Published in the September 2010 issue of Today’s Hospitalist
More than 60% of physicians sued at some point
ACCORDING TO SURVEY RESULTS released last month by the AMA, more than 60% of physicians over age 55 have been sued at least once in their career. That comes to about 95 malpractice lawsuits filed for every 100 practicing physicians.
The survey also found that while physicians will likely be sued at some point in their career, only about 5% of physicians are sued in any given year. Survey results also indicate that 65% of claims brought against physicians are dismissed or dropped.
Results were culled from a 2007-08 survey of more than 5,800 physicians. Physicians with the highest risk of being sued include general surgeons and OB/GYNs, compared to fewer than 30% of the pediatricians and psychiatrists surveyed.
While the majority of cases are dropped, costs remain high: Defense costs for dropped or dismissed cases average around $22,000, while costs for cases brought to trial are $100,000. Survey results also indicate that doctors in single-specialty practices run a higher risk of being sued than those who work in multispecialty groups or in hospitals.
Preventing UTIs: More evidence that reminders work
A NEW META-ANALYSIS from hospitalists affiliated with the University of Michigan Health System in Ann Arbor finds that one in two catheter-related UTIs can be prevented by using stop orders and by reminding doctors and nurses that a catheter is in place.
The analysis, which looked at interventional studies, was published in Clinical Infectious Diseases. Researchers found that using such reminders and stop orders resulted in 52% fewer catheter-related UTIs, as well as a 37% reduction in the mean time of catheterization. That translated to 2.61 fewer days that patients were catheterized.
According to the study, many catheters aren’t necessary, and physicians aren’t aware of how long catheters remain in place. Automatic reminders that can be included in electronic medical records are effective, authors said, as are stop orders similar to ones ending the use of antibiotics or restraints.
Researchers concluded that reminders and stop orders “should be strongly considered” to improve patient safety, expedite patient discharge and reduce the costs to hospitals associated with hospital-acquired UTIs.
IMGs: Same mortality figures as U.S. medical grads
A STUDY FINDS SIGNIFICANT DIFFERENCES in the mortality rates of patients treated by three groups: international medical graduates (IMGs), U.S. medical school graduates and U.S. nationals who train abroad.
The study looked at more than 244,000 patients in Pennsylvania hospitals who had congestive heart failure or acute MI and were treated by doctors trained in internal medicine, family medicine or cardiology. While the patients of IMGs and of U.S. medical school graduates had virtually the same mortality rates, higher death rates were found among patients treated by U.S. citizens who trained in foreign medical schools.
The study, which was published in Health Affairs, also found that U.S. medical graduates had the lowest lengths of stay, while U.S. citizens who trained abroad had the highest. According to the study authors, 25% of physicians practicing in the U.S. are international medical graduates.
The high price of avoidable errors
A NEW STUDY looking at preventable medical errors finds that the total price tag for those errors in 2008 was $19.5 billion in inpatient, outpatient and pharmacy expenses.
Treating pressure ulcers topped the list of the 10 most expensive avoidable errors, with a price tag in 2008 of $3.58 billion. (Claims data showed that about 375,000 instances of pressure ulcers were considered errors that year.) Each incidence of an avoidable pressure ulcer cost more than $24,000 to treat, according to study results. The study, which was prepared by the actuarial firm Milliman Inc., used claims data.
The second most expensive preventable complication that year was postoperative infections, which cost more than $3.6 billion. Rounding out the top 5 were mechanical complication of a device, implant or graft ($1.13 billion); postlaminectomy syndrome ($1.12 billion); and hemorrhage following a procedure ($960 million).
According to the report, 7% of the hospital admissions in the claims database used had some type of medical injury, of which errors were a subset.
Depression rates soar among nation’s interns
A STUDY ASSESSING INTERNS at three-month intervals during their first year of residency found that the number of those who met criteria for depression spiked from 3.9% on entering internship to a mean of 25.7% during their intern year.
The study, published in the June issue of Archives of General Psychiatry, looked at 740 interns in 13 U.S. residency programs. Research found that among interns beginning residency, depressive symptoms were associated with being female, a U.S. medical graduate, and having a difficult childhood or history of depression, among other factors.
During internship, depression was associated with a greater number of work hours, perceived errors and stress. Like other studies, this research found an association between depression and medical errors, although the incidence of medical errors in the study was self-reported.
Researchers called for further studies to look at how depression changes over the course of medical training and physicians’ careers, and how depression affects doctors’ general health.
Dramatic drop in MRSA infection rates
PUBLIC HEALTH OFFICIALS writing in the Aug. 11 issue of the Journal of the American Medical Association say that the rate of hospital-onset MRSA fell 9.4% each year between 2005 and 2008, for a total decrease of 28%.
Researchers also found a 5.7% drop per year over that same time period for health care-associated or community-acquired MRSA infections, with the most pronounced drop “34% “in the rate of hospital-onset MRSA blood-stream infections. The authors looked at lab reports from nine U.S. metropolitan areas covering 15 million people.
While researchers suggested that falling MRSA rates may be due to inpatient prevention efforts, an accompanying editorial noted that many hospitals have yet to implement such prevention programs. Instead, the editorial speculates that lower infection rates may be due to better hand hygiene and the use of alcohol-based sanitizers.
And while the editorial lauded study results, which were culled from a CDC surveillance system of those nine metropolitan areas, the authors pointed out that the CDC should extend that surveillance to much more of the U.S. and track other pathogens besides MRSA, including Acinetobacter, pseudomonas and candida.