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.
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.
Everyone occasionally struggles to remember a name, blanks out on an appointment or forgets why they walked into the other room. But somewhere around age 40, those “senior moments” start to take on a new seriousness. They suddenly seem like scary signs of aging, perhaps harbingers of major memory loss to come. “A few years ago, these complaints were just dismissed,” says Dr. Anne Louise Oaklander, a neurologist at Massachusetts General Hospital in Boston. Now, researchers have become interested in mid-life memory, both to understand their patients’ complaints, and because of the recognition that the seeds of dementia are laid around this time of life.
In more than half of Connecticut’s emergency rooms, the waiting time to see a health-care provider exceeds the national average of 28 minutes – a problem that experts say could get worse, as thousands more residents obtain health insurance. The average wait can stretch to an hour or more at Rockville General, Manchester Memorial, Bridgeport, Waterbury and Hartford hospitals, according to a C-HIT review of federal data. The statewide average waiting time is 30 minutes. The longest wait time is at Hartford Hospital, where patients were not seen for 82 minutes, on average; the shortest wait of 14 minutes is at Windham Hospital, the data compiled by the Centers for Medicare & Medicaid Services (CMS) through 2012 show. Officials at Hartford and Bridgeport hospitals claim shorter wait times than the federal data.
Nancy Cappello wants all women to receive the same opportunities for breast cancer screening that women in Connecticut have had for years. Cappello, who worked for passage of the state’s 2009 breast density notification law, has taken her cause nationally – advocating for similar legislation in every state and lobbying policymakers in Washington D.C.
Connecticut’s law — the first of its kind in the country — requires radiologists to inform women who undergo mammography if they are diagnosed with dense breast tissue, a condition known to obscure cancer detection. These “inform” reports must reference potential benefits of supplemental screening such as an MRI or ultrasound. So far, 11 states have followed Connecticut’s lead by passing similar laws. According to data collected in Connecticut, ultrasounds have detected breast cancers that mammograms missed.
At Bridgeport Hospital, “talking bed rails” programmed to speak to patients in the geriatric psychiatric unit are helping to reduce the number of alarms that sound when a patient at risk for falling tries to get out of bed. At the Hospital of Central Connecticut in New Britain, health care professionals are adopting techniques from aviation safety experts to reduce the chances of a catastrophic event happening before a clinical alarm goes off. These are among the many ways Connecticut hospitals are tackling a phenomenon known industry-wide as alarm fatigue. Health care experts worry that medical devices with built-in alarms – such as heart monitors, infusion pumps and ventilators – designed to alert caregivers that patients are in danger could potentially put patients at risk because caregivers are desensitized by the sheer number of alerts and false alarms and fail to respond in a timely fashion. Research shows alarms in intensive care units are accurate less than 10 percent of the time, and 90 percent are false alarms.
Solutions for combating alarm fatigue range from alarm integration technology that sends alerts to a caregiver’s telephone to the development of a new generation of “smart alarms,” including ones designed to monitor multiple vital signs.