Published in the July 2005 issue of Today’s Hospitalist
Beware of fake hospital inspectors
The Department of Homeland Security and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) earlier this spring warned the 5,000 hospitals and other institutions it accredits to beware of individuals posing as inspectors with the organization.
The FBI was investigating incidents in three cities “Boston, Detroit and Los Angeles “in which individuals posed as unannounced hospital inspectors. In all three incidents, the individuals left the facilities they were visiting when pressed for information about the nature of their visit.
The two agencies did not identify the specific hospitals, and they said they were not sure of the individuals’ identity or motives.
JCAHO occasionally receives reports of people falsely claiming to be inspectors working for it. In most instances, however, individuals are usually trying to get treated sooner or obtain copies of a patient chart.
After the incident, JCAHO officials said they will require all unannounced surveyors to carry a letter identifying the purpose of their visit.
Hospitalists reduce length of stay, time to surgery for hip patients
New research highlights the role that hospitalists can play in streamlining the care of surgical patients in the hospital for hip-fracture surgery.
A study published in the April 11 Archives of Internal Medicine examined more than 450 patients admitted to Mayo Clinic in Rochester, Minn., for hip surgery. Researchers found that when patients were co-managed by hospitalists, they were sent to surgery more quickly and left the hospital an average of 2.2 days sooner.
The study found no significant difference in 30-day readmission rates or inpatient
deaths or complications. Hospitalists co-managing hip fracture patients, however, did diagnose delirium more frequently than other attendings. Patients diagnosed with delirium tended to be discharged from the hospital sooner than other patients.
The discussion section of the study notes that patients diagnosed with delirium were not typically living alone, so they could be sent home sooner than patients who had no support system waiting for them.
The study’s authors also note that hospitalists’ ability to better coordinate care and decrease variability may explain the results.
FDA warns about giving some antipsychotics to the elderly
The FDA earlier this spring issued an advisory warning that using certain second-generation anti-psychotic drugs to treat elderly patients for dementia may increase the risk of mortality. The warning, which appeared in the May 25 issue of the Journal of the American Medical Association, focused on six drugs: aripiprazole, clozapine, olanzapine, quetiapine, risperidone and ziprasidone.
A meta-analysis found that when prescribed to elderly patients with dementia, four of the drugs produced a mortality rate nearly twice that encountered by patients taking a placebo. The cause of death varied, but most instances involved cardiovascular problems like heart failure and sudden death, or infections like pneumonia.
While the FDA approved the drugs to treat schizophrenia, the agency believes that they are often used to treat behavioral disorders in patients with dementia.
The FDA has asked manufacturers of these drugs to add warning language to their package inserts.
The agency is also considering adding a similar warning to older antipsychotic drugs because limited data suggest a similar increase in mortality for those agents. The advisory is online.
Medicare moves to surveying patients about their hospital stay
The Centers for Medicare and Medicaid Services (CMS) earlier this spring took another step toward finalizing a survey that will ask Medicare patients who have been hospitalized to rate their inpatient experience.
In May, the CMS published a notice in the Federal Register asking hospitals to test a revised version of a hospital survey tool. The results of those surveys will eventually be posted online to allow Medicare patients to compare hospitals.
The CMS has been testing and refining the 27-item survey, known as HCAHPS, for several years. According to several published reports, Medicare plans to begin using the survey this summer or fall.
During the trial period, hospitals and vendors will begin reporting data collected using the survey, but the results will not be publicly reported.
More information on the tool is available in the May 9 issue of the Federal Register online.
Many hospitalists seek career guidance; all seek job satisfaction. Watch for the forthcoming feature: 2008 Hospitalist Salary Survey appearing in October 2008.