From the President

The Coming Tsunami
President's Fall Newsletter
Robert M. Blumm, MA, PA-C, DFAAPA

 

The Oxford Dictionary defines tsunami as a series of huge sea waves caused by disturbance of the ocean floor or by seismic movement. Several few years ago we were global witnesses to the awesome power of the tsunami as it rose from the depths of the sea and rushed inland, destroying everything in its path. On October 1, 2008 there will be a different type of tsunami that will affect medicine in the United States, in particular hospitals and university medical centers. The Centers for Medicare and Medicaid services (CMS) will stop reimbursing hospitals for what they have determined to be eight preventable medical errors.

 

This event, by striking the institutions of healing, will also place every specialty and every practice and all of the medical and surgical providers under a microscope. No one, from the housekeeping staff to the technology departments, from nursing, the allied health services to the medical staff will remain untouched by this event. This will become a nightmare for administrators, hospital boards and in particular, for the CFO who will be the first to examine the outcome. With the proper equipment there can be early warning, an alert that can preserve the potential victims of the tsunami. Can health care in this country heed the early warning of this most significant change by the CMS?

 

The late Senator Daniel Patrick Moynihan said, “You can’t solve a problem until you measure it.” In May 2008, Clinician Reviews reported on Multiple Efforts to Prevent Hospitalization-Related Errors. This well-written article clearly defines Moynihan’s argument and discusses the results of a study of non-federal hospitals. This study focused on 3% of all Medicare hospitals from 2004-2006 and discovered 1.1 million patient safety incidents. 238,000 of these incidents resulted in the death of a patient. The financial outcome in cost to the Medicare budget affected every taxpaying citizen of the United States to the tune of an additional 8.8 billion dollars. This is untenable and the laws of cause and effect are now in play.

 

The edict has been announced and we are confronted with an opportunity to “confess our failures,” to examine our shortcomings and educate our staffs in how to address preventable tragedies. Patients represent our parents and grandparents, our children and grandchildren as well as ourselves. Families have been devastated because of preventable extended illness, need for additional care, loss of income, medical expense and untimely death. Can you hear the echo of the words “I’m mad as hell and I’m not going to take this anymore?” What has the potential of creating a collapse in the infrastructure of medical institutions also provides an opportunity for learning and implementation of a patient safety plan that will greatly decrease or eliminate these infractions and simultaneously protect the most important member of the medical team, the patient.

 

At the current moment there are eight areas under consideration with the potential to add additional infractions. These infractions are part of a group called never events. The focus of education for all caregivers in institutions will be on the following:

  • use of incompatible blood
  • objects left behind during surgery in spite of a supposed count i.e.: sponges, lap pads, towels and instruments
  • UTI’s as a result of catheterization and faulty technique as well as care of indwelling Foley catheters
  • vascular infections resulting from poor technique in inserting central lines as well as peripheral lines as well as their care and
  • maintenance and timely removal and reinsertion
  • falls relating to ignoring procedures that have been instituted
  • air embolism from poor techniques in removing central lines or perfusion of medications
  • pressure ulcers relating to patient positioning being neglected and personal care being overlooked
  • mediastinitis

As a medical provider for 37 years, I perceive a need for changes that can ultimately correct these unsatisfactory statistics and simultaneously prevent the sorrow and loss presently affecting patients. The short list of corrections may need to include a reinstitution of the Nursing IV Team that was eliminated for cost containment. If hospitals were held financially responsible for the negative outcomes from this alone, they might see the need to recreate this much needed position. Another essential arena for re-evaluation is the nurse-to-patient ratio. In my career I have seen this rise from 4:1 to 12:1. This has been clearly cost saving, but ultimately the cost is unacceptable.

 

Our intention is to make NPs and PAs aware of what they can do to institute change and provide a climate of safety. This will require a team effort, greater cost to the institutions and a firm commitment from all caregivers. The coming changes will require greater quality control and identification and immediate correction of faulty technique. This will become known as the “era of excellence” as the upcoming tsunami brings with it CHANGE.

 

Warmly and Fraternally,

Bob Blumm MA, PA-C, DFAAPA
President, APSPA