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Top 10 Most Dangerous Hospital Hazards: Some May Surprise You

Alarm fatigue is the most dangerous of health care technology hazards, topping even radiation exposure and medication errors from infusion pumps, according to the updated Top 10 list offered by ECRI Institute.

It’s not surprising that alarm fatigue rang in at #1. There can be as many as 40 alarms an hour in some units. Staff modify alarm setting outside of safe parameters, can’t tell the alarm’s importance (or even which device is issuing it) or the alarm isn’t relayed to the paging system, according to ECRI Institute, a nonprofit organization focusing on patient-safety and cost-effectiveness in health care. Its report (registration required) is online. The report includes recommendations and resources for each of the 10 top hazards.

Staff may turn alarms off or down to reduce alarm fatigue, as well as reduce stress on the patient and family, the report notes. And properly setting alarms is complex to begin with, so ECRI offers best practices to reduce alarm fatigue while maintaining patient safety: Read more »

*This blog post was originally published at ACP Hospitalist*

Another Example Of Good Medicine That Does Not Follow “Protocol”

As far as I can tell, there are very few physicians currently involved in the innermost circles of healthcare reform. This is concerning to me, not because I’m one of those “paternalistic doctors” who “drive up in their Porsches threatening to pull out of Medicare” but because I think that many policy makers don’t really understand the incredible complexity associated with doing the right thing for patients. Here is an excerpt from the WhiteCoat’s Call Room blog that perfectly illustrates why practicing good medicine often requires a break from protocol:

It isn’t just the patients who think I’m a bad doctor.

Based on the information from all the pinheads at Medicare’s “HospitalCompare” web site, I’m downright dangerous.

For those who don’t know about Hospital Compare, it is a site where the general public can compare the “quality indicators” for hospitals on measures deemed important by the AHRQ.

I failed to meet a couple of indicators recently, so I received notices from our hospital administration that I am now considered out of compliance with the HospitalCompare guidelines and am bringing down our numbers on the web site.

In other words, Medicare thinks I’m a bad doctor.

Let me tell you about the patients I screwed up on.

The first patient was a gentleman in his 70’s who started having chest pain at home. He got sweaty, passed out, and hit his head on the concrete floor in his house, causing a nice goose egg on the back of his noggin. When he arrived in the emergency department, he was still having chest pain, so we hooked him up to an EKG and … lo and behold … he was having a myocardial infarction.

According to the quality indicators at “HospitalCompare”, if a patient with a heart attack is going to receive thrombolytics (”clot busters”), the thrombolytics must be given within 30 minutes of the patient’s arrival at the hospital. If a health care provider takes longer than 30 minutes to administer thrombolytics to someone with a heart attack, the government considers that provider to be practicing bad medicine.

Now I’m faced with a choice:
A. Do I give clot busters to someone who sustained a significant head injury (and may be bleeding internally) so that I can look like a “good doctor” to Medicare and If there is bleeding inside his brain, clot buster medications will make the bleeding worse and could kill him.
B. Do I perform a CT scan on the patient to make sure that there is no bleeding inside his brain before I give the clot-buster medications? If I do the CT scan, there is no way that we’ll get the results and be able to give the patient thrombolytics within the 30 minute window.

If I choose “A,” the hospital stays in the upper echelon of facilities that meet’s guidelines. Doesn’t matter if the patient dies – according to Medicare, “We’re Number ONE!”

If I choose “B” I’m doing what is right for the patient, but our hospital will look bad and will plaster it all over the internet that our hospital doesn’t follow Medicare’s rigid and sometimes life-threatening guidelines.
I chose “B.”

According to, my decision made me a bad doctor…

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