Category: Hospitals

Putting the Informed into Informed Consent

published date
December 8th, 2006 by

Putting the Informed into Informed Consent

Physicians and clinical trial coordinators often view “informed consent” as just a form that needs to be filled out or a procedure that needs to be undertaken. A common consequence is that those who have consented have not necessarily been well informed. Informed consent should really be treated as an ongoing process, with a chance for patients to absorb and discuss information over time.

A new study of informed consent for clinical trials conducted in the ICU comes to the not very surprising finding that most patients who consented to participation in a trial don’t really know what’s going on. I would have been shocked if the data showed anything else.

A more useful study, in my view, would examine how many patients undergoing elective procedures or enrolling in clinical trials outside of the hospital understand what is happening.

Enquiring minds want to know

published date
December 4th, 2006 by

Enquiring minds want to know

Found this disturbing piece in the New York Times:

BILL CLINTON’S identity was hidden behind a false name when he went to New York-Presbyterian Hospital two years ago for heart surgery, but that didn’t stop computer hackers, including people working at the hospital, from trying to get a peek at the electronic records of his medical charts.
The same hospital thwarted 1,500 unauthorized attempts by its own employees to look at the patient records of a famous local athlete, said J. David Liss, a vice president at NewYork-Presbyterian.
The usual approach has been to allow types of personnel who need to see the records to have access and log the results. But logging means nothing without consequences for improper access. What did Columbia do to discipline those who tried improperly to access celebrity charts?
It may be necessary to have a person monitoring the process in real time and denying access in some situations. This is what happened in the era of paper charts for a patient not in the hospital. For a patient in the hospital the chart sat in a rack and if there was a parade of people coming to peek they would have been stopped.

Hospital financing in France

published date
November 28th, 2006 by

Hospital financing in France

Saw this cute little item in The Daily Telegraph on my way back to the US.

The chairman of Paris Saint-Germain football club is to contribute to the hospital fees of a member of a racist, anti-Semitic group of fans injured by a black policeman during an attack on a rival Jewish fan…

Another PSG fan died after the policeman opened fire when around 100 hooligans attacked him last Thursday. The officer was shielding a supporter of the Israeli club Hapoel Tel-Aviv, who the fans were trying to assault outside the… stadium.

Politicians and commentators regularly accuse PSG of turning a blind eye to fans with links to the far-Right.

I wonder why.

Toyota enters the health care provider market

published date
November 8th, 2006 by

Toyota enters the health care provider market

The Detroit News has an article about Toyota’s pickup truck factory in San Antonio, TX, which will soon have the company’s first medical clinic. The ironically named Ford Brewer, Toyota’s executive in charge of health and wellness, says Toyota is taking the same approach to health care as to cars: lower costs by improving quality.

The Institute for Healthcare Improvement has been modeling its hospital quality efforts on the Toyota production system, and I’m encouraged that Toyota is picking up the ball itself. The clinic will focus on primary, outpatient care. What would really be great would be for Toyota to get big enough in San Antonio to build an inpatient hospital. That way we could see what’s really possible from a cost and quality standpoint.

For now, though, Toyota has enough on its hands, like trouncing the Big 3, so I’m not holding my breath for bolder moves.

Hooray for hospitalists

published date
October 30th, 2006 by

Hooray for hospitalists

Hospitalists, physicians who practice internal medicine solely within the inpatient setting, are profiled in today’s Boston Globe. One of the weirder things about hospitals is there usually aren’t many doctors around. Primary care physicians tend to round in the early hours of the day, and then patients are left with nursing and administrative staff the rest of the time. Hospitalists address that deficiency by actually being in the hospital most of the day.

The article profiles Dr. Faisal Hamada, who runs the hospitalist program at Brockton’s Caritas Good Samaritan Medical Center. He’s actually employed by Cogent Healthcare, an Irvine, CA –not Philadelphia as the article states– based provider of turnkey hospitalist programs. Cogent provides the hospitalists, support staff, protocols and IT systems. The company generates a return on investment for its clients by improving the quality and efficiency of the hospital. Because hospitalists are around they can make adjustments in a patient’s schedule during the course of a day, something a primary care is unlikely to do after rounds . That kind of intervention tends to improve length of stay.

Good hospitalists develop a rapport with community physicians, which is essential so that those physicians don’t feel like the hospitalists are stealing their patients. I’m not surprised that Dr. Hamada is complimentary to the community physicians, but it’s also a fact that hospitalists tend to be more competent working in the hospital than their community-based colleagues. Hospitalized patients tend to be very sick –sicker than office-based physicians are used to seeing. Hospitals also have their policies, procedures, and informal ways of getting things done. It’s easier for a hospitalist to be good at this part of the job than someone who is only in the hospital occasionally.

One of the common complaints about hospitalists, also echoed in this article, is that there is a gap in communication between the hospitalist and the primary care physician, so that patients can get in trouble in between the time they are discharged and the time they see their community doc again. But that actually shouldn’t be such a problem in Brockton. Unlike most hospitalist programs, Cogent has its own call center to follow up with discharged patients, and has specific protocols for communicating with community physicians. In addition, Brockton is one of the three Massachusetts communities that is being wired up with a health information exchange as part of the Massachusetts eHealth Collaborative. That should make it much more straightforward for hospital-based and community-based physicians to stay in touch. Patients will benefit.