Healthcare Risk Management Blog

You may find this article of interest. It discusses the benefits of cell phone (and laptop) use in the hospital, such as providing support for patients and their families, and improving communication among providers (therefore reducing medical errors!).

Cellphones get the 'all clear' at some hospitals
By Robert Davis, USA TODAY

Anyone who has been inside a hospital probably has been cut off from relatives and colleagues because of a common rule: no cellphones.

But some health care facilities are creating wireless networks to let patients, family members, physicians and staff members use their phones.

The concern about the phones, hospital officials say, is that their signals could create electromagnetic interference with sensitive medical devices, such as ventilators or external pacemakers. Opinion is divided; some experts say the risk has been overblown.

Some doctors even say cellphones promote better communication, which reduces medical errors. And people rely more heavily now on their wireless devices to stay connected to work and family.

An increasing number of patients arrive with laptops and other means of communication and are frustrated if they cannot connect with the outside world, says Andrew Cooper, information technology manager at the Zangmeister Center, an oncology and hematology clinic in Columbus, Ohio. It has installed a $70,000 antenna system for better cellphone use.

The system puts the antenna closer to the cellphone by installing an antenna inside the medical facility instead of a mile or more away. That allows a cellphone to connect using a lower signal strength.

The system is designed around the fact that cellphones boost signal strength to reach distant antennas, and medical devices are more likely to be affected by strong signals than weak ones, says Howard Melamed, president and chief executive of CellAntenna Corp.

By putting the antenna inside the medical facility, the phone signals are reduced, and engineers can measure and better control the electromagnetic energy in-house.

The system even penetrates areas called "black zones," such as the thick-walled radiology area.

"With cancer, you are in the clinic for hours," Cooper says. "We are not just treating the patient, we are treating the supporting family. We are supporting them. If that means spending additional dollars to allow them to have a cellphone or a laptop, that is what we need to do."

Other hospitals using the CellAntenna system include Columbus Regional in Columbus, Ind., and Bethesda Memorial Hospital in Boynton Beach, Fla.

Still, most hospitals are still reluctant to allow cellphones. "The technology of cellphones is growing so fast that the cellphone of today and the cellphone of tomorrow might have totally different effects on things," says Rick Wade, a spokesman for the American Hospital Association. "Nobody has any idea of what effect iPod phones have" on medical devices. "This is an evolving situation."

Wade says most hospitals still restrict cellphone use in critical-care areas and around their most sensitive electronic devices: "Until they have scientific proof that these phones can be used anywhere and everywhere, hospitals are going to restrict it in those areas most senstitive to patient safety."

Many hospitals and clinics reevaluated their cellphone bans recently after a five-month study by the Mayo Clinic showed that the phones caused no noticeable interference with equipment. The study, which appeared in the March issue of Mayo Clinic Proceedings, said bans should be reconsidered because of the inconvenience they cause for patients and families who must leave care areas to use their cellphones.

The authors urged the Food and Drug Administration to provide guidance to the industry. An FDA spokeswoman says the agency recommends that hospitals test for electromagnetic energy levels and follow published industry standards, which include coordinating electronic equipment use to keep transmission levels low.

Some doctors say banning cellphones puts patients at risk.

In a 2003 survey published last year in Anesthesia and Analgesia, anesthesiologists said cellphones help reduce medical errors by allowing timely communication.

"The most effective patient care is driven by timely communication," Cooper says. Clinic doctors have a secured text-message system in addition to cellphones. "Our physicians and our staff have to be able to communicate timely and effectively with each other."

Here is the link if you should want to use it. http://www.usatoday.com/tech/wireless/2007-09-04-hospital-cellphones_N.htm?csp=34

OHIC Insurance Company's parent company, The Doctors Company, has resources available on the website for dealing with the stress of depositions and litigation. If you follow this link: http://www.thedoctors.com/risk/general/litigationclaims/default.asp you will be directed to the Patient Safety/Risk Management area of the website. (And check out the picture here - yours truly Darrell Ranum!)

There is an article on "Coping with Depositions and Trials" as well as a "Physician Litigation Stress Resource Center." The Resource Center has information on "Traversing the Legal Process" as well as another article on "Coping with the Medical Malpractice Suit." These articles give an overview of the legal processes involved and provide coping strategies for dealing with the emotional issues.

If you are not already a member of our professional society - the American Society for Healthcare Risk Management (ASHRM) - I would encourage you to join. The organization is a good resource for educational materials and provides news of current events that affect healthcare organizations. Your state will also have a chapter of the organization that should keep abreast of things a little closer to home. The state and national meetings are a great way to network with other Risk Managers.

The Annual Conference for 2007 is being held in Chicago on October 10-13. You can view information about the conference on the ASHRM website at http://www.ashrm.org

If it is too late to get that into your budget for this year, the annual conference for next year is in Boston on October 2-5.

There has been a lot of discussion among the Risk Management/Patient Safety specialists at OHIC and at The Doctors Company about the book "How Doctors Think." The book was written by Jerome Groopman, MD, who holds a chair in medicine at Harvard Medical School.

As a patient, Dr. Groopman sought the care and opinions of six different physicians. He was given four different diagnoses. He went on to write this book about the errors in thinking that caused the misdiagnoses. Darrell discussed some of Dr. Groopman's theories in the blog on "Cognitive Errors."

Here is the link to an interview with Dr. Groopman on National Public Radio that you might find interesting. It also includes an excerpt from the book. http://www.npr.org/templates/story/story.php?storyId=8946558

If you've read the book, I'd be interested in hearing your opinions!

I attended a conference this week and heard Jerome Groopman, MD, author of “How Doctors Think”, speak. He highlighted some concepts that I found to be very enlightening.

The conference topic was reducing diagnostic errors. Dr. Groopman said that lack of knowledge is not usually the cause of misdiagnoses. They are due to errors in thinking. We then proceeded to outline several cognitive errors and recommendations for addressing them.

Cognitive errors include “anchoring”. This is the tendency to latch on to the first data that supports our working diagnosis. We give too much weight to the importance of that bit of information rather than keeping our minds open to other possibilities.

Another concept is “availability”. This is the tendency to allow recent experience that is similar, to create a bias leading us to believe that the two situations are the same. In other words, we think that we have seen this situation before and we jump to the conclusion that the same response is appropriate for the new experience. It may not be appropriate for the new experience leading to a diagnostic error.

Most people are familiar with the concept of confirmation bias. This occurs when we focus on or select data that confirms our initial diagnosis. This bias often causes us to down-play the importance of data that does not confirm our “anchored” impression.

Our feelings and emotions can also play a role in clouding our ability to reach a correct diagnosis. We receive satisfaction when we reach a conclusion that we believe is correct. This can reduce our willingness to look for other possible alternatives. We form stereotypes that prompt us to overlook important information because we think that this person looks like the other “drug seekers”, for example.

To guard against these cognitive errors, Dr. Groopman recommended asking the following questions:

What else could it be?
Could two things be going on at the same time?
Is there any data that does not fit with our initial thoughts about a diagnosis?

We should also set up systems of communication that prompt others to ask questions or raise other possibilities. Set up a script so that the correct questions are asked. Encourage people to think independently and not just confirm the incorrect diagnosis.

Let’s create environments that facilitate open discussion, welcome questions and encourage everyone who has information, to speak up.

While not related directly to risk management, Mayo Clinics Tools for a Healthier Life is a very interesting site. During the summer residency we will focus some time on how to present a more positive image for your institution. Obviously, Mayo has used this vehicle as one way to positively present their Clinic.

Enjoy

John

One of the best ways to develop program ideas in any field, including risk management, is through the study of best practices. Best practice forces us to look outside our own organization and even our own discipline and combats that deadly organizational sin, NIH (not invented here). When we study other organizations, we do not necessarily try to directly copy their approach, after all they are in a somewhat different context. We can, however, get ideas of what works for them and why it works. We can then use this as raw materials to stimulate our own ideas and develop our own innovation.

With this in mind, I encourage you to look at the site, Risk and Insurance Management at Vanderbilt Medical Center. It includes some details on their approach to risk management, patient safety, medical malpractice and other issues. Enjoy!

John

In the last 20 years, new areas of focus have arisen requiring attention from those in healthcare (and other industries) who desire to provide the highest quality of services and products (outcomes). Healthcare professionals recognize that they have a duty to protect their patients and their organizations. They gather information and knowledge to assist in meeting requirements as each new standard is introduced.

While we work to improve quality, comply with regulations and adopt patient safety goals, we need to understand that the standards against which healthcare is measured are constantly changing. The legal system continues to modify the definition of the standard of care. The standard of care is the minimum legal standard and is defined by what a reasonably prudent healthcare professional would do. Failing to meet this minimum standard is defined as negligence.

We must not only adopt and implement patient safety goals, new regulations and quality measures, we must recognize that they are becoming the new minimum legal requirement. Failing to properly implement patient safety goals, etc. means that we risk being found negligent if our patients suffer as a result of our failure to meet these new standards and goals.

Rhonda asked that I put up some information on the difference between urgent activities (or demands) and important activities. I made the remark at the residency that the urgent often drives out the important and, when that happens, we are less effective than we should be.

Rather than composing a lecture for you, I decided to give you two short, but very good sources of information. The first focuses on the difference between urgent and important and the relative importance of each. The second focuses on how to manage your time so that you make certain that the urgent does NOT drive out the important.

Hope you find these useful.

John

http://www.yuni.com/library/docs/633.html

http://www.prioritymanagement.com/EN/productivity_tips/urgent_vs_important/

Hello and here goes my first attempt at the blog!
I hope all of you had uneventful travels back home and were able to enjoy the rest of your weekend! It was great meeting all of you and we are looking forward to a great program with you!
Karan, Kim and I had a discussion over lunch about about a salary range for a hospital risk manager. Here is an opening that lists the pay range for a smaller community hospital. (I believe the ASHRM salary survey comes out higher than this.) --Julie

Risk Manager
Position: Risk Manager
Organization: Nonprofit, Rural, Community Hospital
Location: NE Ohio between Cleveland, Youngstown, & Erie, PA

Duties: Develop, manage, & implement policies, procedures, & practices related to risk management. Perform risk management surveys to assess risk points and help design risk reduction strategies to address those points.

Experience Desired: Previous Healthcare Risk Management experience

Compensation & Benefits: $49k-$61k plus paid time off and healthcare benefits are just part of the comprehensive benefits package offered by the organization

Robert Wombacher
Medical Recruiting Director
Bergan Newport Corp. Executive Recruiting Firm
Phone: 919-363-0225
1-800-894-4186
bnewport@nc.rr.com
P.O. Box 1663
Apex, NC 27502-3663
“Placing Healthcare Professionals across the United States”