightA third, less frequently reported error involving patient weights is the inappropriate use of either ideal body weight or actual body weight given the patient’s condition or specific medication. For certain types of patients, medications may be dosed on an ideal body weight instead of an actual body weight. For example, if a patient is dehydrated, his or her actual weight will be lower than his or her ideal body weight, and conversely, a patient who is obese will have an actual body weight that is greater than his or her ideal body weight. Examples reported to the Authority include the following:Patient was started on a heparin infusion per protocol. A partial thromboplastin time (PTT) level came back from the lab at high panic [greater than] 249. According to protocol, the heparin infusion was stopped for three hours and another PTT drawn. When the second PTT results were reported, the infusion was recalculated and the original calculations were noted to have been made using ideal body weight, when actual body weight should have been used in this case (the actual body weight in this patient was less than ideal body weight).
New drip calculations were done and verified with pharmacy, as well as another registered nurse on the unit.The physician ordered “acyclovir 2 gm IV” based on patient’s actual weight of 98 kg. The pharmacy did not clarify the high dose order with the physician.Risk Reduction StrategiesObtain WeightsIt is vitally important that an accurate weight is obtained when patients arrive at a healthcare facility.
Establish a communication process that facilitates the timely transfer of accurate patient weights from nursing to the pharmacy.17Build a hard stop for patient weight into CPOE and pharmacy order entry systems. In a study to evaluate preprinted order forms, a form was designed to guide prescribers through the process of handwriting a complete inpatient prescription by using forcing functions.
To assess the effectiveness of this intervention, medication prescriptions were collected for two weeks before and after introduction of the new forms and evaluated for compliance with medication prescription guidelines. ISMP 2007 survey on HIGH-ALERT medications: differences between nursing and pharmacy perspectives still prevalent.
Errors in weight estimation in the emergency department: comparing performances by providers and patients. Estimated height, weight, and body mass index: implications for research and patient safety. Hospital survey shows much more needs to be done to protect pediatric patients from medication errors. Preprinted prescription forms decrease incomplete handwritten medication prescriptions in a neonatal intensive care unit.
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