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Do you report impaired colleagues?

August 2010

Published in the August 2010 issue of Today’s Hospitalist

How comfortable are you reporting an impaired colleague?

WHILE PEER REPORTING remains a key way in which impaired or incompetent physicians are identified, a national physician survey finds that peer monitoring may not be very effective in weeding out “bad” doctors.

The survey finds that only two-thirds of physicians feel it is their professional duty to report colleagues who are incompetent or impaired. While 17% of the nearly 1,900 respondents said that they had personal knowledge of an impaired colleague, only 67% of those went on to make a report.

The survey, which was published in the July 14 Journal of the American Medical Association, found that physicians who work in hospitals and medical schools were more likely to file reports. International medical graduates and minority physicians were the least likely to file reports.

The authors called for more regulation of peer reporting, along with greater physician education and confidential reporting systems.

More work needed on central line infections

WHILE AN ESTABLISHED BODY OF RESEARCH has shown hospitals how they can dramatically reduce infections from central lines, relatively few appear to be implementing programs of their own.

A new survey of state hospital associations published in the July-August American Journal of Medical Quality found that while 84% of state hospital associations ranked central line bloodstream infections as a high priority, only 22% could produce statewide rates of the infections. The survey found that central line infection prevention programs were active in 12% of states, and that programs were being planned in 14% of states.

The survey identified inadequate resources, limited infrastructure and a lack of coordination in priorities as barriers to implementing prevention programs. Researchers also claimed that many state hospital associations lack statewide, coordinated prevention and monitoring programs.

The authors noted that a national collaborative could effectively help reduce infection rates while also building an infrastructure that could address other quality issues.

Leapfrog: CPOE systems miss half of drug errors

A NEW REPORT from The Leapfrog Group says that the CPOE systems being used in many of the nation’s hospitals may miss one-half of common medication errors “and one-third of potentially fatal orders.

The group uncovered the problems during simulations it conducted through January of this year. Hospitals were able to improve the performance of their CPOE system in subsequent simulations by making adjustments to their protocols and systems.

Leapfrog hopes publicizing the results will convince federal officials to build oversight requirements into health care information technology regulations currently being created in Washington. In its report, the group also called for improved testing and monitoring of CPOE systems.

The report also pointed out that all too often, hospitals must rely on their vendors or on their own homegrown efforts to fix problems within CPOE systems. Instead, the report says, hospitals need to “share information transparently.”

Substance abuse or mental disorders drive one in eight ED visits

AN ANALYSIS OF ED VISITS in 2007 finds that nearly 12 million visits ” out of a total of 95 million “were by patients suffering from a mental disorder, substance abuse or both. According to the analysis, which was conducted by the Agency for Healthcare Research and Quality, close to 41% of those ED visits resulted in a hospitalization.

Almost one-third of those visits (30.1%) treated patients covered by Medicare, followed by patients with private insurance (25.7%), uninsured patients (20.6%) and patients on Medicaid (19.8%). Patients visiting the ED for mental disorders or substance abuse who were billed as uninsured were between two and four times less likely to be admitted as an inpatient.

Among ED visits for mental disorders or substance abuse, 43% were for depression or another mood disorder, 26% were for anxiety disorders and 23% were related to alcohol use. The remainder were due to drug-related problems, psychoses including schizophrenia and episodes in which patients had intentionally harmed themselves.