Hospitals Wake Up To The Need For Sleep

Clattering carts, overly bright lights and frequent disruptions make hospitals a tough place to get a good night’s sleep. But now, hospitals across Connecticut are launching efforts to help patients sleep longer and better. At Yale-New Haven Hospital, researchers are expanding a pilot program that successfully reduced noise in the medical ICU and kept staff out of patient rooms overnight. At Hartford Hospital, where noise levels sometimes resembled airport runways, they’ve eliminated overhead paging on patient floors except in true emergencies. And Stamford Health’s new hospital building, slated to open in September, is designed with sleep in mind.

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Hormones, Genetics Make Women More Susceptible To Arthritis

A growing number of adults—about 52 million—suffer from arthritis, and data show women are more likely than men to develop it. In 2014, 26.5 percent of women reported having doctor-diagnosed arthritis, compared with 20.5 percent of men, according to new data from the Centers for Disease Control and Prevention behavioral risk survey. Many women don’t realize they are at a higher risk than their male peers, said Dr. Abhijeet Danve, a rheumatologist and faculty member in Yale School of Medicine’s rheumatology division. “Of all the patients with arthritis, almost 60 percent of them are women,” he said. Several factors likely make women more susceptible than men: biological traits, genetics and hormones, Danve said.

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Acute Drug Shortages Forcing Workarounds In Hospitals

In hospitals across Connecticut and nationwide, workarounds to compensate for medication shortages are daily routines for treating patients – and health experts say it’s not about to change any time soon. Some acute-care drugs in short supply nationally are antibiotics, antipsychotics, intravenous saline, and morphine, according to the most recent shortage list from the U.S. Food and Drug Administration. In Connecticut, hospital officials say they are turning to alternative drugs, rationing supplies, or seeking new suppliers to work around the shortages. At St. Francis Hospital and Medical Center in Hartford, Dr. C. Steven Wolf, chief of emergency medicine, said doctors most recently have been dealing with shortages of dextrose, used to treat dehydration and low blood sugar, as well as intravenous saline and other basic medications.

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Docs Expanding Their Reach With Tweets

Despite national debate on whether doctors should use social media, some physicians are forging ahead, using platforms such as Twitter to interact with colleagues, expand their knowledge and even connect with patients. Dr. Nick Bennett, the infectious disease and immunology medical director for Connecticut Children’s Medical Center in Hartford, said he benefits professionally from Twitter. He created his account, @peds_id_doc, a few years ago to see what Twitter was about, and he’s remained a loyal user. Bennett started by following health-related accounts and live tweeting from conferences. He also joined Twitter chats – conversations that use hash tags to link tweets.

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Patient and gurney

18 State Hospitals Penalized For High Infection Rates

Eighteen Connecticut hospitals will lose 1 percent of their Medicare payments in 2016 as a penalty for comparatively high rates of avoidable infections and other complications, such as pressure sores and post-operative blood clots, according to new federal data. The Centers for Medicare & Medicaid Services (CMS) announced this month that 758 of the nation’s hospitals – about 23 percent of all eligible hospitals — would be penalized for patient safety lapses in the second year of the Hospital-Acquired Condition Reduction Program, which was mandated by federal health care reform. The penalties are based on rates of infections and other complications that occurred in hospitals between 2012 and 2014. The 18 hospitals in Connecticut include larger urban institutions, such as Yale-New Haven, Hartford and Bridgeport hospitals, and smaller hospitals, such as Manchester Memorial and Windham. They are among hospitals in the worst performing quartile nationally on patient-safety measures including the frequency of central-line and catheter-related infections, post-operative sepsis and accidental laceration.

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Adverse events

Hospital Reports Of Surgical, Medication Errors Climb

Connecticut hospitals reported record numbers of patients killed or seriously injured by hospital errors in 2013, with large increases in the numbers of falls, medication mistakes and perforations during surgical procedures, a new state report shows. The report, covering 2013, marks the first time that the number of so-called “adverse events” in hospitals and other health care facilities has topped 500 – double the number in 2012, when 244 such incidents were reported. Much of the increase was due to an expansion of reporting on pressure ulcers, which added a new category with 233 “unstageable” ulcers that were not counted before. Even without that category, however, reports of adverse events climbed 20 percent over 2012. The most significant increases were in the numbers of patients harmed by foreign objects left in their bodies after procedures – doubling from 12 to 25 in one year — or those harmed by perforations during surgical procedures – 79, compared to 55 the previous year.

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Windham Hospital, Willimantic

Operating Profits Drop At State Hospitals: New Report

Connecticut’s acute-care hospitals saw gains from their operations tumble 35 percent in the last fiscal year, with seven of 29 hospitals reporting operating losses, according to a new state report. While hospitals still ended the year with $597 million in profits overall, the report by the state Office of Health Care Access (OHCA) raises concerns that non-operating revenue, such as income from investments, was masking the decline in operating revenue. “While hospitals’ operational financial performance weakened in FY 2013, they continued to generate significant non-operating gains, helping to keep overall hospital financial performance strong,” the report says. “However, a robust financial picture should rely more on patient and other operating revenues, and not on a less than reliable income source, such as investment performance.”

Hospitals’ profits from operations dropped to $333.6 million, from $513.5 million in the 2012 fiscal year. At the same time, hospitals earned $70 million more from investments, charitable contributions and other sources of revenue.

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Prenatal blood test

Early Pregnancy Blood Test Reducing Need For Amniocentesis

A simple blood test is transforming the world of prenatal screening, offering women a risk-free way to learn about fetal abnormalities early in pregnancy. Already, the new test has drastically reduced the demand for amniocentesis, an invasive procedure that diagnoses chromosomal disorders in mid-pregnancy and occasionally causes miscarriage. The blood test, which became available in late 2011, can analyze DNA to predict Down Syndrome and a few other genetic diseases as early as nine weeks in pregnancy, says Dr. Daniel Gottschall, medical director of Women’s Health Connecticut, a group practice with 80 offices around the state. “It’s almost like science fiction to see how they can do this with such a high level of accuracy,” says Leslie Ciarleglio, a genetics counselor at Hartford Hospital, where the number of amniocentesis procedures plummeted by more than 70 percent in just two years — from 112 in 2011 to 32 in 2013.   “It’s far more accurate than any screening test we’ve had before.”

The test, which experts consider one of the most important clinical tools to emerge so far from the genomics revolution, can alleviate fear and suffering for pregnant women worried about birth defects.   But the medical advance also raises disturbing questions about the future of screening — and whether the quest for the perfect baby could go too far. Currently, most women who get the blood tests are carrying high-risk pregnancies.

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Restraints

State Restrains Psychiatric Patients At High Rate

As the state works to improve its mental health system, new federal data show that hospitals in Connecticut restrain psychiatric patients at more than double the average national rate, with elderly patients facing restraint at a rate seven times the national average. In addition, the state lags behind in providing adequate post-discharge continuing care plans for psychiatric patients, especially teens and the elderly. Connecticut’s 28 inpatient psychiatric units and hospitals developed continuing-care plans for fewer than 70 percent of patients they discharged from October 2012 to March 2013 – indicating that thousands of patients may have left facilities without adequate treatment and medication plans. A C-HIT analysis of the federal data, released by the Centers for Medicare & Medicaid Services for the first time, show that Connecticut ranks in the top fourth of states (11th highest) in the use of physical restraints in inpatient psychiatric facilities – and is the third highest state in restraining patients 65 and older. Two psychiatric units – at Bridgeport Hospital and Masonicare Health Center in Wallingford – have the 10th and 12th highest rates of restraint use, respectively, among the 1,753 psychiatric facilities nationwide that are included in the federal reports, which cover October 2012 through March 2013.

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HospitalCareCosts

Undocumented Immigrants To Strain Safety-Net Hospitals

Undocumented immigrants are expected to make up a larger share of Connecticut’s uninsured population next year, putting new financial pressures on safety-net hospitals that provide emergency care to everyone, state and national health experts predict. The Affordable Care Act (ACA) provides coverage options for legal immigrants, but those in the U.S. illegally cannot apply for Medicaid, even if they are poor, or buy coverage at Access Health CT (the new insurance marketplace), even if they have cash. That means illegal residents without coverage will continue turning to local emergency departments for care at a time when Connecticut hospitals face the loss of millions of dollars in federal and state subsidies to help defray the cost of uncompensated care. “This is a global problem that isn’t going away. This population (of undocumented residents) is not being addressed by any state or federal initiatives.

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