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Suicides and drugs cut U.S. life expectancy

U.S. life expectancy dropped to 78.6 years in 2017, according to the CDC, with the main culprits of the decline being drug overdoses and suicides. The research shows that a baby born in 2017 had 1.2 months shaved off its life expectancy compared to one born 12 months earlier.  This is the third year in a row where life expectancy has declined.

“Life expectancy gives us a snapshot of the nation’s overall health and these sobering statistics are a wakeup call that we are losing too many Americans, too early and too often, to conditions that are preventable,” CDC director Robert Redfield, MD said in a public statement.

The CDC release three reports on November 28—one on suicide mortality, one on drug overdose deaths, and one on mortality overall. And while healthcare organizations have been working hard to treat, prevent, and respond to these issues, the CDC’s numbers show that more work is to be done.

In 2017 there was a grand total of 2.8 million deaths— 69,000 more than the prior year and the most deaths in one year since the government started recording over a century ago. Of those deaths 70,237 were due to drug overdoses and 47,000 were suicides.

Drug overdoses

The spike in drug addiction and deaths was rapid and devastating for many. Drug overdose deaths have increased 16% per year since 2014 says the CDC. And between 2016 and 2017 that number grew 9.6% to 21.7 deaths per 100,000. So far 20 states and the District of Columbia have overdose death rates higher than the national average, and eight have rates comparable to the national average.

Drug Overdoses Statistics

  • The rate of drug overdose deaths in 2017 was 21.7 per 100,000. That’s 3.6 times what it was in 1999 (6.1).
  • While drug use increased in all age groups, overdose rates were much higher for those aged 25–34 (38.4 per 100,000), 35–44 (39.0), and 45–54 (37.7)
  • Men are more likely to die of an overdose than women
  • The number of drug overdoses caused by synthetic opioids increased 45% between 2016 and 2017.

Suicide

As we’ve written about before, suicide has been the 10th leading cause of death since 2008, with suicide rates on the rise. There’s no single identifiable cause for the increase, though some suggest better reporting, a lack of accessible mental healthcare, economic stresses, and social isolation have played a role.

CMS and other healthcare organizations have made efforts in recent years to reduce ligature risks and patient suicides—new ligature regulations, resources and training, etc. Just on November 28, The Joint Commission released a new R3 report on improving suicide care.

Additional research has shown that many suicide victims visit a healthcare provider in the months leading up to the act. And screening programs, ligature risk checklists for patient rooms, and safety planning for after discharge have been shown to be effective.

Suicide Statistics

  • The CDC report says that between 1999 and 2017 the age-adjusted suicide rate rose 33%, up to 14 deaths per 100,000 from 10.5
  • In 2017 47,000 people died by suicide and 1.3 million made a suicide attempt
  • The number of suicides committed by women (9.7 per 100,000) is lower than for men (22.4). However, suicide rates for women have been growing rapidly and is up 53% since 1999
  • Suicide rates increased for men of every age except those aged 75 and older. However, men in this age group still commit suicide far more often than any other (39.7)
  • Suicides are more common in rural counties (20) than in urban ones (11.1). Between 1999 and 2017, suicide rates for rural areas increase 53%. Meanwhile the rate only grew 16% for urban areas.

 

CMS Reverses Plan to Cut Reporting of HAIs

The Centers for Medicare & Medicaid Services (CMS) has decided not to carry out a proposal to remove public reporting of hospital-acquired infections (HAI), medical errors, and injuries. Instead, CMS will publish the information on the Hospital Compare site and in a database.

After the plan was announced in June, there were complaints from patient safety advocates. A new rule, published last week, restores reporting of data through the Inpatient Quality Reporting Program, including infection rates of Clostridium difficile, Methicillin-resistant Staphylococcus aureus, and post-surgery sepsis.

The Trump administration had initially agreed to remove the reporting measures at the request of the American Hospital Association, which argued that they unfairly penalize hospitals for safety problems.

Healthcare and Law Enforcement: Working Together Instead of Against Each Other

A working relationship with law enforcement is key to the safety, efficacy, and well-being of everyone in the hospital. That said, hospitals and law enforcement have different goals, and while the two usually work well together, they can find themselves at odds.

During this 90-minute webinar on May 22, industry expert Lisa Terry, CHPA, CPP, will review the hospital’s role in successfully partnering with law enforcement. She will discuss how to balance best practices for ensuring the safety of patients as well as the hospital staff. Participants will also learn how they should communicate with law enforcement, as well as how to plan and implement “crucial conversations” between hospitals and law enforcement.

At the conclusion of this program, participants will be able to:

  • Access and use the best resources on how hospitals who are treating patients “under arrest” should interact with the police
  • Plan and implement “crucial conversations” between the hospital/healthcare executive team and local law enforcement leadership
  • Use the tenets and teachings of “Verbal Judo” to benefit both clinicians and law enforcement first responders
  • Understand how hospitals can support and help facilitate law enforcement’s “guardians of the peace” mentality as they partner with hospitals
  • Apply enterprise security risk management (ESRM) to situations that may arise

Presented on:
Tuesday, May 22, 2018
1:00-2:30 p.m. Eastern

Presented by:
Lisa Terry, CHPA, CPP

Level of Program:
Intermediate

To register or get more information, please visit the event page at HCMarketplace.com.

Lawmakers want more AO oversight

In a letter to CMS Administrator Seema Verma, the committee is asking for what could be reams of information from the agency about patient harm and incidents of misconduct at acute care hospitals. The committee has also asked for similar information from each of the four hospital accrediting organizations (AOs).

The committee was particularly concerned about information in a report to Congress published last summer that indicated AOs “conducting hospital surveys did not report 39% of ‘condition level’ deficiencies that were subsequently reported following validation surveys conducted by [CMS] State Survey Agencies no later than 60 days following the AO survey.”

“Although CMS has worked to strengthen its oversight of AOs, the committee is concerned about the adequacy of CMS’ oversight as well as the rigor of the accrediting organization survey process,” wrote the committee leaders.

Noting that the Department of Health and Human Services, through CMS, must provide oversight of accrediting organizations, including CMS’ own survey agencies, “the Committee is concerned about the adequacy of CMS’ oversight as well as the rigor of the AO survey process,” read the letter to Verma.

More coverage of this story will be in the May edition of Briefings on Accreditation and Quality

CMS Cites Baltimore Hospital for Abandoning Patient in January

A Baltimore hospital was cited by CMS in a report released this week for its actions in removing a mentally ill patient from its emergency room (ER) and leaving her at a bus stop wearing just a hospital gown. The Washington Post reports that the University of Maryland Medical Center (UMMC) was cited for failing to comply with the Emergency Medical Treatment and Labor Act (EMTALA).

The hospital came under fire in January after a bystander filmed the incident as the woman was left by security guards at a bus stop on a cold night. According to the Post, the patient was admitted to the hospital earlier that day after a fall from a motorized bike. She was cleared for discharge, but resisted and refused to dress, the report said. Security then dropped the patient off at a nearby bus stop, where the man who filmed the incident and then called for an ambulance. The woman was brought back to the hospital and then taken to a homeless shelter in a taxi without an exam, and it was not registered that she returned to the facility, the Post reports.

According to the Baltimore Sun, CMS found that UMMC violated a federal law that hospitals must protect and promote each patient’s rights. The hospital also was found to have violated the woman’s right to receive care in a safe setting, to be free from all forms of abuse or harassment, and her right to confidentiality of records because non-clinical staff were given access to or made aware of part of the patient’s medical history. CMS also found that UMMC failed to meet data collection and analysis standards and failed to perform quality improvement activities.

The Sun reports that the hospital has now begun to record every time patients visit the ER. It also conducts audits of the patient log each month, provides additional staff training on federal requirements, and keeps ER doors unlocked. The staff bylaws were updated to specify who can perform medical screenings.

In a statement reported by the Post, a UMMC spokesperson admitted that mistakes were made. “We take responsibility for the combination of circumstances in January that failed to compassionately meet our patient’s needs beyond the initial medical care provided. While our own thorough self-examination revealed some shortcomings, the regulatory assessment punctuates the necessity to more firmly demonstrate our unwavering commitment to safety quality, compassionate patient care.”

EMTALA, in general, requires hospitals to care for patients with emergent conditions, regardless of their ability to pay. Violations of EMTALA are often cited by CMS surveyors under patients’ rights or failure to do an adequate medical screening exam. In addition to potentially impacting a hospital’s accreditation or ability to bill Medicare, EMTALA violations can also come with a civil penalty, which can reach nearly $105,000 for each citation. The newspaper reports did not mention whether the hospital was fined in relation to the CMS findings.

Like CMS, you should pay attention to sexual harassment

With all the recent focus on sexual harassment in the workplace, healthcare organizations shouldn’t expect to avoid scrutiny. Especially not from CMS or the press. Sexual harassment always has been an issue in healthcare, and it’s not hard to find examples. Like the California surgeon who slapped a nurse’s rear every morning while saying “I’m horny.” That behavior and the facility’s inaction led to a $168 million lawsuit, plus months of bad publicity.

“I suspect we’re going to see much more attention to this in healthcare, because it’s in the headlines,” says Kate Fenner, PhD, RN, managing director of Compass Clinical Consulting. “We know that we have some healthcare incidents that have gotten national attention. We know that CMS takes this seriously, Joint Commission takes this seriously. So healthcare organizations need to review their vows about how they provide a safe working environment for employees.”

The Joint Commission requires that its accredited facilities meet all applicable laws (Civil Rights Act of 1964, Title IX, for example, the recognition of sexual harassment as an infringement on civil rights for employees), and CMS is stringent about protecting patient rights (CMS Tag A-0145), including the right to receive care without harassment.

“Regulators and surveyors (CMS and The Joint Commission) pay careful attention to the news and trends in public interest,” Fenner says. “Allegations of improper conduct such as that recently lodged against a physician then practicing at a highly regarded medical center pique regulator interest and focus attention.”

Editor’s Note: You can learn more about sexual harassment in the April editions of Patient Safety Monitor Journal and Briefings on Accreditation and Quality. 

Surgeon sued for double booking surgery

There’s a reason why the American College of Surgeons (ACS) recommends asking patients if they’re okay with a concurrent surgery before operating. A Manhattan doctor found that out the hard way, after two former patients sued him last month for $14 million, according to the Boston Globe.

The patients claim that David B. Samadi, MD, chief of urology at Lenox Hill Hospital, allowed doctors-in-training to perform their prostate surgeries, and was only present for 25 minutes for one of the surgeries. Further, they claimed they were put kept under general anesthesia longer than necessary to hide Samadi’s absence, and that the operations were botched.

Last year, a review of more than 2,000 neurosurgical cases published in the Journal of the American Medical Association found no greater risk of postoperative complications for patients operated on by surgeons conducting overlapping surgeries. That said, the ACS guidelines are clear that patients need to know about and consent to an concurrent surgery before a provider does one.

Bradley T. Truax, MD, principal consultant of the Truax Group, says that patients should absolutely be informed if you plan to do their surgery concurrently.

“It is one thing for the surgeon to discuss with the patient that other personnel (residents, fellows, surgical assistants, etc.) will be participating in their surgery,” he says. “But the surgeon needs to make it clear what their roles will be and that the attending surgeon him/herself may not be present for the entire procedure.”

West Virginia cities sue Joint Commission over alleged role in opioid crisis

Four West Virginia cities and towns filed a class-action lawsuit against The Joint Commission and Joint Commission Resources on November 2, claiming the accreditor “grossly misrepresented the addictive qualities of opioids” in their pain management standards. The town of Ceredo and cities of Charleston, Huntington, and Kenova claim that those standards forced hospitals to prescribe unsafe amounts of painkillers, fueling addiction and deaths in the state. [Is there any dollar amount named in the lawsuit? What is it asking for?]

“This lawsuit is a critical move toward eliminating the source of opioid addiction and holding one of the most culpable parties responsible,” said Huntington Mayor Steve Williams. “For too long, [The Joint Commission] has operated in concert with opioid producers to establish pain management guidelines that feature the use of opioids virtually without restriction. The [commission’s] standards are based on bad science, if they are based on any science at all.”

West Virginia has the highest drug overdose death rate in the nation, with 41.5 deaths per 100,000 in 2015. Huntington and Cabell County had the highest overdose fatality rate in the state last year.

The lawsuit claims that the pharmaceutical companies like Purdue Pharma (the makers of OxyContin) worked with The Joint Commission to create the pain management standards. These companies stood to gain from the overuse of their drugs, the lawsuit claims.

The Joint Commission accredits at least 10 hospitals and healthcare facilities in Charleston and Huntington, and other cities and towns are expected to join the federal lawsuit.

The Joint Commission updated its pain management standards in June to reduce over prescriptions, which will take effect on January 1. However, the lawsuit says the accreditor waited too long to make those changes.

This isn’t the first time that The Joint Commission has come under fire either. In 2016 more than 60 medical experts and nonprofit organizations signed petitions asking the commission to change its standards. Claiming they “foster dangerous pain control practices, the endpoint of which is often the inappropriate provision of opioids with disastrous adverse consequences for individuals, families, and communities.”

USP <800> deadline on hazardous drug handling postponed until 2019  

The U.S Pharmacopeial Convention (USP) announced today that it is pushing back the compliance deadline for General Chapter <800> Hazardous Drugs; Handling in Healthcare Settings, from July 1, 2018 to December 1, 2019.

USP <800> covers from the moment a hazardous drug is received at the loading dock all the way through to the medicine’s disposal. Its standards apply to anyone who comes into contact with hazardous drugs: nurses, physicians, pharmacists, pharmacy technicians, loading dock personnel, etc.

“USP encourages early adoption and implementation of General Chapter <800> to help ensure a safe environment and protection of healthcare practitioners and others when handling hazardous drugs.  We will continue to support our stakeholders through education and outreach,” the organization wrote in a press release.

For more on the chapter, please join us for a webinar on October 30 with expert speaker Patricia Kienle.

Mass shooting tests Las Vegas hospitals with surge of more than 500 patients

Moments after shots rang out along the iconic Las Vegas strip Sunday night, sending thousands of concertgoers scrambling for cover, the city’s hospitals sprang into action.

Dignity Health-St. Rose Dominican Hospital treated more than 50 people across its three campuses; the city’s only Level 1 trauma center, University Medical Center, treated another 100 people; and Sunrise Hospital and Medical Center—the trauma center located closest to the strip—treated more than 175 patients, according to a statement from the American Hospital Association (AHA).

“With at least 58 people killed and more than 400 taken to area hospitals with injuries, this tragedy painfully reminds us why violence is now viewed as one of the major public health and safety issues throughout the country,” said AHA Chairman Gene Woods, MBA, MHA, FACHE, president and CEO of Carolinas HealthCare System based in Charlotte, North Carolina, in a statement. “Like all of you, my heart is heavy and my thoughts and prayers are with the victims and their families. My mind is also focused on our colleagues in Las Vegas who are working tirelessly in an overwhelming, mass casualty situation to provide life-saving support to those in need.”

Those colleagues undoubtedly faced a gruesome scene overnight. In its own statement, Sunrise Hospital and Medical Center said 14 of the patients it treated had died. About 30 surgeries had been performed at the site—thus far.

“This has been an unprecedented response to an unprecedented tragedy,” Sunrise CEO Todd Sklamberg, MBA, said in the statement. “Our trauma team and all supporting nursing units, critical care areas and ancillary services are all at work this morning in the aftermath of this tragedy—and most stayed throughout the night—to help the victims and to assist their loved ones.”