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Tag Archives: Press Ganey

Healthcare Update — 01-23-2012

See more medical news from around the web over at the Satellite Edition of this week’s Update at ER Stories. The story of “Dr. Douchebag” and why morale is declining in many of this country’s emergency departments. Even if you say “thank you, sir” for the abuse, your job may still be threatened because of bad Press Ganey scores. More than 80% of medical mistakes go unreported by hospitals. Let’s just get this out of the way: Doctors kill every single patient that they treat and plaintiff attorneys should be paid even more money to sue our way to better health care. That should do it. Indiana woman awarded $1.5 million after surgeon did not operate on abdomen soon enough. Two days after initial presentation, she required emergency surgery for ischemic bowel requiring that a large portion of her intestines be removed. Sorry, Grandma, I know that your bone cancer is causing you excruciating pain, but you can’t have any more pain medication. As Florida cracks down on doctors who treat chronic pain patients, the patients are having more difficulty getting their medications. Where do the patients end up? In the emergency departments. When pill abusing patients go to the emergency department and don’t get their medications, some become abusive and violent. Now some Florida hospitals are implementing a “chronic pain management plan” which requires doctors to “help educate patients about the dangers of abusing prescription drugs and addiction.” Got that, Granny? You have bone cancer and you have six months to live, but abusing oxycontin is dangerous and can kill you. As part of the “plan,” emergency physicians then will “refer the patient to a primary care physician” – who has already been “cracked down upon” and who won’t prescribe the pain medications, either. End result? In an attempt to curb abuse by criminalizing the prescription of pain medications, Florida is now affecting the ability of patients who are legitimately in pain to receive necessary treatment. Cancer pain patients in Florida now more likely to get bounced around the system and die in pain. And people blame the physicians instead of the legislators. Why let a little thing like a gangrenous appendix get between you and your wedding? Ceremony held in hospital. Both bride and groom wear “gowns.” New York jury awards 18 year old patient $3 million for delay in c-section at birth that allegedly caused patient’s cerebral palsy. Patients gone wild in Pennsylvania. Woman gives medical staff hard time in ED, pulls out IV, threatens to infect everyone around her with HIV, kicks a security guard in the cha-chas when trying to escape, then is wheeled out of the hospital by police kicking and screaming in a wheelchair. Initially charged with three felonies, but those charges were dropped by persecutors er, um prosecutors. Of course, if the security guard was an off duty police officer, the patient would be doing 20 to life in Leavenworth. Patients gone wild then … police gone wild? Patient becomes combative in emergency department. Police called, then allegedly “strike the patient, place him in a headlock, pull and twist his head and forced handcuffs on him with force and violence.” Another officer allegedly “pushed the handcuffed man over a metal chair arm with the force of his weight pressing upon him.” The officers could face jail time and fines if found guilty. Patients gone wild — Twilight Edition. Toledo woman allegedly tries to steal baby from hospital. When ED nurse approaches her, the woman turns around and bites her. Then she hisses, turns into a bat, and flies away. The Medical Marijuana ...

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Presidential Voting and Press Ganey Part 2

If you haven’t read the first part of this two-part series, which was published before the primary results were known, please go here to review it. The final results in the New Hampshire Republican presidential primaries have been published and I’m confused. Based upon the sample from Dixville Notch, each candidate should have received one portion of the votes, but when a larger sample size was taken, the candidates all received different portions of the vote. None of the final results were even close to the predicted results from Dixville Notch. Jon Huntsman’s scores were off by 31% Ron Paul’s scores were off by more than 100%! Rick Perry’s scores were pretty close, but he still got votes even though the survey said that he wasn’t supposed to get any votes at all. Rick Santorum should be happy. The initial survey said that he would get 0.000% of the vote. He ended up with 9.4% of the vote. What a massive error that was! Candidate Dixville Notch Predicted Percent Vote Actual Percent Vote Difference Newt Gingrich 1/9 = 11.1% of vote 9.4% of vote – 18% Jon Huntsman 2/9 = 22.2% of vote 16.9% of vote – 31.3% Ron Paul 1/9 = 11.1% of vote 22.9% of vote + 106% Rick Perry 0/9 = 0% of vote 0.7% of vote + “a lot” % Mitt Romney 2/9 = 22.2% of vote 39.3% of vote + 77% Rick Santorum 0/9 = 0% of vote 9.4% of vote + “even more” % . . . .   Now you can see from the sample of an actual Press Ganey report in the previous post, a difference in a “mean score” of less than 1% can make the “percentile rank” change by 5 points or more. What happens when the mean score changes by 100% or more? Disaster. So it seems that the scores from small sample sizes in Press Ganey surveys are pretty much like random number generators. Kind of like administrators praising and demeaning staff based upon how many blue Chevrolets drive past the hospital between 3PM and 4:30PM on Tuesday afternoon. If there are 5 Chevys, you’re the best. If there are 0 Chevys, you’re fired. If administrators and hospital boards can’t see the problems with basic statistics, how are they supposed to run hospitals effectively? Make sure to leave a copy of this post on your administrator’s desk or under your administrator’s door. We need to bring some accountability to those who manage our profession.

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Presidential Voting and Press Ganey

Well, the results are in. Based on a survey of New Hampshire voters, Rick Perry and Rick Santorum will receive NO votes in the New Hampshire primaries. Jon Huntsman and Mitt Romney will receive the exact same number of votes and will be tied for first place. Ron Paul and Newt Gingrich will receive the exact same number of votes and will be tied for second place. And, in the general elections, Barack Obama will receive exactly three times as many votes as either Ron Paul or Newt Gingrich and will receive exactly 50% more votes than Mitt Romney or Jon Huntsman. You see, in the New Hampshire town of Dixville Notch, nine registered voters casted their votes in the Republican primary. The tallies of the votes were: Newt Gingrich: 1 Jon Huntsman: 2 Ron Paul: 1 Rick Perry: 0 Mitt Romney: 2 Rick Santorum: 0 Barack Obama: 3 Applying those statistical breakdowns to the population of New Hampshire, and to the country at large, one can only come to the conclusion that Jon Huntsman and Mitt Romney will receive the exact same number of votes in the New Hampshire primaries. Those are the statistics and statistics don’t lie. No problem, right? Is anyone willing to conclude that a breakdown of the statistics from Dixville Notch is an accurate representation – down to one tenth of a percent – of the percentage of voters supporting each candidate in New Hampshire? Anyone? Any hospital administrators? Any hospital board members? Any CMS officials? Bueller? Bueller? Didn’t think so. Yet administrators and boards of directors of many multimillion dollar hospitals make similarly irrational and childish conclusions every day. How? Let’s change the voting situation above just slightly. Instead of making this voting a presidential primary, let’s make the voting a patient satisfaction survey. Instead of voting for presidential candidates, let’s make the votes a rating of health care providers.

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Healthcare Update — 11-07-2011

Also see the Satellite Edition of this week’s update at ER Stories.net (I hope) $9 million verdict against Wyoming hospital and emergency physician after patient with neck pain was discharged from emergency department after accident with no neck imaging. Later, he was diagnosed with multiple cervical fractures and has chronic pain. $2 million of the patient’s verdict goes to his wife for loss of consortium. $29 million judgment upheld against Northwestern Memorial Hospital after obstetricians fail to diagnose Group B Strep infection at birth. Want to know what some Michigan hospital CEOs earned in 2010? Here’s a list. Six patients in a south Chicago hospital last weekend waited 2 to 4 days in the emergency department before emergency department staff could find a psychiatric hospital to take them. Meanwhile, staff is making regular phone calls, faxing documents back and forth, filling out all the government-mandated paperwork, etc. And now Illinois’ governor wants to close more state-run psychiatric hospitals. Wonder why wait times in the emergency department are so high?

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Greet and Street

Another article that I was going to put in a Healthcare Update that just irked me enough that I had to make it into its own post. First, the news … In order to cut down on unpaid health care bills while also complying with federal EMTALA laws, hospitals emergency departments are increasingly engaging in the “greet and street” approach. EMTALA requires that hospitals provide a screening exam to every patient seeking emergency medical care. If that screening exam does not reveal an emergency medical condition, then the hospital has no further duties under EMTALA. Doesn’t have to do any other testing. Doesn’t have to provide treatment. Doesn’t have to give you a prescription. It is only when a hospital discovers an emergency medical definition that the hospital is then obligated to either provide stabilizing treatment or to transfer the patient. If you want to read all of EMTALA’s definitions and requirements, here’s a link. So if a patient seeks medical care in an emergency department and does not have an emergency medical condition, the hospital is not obligated to provide treatment to the patient. More and more hospitals – especially those with higher volumes of patients – are implementing policies embracing that concept. One of the latest examples is Halifax Health in Daytona Beach, Florida. If patients go to the Halifax Health emergency department and do not have an emergency medical condition, then those patients now have several options. First, they can either pay their insurance co-pay or pay $350 cash up front, then be seen in the emergency department. Second, they can choose to go to the on-site clinic and pay $48 to be seen. Third, if they don’t want to or can’t afford to pay anything, they are given a list of community resources to follow up with – such as county health departments. The policy only applies to patients 18-64 years of age. Those 65 and older are covered by Medicare. Those under 18 are likely covered by some form of state insurance for children. Halifax Health estimates that one third of its bad debt is generated through its emergency department and is trying to cut $5 million from its budget. The hospital system noted that people from neighboring counties generated more than $7 million in unpaid medical care with a large portion of that uncompensated medical care coming through the emergency department. So, it appears that as financial pressures for hospitals mount and as additional patients enter into a system that does not have sufficient primary care resources, patients will increasingly be left in what will become medical purgatory – a place where patients are not sick enough to warrant emergency medical care and they are unable to find a doctor to treat them in a timely manner. End of news blurb. [wp_campaign_2] Beginning of rant. The author of the article interviewed a patient who was told “she would have to pay the entire cost of the visit if she wanted to have her upper respiratory infection with a touch of bronchitis treated.” The patient was upset because this chest cold was an “emergency” to her. She then had to wait three days to get her emergency antibiotics for the viral infection she was experiencing. Not surprisingly, her emergency “ZeePack” didn’t work. Then some doctor who obviously hasn’t read my “Don’t Use Raid on Dandelions” post gave the lady a second round of antibiotics. Obviously the first round of antibiotics was much too weak. The patient should have been prescribed Gorillamycin to begin with so that all viable flora in her body could be simultaneously eliminated. ...

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What Goes Inside?

After my hospitalization, I got a letter from a patient satisfaction survey company. It contained a envelope addressed back to the same patient satisfaction survey company and the envelope stated that “POSTAGE WILL BE PAID BY ADDRESSEE.” I wasn’t sure what I was supposed to put inside of the envelope, though. Can you all give me some ideas?      

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