Capnography

Physician-Patient Alliance for Health & Safety Turns 4 Years Old

The Physician-Patient Alliance for Health & Safety (PPAHS) today celebrates its fourth anniversary.

PPAHS posted its first blog on July 27, 2011, “Is it possible to survive 96-minutes without a heart beat?”.

This post featured what happened to Howard Snitzer, who suffered a heart attack outside of a grocery store in Goodhue, Minnesota. Two volunteer paramedics responded and began a 96-minute CPR marathon involving 20 others, who took turns pumping his chest.

Mayo Clinic Video Howard Snitzer

(To see the Mayo Clinic video on Howard Snitzer, please go to https://www.youtube.com/watch?v=IsPq3oQZGNs&feature=youtu.be)

Generally, if a victim’s pulse has not returned after 45 minutes of CPR, resuscitation is discontinued. However, fortunately for Howard, the paramedics were using capnography, a “monitoring device that measures the concentration of carbon dioxide in exhaled air and displays a numerical readout and waveform tracing.”

In writing about his experience, Mr. Snitzer says, “I hope that more rescue squads will acquire the Capnograph in the future. I have already heard stories about that happening as a result of people reading my story. If even one other person is helped by this then all the efforts that went into my rescue were worth it. I hope this helps thousands.”

“PPAHS was started with a simple goal – save one life from unnecessary death,” said Michael W. Wong, JD (Founder and Executive Director, PPAHS). “Since that time, PPAHS has together with leading health experts developed the PCA Safety Checklist for patients receiving opioids through patient-controlled analgesia, the OB VTE Recommendations to prevent blood clots in pregnant and delivering mothers, and the Stroke VTE Safety Recommendations to reduce the incidence of blood clots in stroke patients.”

PPAHS is engaged in the following key initiatives for improving patient safety and health outcomes:

Patient Monitoring, Patient Safety

Podcast on Continuous Electronic Monitoring

In this podcast AAMI Foundation’s Healthcare Technology Safety Institute, Frank Overdyk, MD, professor of anesthesiology at Hofstra North Shore-LIJ School of Medicine and executive director for research at North American Partners in Anesthesia, and Tim Vanderveen, vice president of CareFusion’s Center for Safety and Clinical Excellence, make the case for continuous electronic monitoring and address the challenges stakeholders face in trying to bring about this change.

Dr. Overdyk is an advisor to the Physician-Patient Alliance for Health & Safety and, with Mr. Vanderveen, is a co-chair of the National Coalition to Promote Continuous Monitoring of Patients on Opioids.

opioids partner

To listen to the podcast, please see “Episode 7” by clicking here.

Patient Monitoring, Patient Safety

Outpatient Centers vs. Hospitals: Lessons Learned from the Death of Joan Rivers

The headline of a recent Washington Post article reads “Joan Rivers’s death spurs new look at outpatient centers”.

Although ABC News reports that the outpatient center that treated Joan Rivers is losing both Medicare certification and accreditation from the American Association for Accreditation of Ambulatory Surgery Facilities (AAASF), Kenneth P. Rothfield, MD, MBA, CPE, CPPS (System Vice President, Chief Medical Officer, Saint Vincent’s Healthcare, Ascension Health) points out that the question is not whether outpatient centers are better or worse than hospitals, but whether the facility is properly equipped and personnel adequately trained:

I don’t think it’s the venue that’s the most important thing,” said Rothfield, a member of the board [of advisors] of the Physician-Patient Alliance for Health & Safety, a nonprofit group. “ASCs [ambulatory surgery centers] traditionally have done simpler procedures in healthy patients,” while hospitals have routinely dealt with a broader and sicker — mix of people. Hospitals, he said, are more likely to be fully equipped and to have staff members with greater experience handling emergencies. “Unless you have drilled for it, and trained for it, it can be hard to pull off.

In addition, the medical standards of care upheld by healthcare facilities may differ. Although hospitals typically seek accreditation from The Joint Commission, ambulatory centers can receive accreditation from a variety of organizations. For example, the AAASF accredits ambulatory surgery facilities like the one where Joan Rivers underwent her medical procedure.

How might these standards specifically differ?

In the article “Medical standards of care and the Joan Rivers death,” differing standards of monitoring patients receiving opioids are discussed:

What is instructive in terms of gained knowledge in the Joan Rivers’ death are the differing patient safety measures in place by the application of standards when a sedative is delivered to the patient.

The AAAASF standard would have monitored for oxygenation by pulse oximeter, which measures the amount of oxygen in blood. Measuring oxygenation provides a very late indicator of hypoventilation, or ineffective breathing. In other words, there would have been a delay in the detection of low blood oxygenation by pulse oximeter.

The ASA [American Society of Anesthesiologists] standards provide an extra level of patient safety by requiring that the adequacy of ventilation be monitored in addition to oxygenation. The ASA standards therefore call for the “continual observation of qualitative clinical signs and monitoring for the presence of exhaled carbon dioxide”.

Even in hospitals, however, multiple standards of care may exist. Although anesthesiologists, the recognized experts in providing safe sedation, are required to monitor adequacy of breathing by measuring exhaled carbon dioxide, non-anesthesiologists such as gastroenterologists, surgeons, and radiologists are not required to provide this extra measure of safety. For example, American Society for Gastrointestinal Endoscopy “Guidelines for safety in the gastrointestinal endoscopy unit” does not require monitoring for adequacy of ventilation by Capnography, as required by the ASA.

So, how can patients decide on which healthcare facility to undergo a surgical procedure?

The Physician-Patient Alliance for Health & Safety offers four simple points to keep in mind:

  1. Even “minor” procedures can have major risks and hidden harm

The ASA reminds us that although “anesthesia is safer than ever before, every person scheduled for a procedure or surgery must have a serious conversation with their physician anesthesiologist about their anesthesia care delivery plan ahead of time … Even ‘minor procedures’ are not risk-free.”

  1. Ask questions to fully understand the medical procedure you are to undergo

Physicians must communicate and patients need to fully understand the full nature of the medical procedure. It is often helpful to have a family member, friend or significant other with you to check if you asked all your questions and another set of “ears” to listen to what is being told or explained to you.

U.S. Department of Health and Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ) believe “clinicians and patients [need] to engage in effective two-way communication to ensure safer care and better health outcomes.”

This type of patient engagement and education should be told to the patient, and then to ensure an adequate level of understanding the clinician should ask for verbal or written feedback from the patient..This validates the patient’s understanding and is termed ”readback feedback”.

AHRQ encourages patients to ask their medical providers questions, as illustrated in this humorous video which shows how patients ask many questions everywhere (such as in a restaurant) but not in the doctor’s office (please click on the image to view the video):

AHRQ Restaurant Ad

AHRQ Restaurant Ad

  1. Make sure you are monitored electronically, with both pulse oximetry and capnography, if you are to receive sedation, opioids or anesthesia

Even “routine” procedures may entail the use of a sedative, opioids, or anesthesia, additionally there maybe use of a combination of more than one of these medications. The endoscopic procedure performed on Ms. Rivers, which would have likely involved insertion of a large scope into her mouth, is a simple and common procedure, but, as noted by Dr. Karen Siebert, “uncomfortable enough that most patients are given sedation or, less commonly, general anesthesia.” The type of sedation given can be Monitored Anesthesia Care (MAC) or I.V. Conscious sedation.

The Anesthesia Patient Safety Foundation (APSF) believes that clinically significant drug-induced respiratory depression in the postoperative period remains a serious patient safety risk that continues to be associated with significant morbidity and mortality.

Continually evaluating and monitoring respiratory and circulatory status prior to, during, and following the procedure is essential. As a recent video released by the APSF demonstrates continuous electronic monitoring of oxygenation (the adequacy of oxygen in the blood) with pulse oximetry and ventilation (adequacy of breathing) with capnography, These combined with traditional in-depth nursing assessment and vigilance, will greatly decrease the likelihood of unrecognized, life threatening, opioid induced respiratory impairment and distress.

Virtually all proceduralists use pulse oximetry to measure blood oxygen levels as a standard of practice. Assessing ventilation is another issue. The ability to tell by simple observation if a patient is breathing adequately or not during a procedure can be tricky. Surprisingly, standards for capnography monitoring are not the same for all medical specialists.

Anesthesiologists are required by the ASA to measure the adequacy of ventilation using capnography (a device which measures exhaled carbon dioxide) to provide breath-by-breath monitoring. Other specialists, such as gastroenterologists and dentists, are not required to use this technology. Without capnography, several critical minutes can elapse after a patient stops breathing before medical professionals are alerted to the situation. Unfortunately, by this time, a serious problem or even a cardiac arrest may occur.

  1. Equipment and resources at an outpatient clinic may be different than at a hospital

If your procedure is scheduled at an outpatient clinic be sure to ask about available emergency equipment at the clinic. Just because your procedure is scheduled in an outpatient type of clinic, do not take this lightly and ask about code cart availability, emergency drugs to manage your condition and any adverse events, and lastly trained clinicians available and knowledgeable about handling potential life threatening emergencies.

As Dr. Rothfield cautions, the venue does not necessarily dictate better patient safety and health outcomes. Ensuring that the facility is properly equipped, its personnel adequately trained and whether its patients receiving opioids are continuously monitored – these are some key questions.

Patient Monitoring, Patient Safety

What Did Joan Rivers Die From?

at the Heller Awards 2013, Beverly Hilton Hotel, Beverly Hills, CA 09-19-13

Reports WomensHealth:

As more details emerge about Joan Riversdeath, one thing is clear: It could have been prevented. When it comes to elective surgery, even famous people who have access to the best – arent immune to complications

One lesson we can learn from this tragedy is to think more than twice before going through any non-essential surgery, says Dr. Marc Leavey, primary care specialist at Mercy Medical Center. In his career, he has seen people want unnecessary surgery, cosmetic or otherwise. After fighting to have it, they end up with untoward complications from disability to death. Surgery is surgery, whether ‘major’ or ‘minor,and should not be entered into lightly,he says.

To read the full article and WomensHealth’s citation of the Physician-Patient Alliance for Health & Safety’s four ways in which patients can learn from Rivers’ experience, please click here.

Patient Monitoring

Healthcare Leaders to Meet on Respiratory Compromise To Improve Patient Safety and Save Lives

Respiratory compromise is the second-most frequently occurring preventable patient safety issue and causes higher mortality rates, longer hospital and ICU stays, and millions of healthcare dollars every single year. It is the third most rapidly increasing hospital inpatient cost in the United States. Respiratory compromise consists of respiratory insufficiency, distress, arrest, and failure.

In a special roundtable discussion to be hosted by the National Association for Medical Direction of Respiratory Care (NAMDRC), healthcare leaders from pulmonary medicine and related fields will review and discuss how to reduce the risk of respiratory compromise.

“Patients admitted to acute care hospitals for a variety of reasons are often at risk for worsening respiratory function that can progress to respiratory failure and poor outcomes,” explained Dennis E. Doherty, MD (President, NAMDRC, Professor, University of Kentucky College of Medicine). “By bringing together key healthcare leaders, we will discuss whether we are missing opportunities to intervene in order to prevent respiratory failure.”

The Physician-Patient Alliance for Health & Safety recently established the Respiratory Compromise Institute (RCI) to leverage industry thought leaders and clinical teams to develop the tools and encourage the research needed to make the changes necessary to save lives from respiratory compromise.

Describing RCI as a broad-based coalition of organizations, companies, and individuals, Michael Wong, JD (Executive Director, Physician-Patient Alliance for Health & Safety) said, “The goal of RCI is to reduce —and eventually eliminating—preventable adverse events and deaths due to respiratory depression.”

Weekly Must Reads in Patient Safety

Weekly Must Reads in Patient Safety (Feb 20, 2015)

There are great benefits to continuously monitoring patients. As members of the National Coalition to Promote Continuous Monitoring of Patients on Opioids, we admit that we have our biases.

However, two “must reads” support our position on continuous monitoring.

Remote Patient Monitoring Lets Doctors Spot Trouble Early

RT Magazine reports:

A merging of wireless technology and medical care is still in its infancy, but health systems that began pilot programs with the technology in recent years say they see signs that it is keeping patients healthier. By enabling doctors to continuously monitor patients, they say, the systems can detect problems well before they grow serious.

Patient Monitoring: Oximetry Enhances Care

Pulse oximeters measure the amount of oxygen in blood.

Pulse Oximeter

Could using pulse oximeters help with patient care and help reduce readmissions? Some industry experts think so.

Thanks to @Senscio for tweeting about CMS’s reimbursement for 24/7/365 support for chronic care:

The Center for Medicaid and Medicare Services (CMS) now recognizes the need for 24/7/365 support for chronic care.  On January 1st of this year, CMS began providing reimbursements to doctors for using technology that assists them in providing 24/7 oversight of their patients with 2 or more chronic illnesses.

These industry experts think use of this technology could reduce readmissions:

Healthcare facilities and medical professionals have been using pulse oximetry for more than eight decades to monitor patients’ oxygen levels. During that time, more sophisticated models with advanced capabilities have been developed. With the full implementation of the Affordable Care Act (ACA), pulse oximetry is poised to play an even bigger role in helping hospitals achieve the end goal of reducing readmissions through patient monitoring.

Do you agree with these industry experts?

VTE

IPC To Prevent Blood Clots in Stroke Patients Recommended at International Stroke Conference

Presenting at a standing-room-only meeting at the recent International Stroke Conference (ISC), health experts recommended shortened door-to-treatment times and the use of intermittent pneumatic compression (IPC) to help prevent deep vein thrombosis (DVT) and pulmonary embolism (PE) in stroke patients.

Stroke Patients

(VTE patients can be both old and young, said Michael Wong, JD, Executive Director, Physician-Patient Alliance for Health & Safety at ISC)

Stroke is a leading cause of death and disability in the U.S., with 800,000 cases occurring each year. Each year in the United States, an estimated 300,000 cases of VTE occur. Mortality can be as high as 3.8 percent in patients with DVT and 38.9 percent in those with PE. VTE is associated with a high risk of death in the U.S. and Europe, with an estimated incidence rate of 1 in 1,000 patients. VTE is particularly common after a stroke. Approximately 20 percent of hospitalized immobile stroke patients will develop DVT, and 10 percent a PE.[1]

In reviewing the treatment approaches to prevent DVT in stroke patients, Mark J. Alberts, MD (Clinical Vice-Chair for Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center) spoke about the results of the recent CLOTS 3 study which showed a 29 percent reduction in life-threatening DVT — and a 14 percent reduction in overall mortality — for patients receiving IPC therapy.

Implementing Clots 3

Although there are many different types of IPC (calf or thigh-length, single or sequential, asymmetric or circumferential, fixed or variable frequency, rapid or slow inflation), only thigh-length sleeves were tested in CLOTS 3. Using thigh-length IPC makes intuitive sense, explained Dr. Alberts, as it applies pressure on areas of the leg where blood clots are likely to develop.

Moreover, Dr. Alberts pointed out five key benefits to using thigh-length IPC:

  1. Non-invasive approach
  2. Generally well tolerated
  3. Minimal side effects
  4. Less costly than medications
  5. Can be used in all types of stroke patients

Assessing and treating stroke patients should be done in as short a period of time as possible. Successful health outcomes in stroke patients often depends on having as short a door-to-treatment time as possible, emphasized Laurie Paletz, BSN, PHN, RN-BC (Stroke Program Coordinator, Cedars-Sinai Medical Center). Delays in evaluation and initiation of therapy should be avoided because the opportunity for improvement is greater with earlier treatment. This not only means having a collaborative team effort, but looking at anything that might shorten door-to-treatment times, including having designated parking for stroke patients.

Ms. Paletz also highlighted the need to use the treatments that Dr. Alberts discussed. For example, clinicians should make sure that the IPC is being used and not hanging across the bedrail, and that the patient is not only wearing IPC, but that it is turned on.

Don't Stop There

Unfortunately, the provision of needed prophylaxis has been sub-optimal. Ms. Paletz encouraged clinicians to use available VTE treatments:

Mr. Wong discussed the Stroke VTE Safety Recommendations. These Recommendations may help reduce death and disability among stroke victims due to VTE. Developed by a group of leading neurological health and patient safety experts brought together by the Physician-Patient Alliance for Health & Safety, the Stroke VTE Safety Recommendations incorporate the latest research.

The Stroke VTE Safety Recommendations provide four concise steps that:

  1. Assess all admitted patients with a stroke or rule out stroke diagnosis for VTE risk with an easy to use checklist.
  1. Provide the recommended prophylaxis regimen, which includes the use of mechanical prophylaxis and anticoagulant therapy.
  1. Reassesses the patient every 24 hours, prior to any surgical or procedural intervention or change in the patient’s condition.
  1. Ensure that the patient is provided appropriate VTE instructions and information upon hospital discharge or transition to rehabilitation.

A pdf of the Stroke VTE Safety Recommendations can be viewed by clicking here.

For a pdf of the presentation given at ISC, please click here.

[1] Dennis MS, Sandercock P, Reid J, et al. Effectiveness of Intermittent Pneumatic Compression in Reduction of Risk of Deep Vein Thrombosis in Patients Who Have Had a Stroke (CLOTS 3): a Multicenter Randomized Controlled Trial. The Lancet. Published online May 31, 2013.

VTE

New Stroke VTE Safety Recommendations Prevent Blood Clots In Stroke Patients

Health Expert Panel Encourage Use of Venous Thromboembolism Recommendations to Reduce Adverse Events and Save Lives

The Physician-Patient Alliance for Health & Safety is pleased to announce the release of safety recommendations targeting the prevention of venous thromboembolism (VTE) in stroke patients.

Stroke is a leading cause of death and disability in the U.S., with 800,000 cases occurring each year.

“Evidence shows that the health of approximately one in three stroke patients will deteriorate within 24 hours after suffering a stroke. This points to a critical need for intensive continuous monitoring of blood pressure, temperature, oxygenation and blood glucose of all stroke patients to rapidly assess and protect their health and safety,” explains Deborah V. Summers (Stroke Program Coordinator, Saint Luke’s Health System’s Marion Bloch Neuroscience Institute). “One of the deteriorating conditions that may develop within 24 hours of a stroke incident and which may be preventable is PE [pulmonary embolism], which may be fatal. If VTE [venous thromboembolism] risk factor and prophylactic measures are instituted early on, fatal PE may be prevented.”

VTE is a common and potentially avoidable cause of death and illness in hospitalized patients. With about 300,000 total cases per year, VTE is particularly common in stroke patients. Approximately 20 percent of hospitalized immobile stroke patients will develop a deep vein thrombosis (DVT), and 10 percent a pulmonary embolism (PE).

Mortality can be as high as 3.8 percent in patients with DVT and 38.9 percent in those with PE.

Despite these statistics, the use of VTE prophylactic treatment has been shown to be suboptimal for admitted patients in general.[1] When specifically looking at stroke patients, it has been found to be “underutilized and rarely started after the first day of hospitalization.

”Based on the high incidence of DVT and PE in patients with stroke, prophylaxis of VTE is recommended for all patients with stroke admitted to the hospital with weakness”, says

Mark Reiter, MD, MBA (CEO, Emergency Excellence Residency Director, The University of Tennessee at Murfreesboro; President, American Academy of Emergency Medicine).

Dr. Reiter recommends the use of intermittent pneumatic compression and cites the landmark Clots 3 study. “We have the clinical evidence – let’s use it,” says Dr. Reiter. “Martin Dennis, MD (University of Edinburgh, Western General Hospital) led a study of nearly 3,000 stroke patients in the United Kingdom comparing the efficacy and safety of intermittent pneumatic compression (IPC) therapy against routine care (hydration, aspirin, graduated compression stockings and/or anticoagulants). The study’s purpose was to evaluate the effectiveness of IPC in decreasing the risk of proximal DVT in patients who have had a stroke. Sponsored by the University of Edinburgh and the National Health Service, the randomized study found a 29-percent reduction in life-threatening DVT — and a 14 percent reduction in overall mortality — for patients receiving IPC therapy. Clots 3 is a landmark study that should transform the clinical practice to prevent DVT in stroke patients.”

The Stroke VTE Safety Recommendations may help reduce death and disability among stroke victims due to VTE. Developed by a group of leading neurological health and patient safety experts brought together by the Physician-Patient Alliance for Health & Safety, the Stroke VTE Safety Recommendations incorporate the latest research.

The Stroke VTE Safety Recommendations provide four concise steps that:

  1. Assess all admitted patients with a stroke or rule out stroke diagnosis for VTE risk with an easy to use checklist.
  1. Provide the recommended prophylaxis regimen, which includes the use of mechanical prophylaxis and anticoagulant therapy.
  1. Reassesses the patient every 24 hours, prior to any surgical or procedural intervention or change in the patient’s condition.
  1. Ensure that the patient is provided appropriate VTE instructions and information upon hospital discharge or transition to rehabilitation.

A pdf of the Stroke VTE Safety Recommendations can be viewed by clicking here.

[1] Gaspar L, Stvrtina S, Ocadlik I et al. Autopsy-proven pulmonary embolism: a major cause of death in hospitalized patients. Adv Orthop. 2010;2:8-14.

Caprini JA, Tapson VF, Hyers TM, et al; for the NABOR Steering Committee. Treatment of venous thromboembolism: adherence to guidelines and impact of physician knowledge, attitudes, and beliefs. J Vasc Surg. 2005;42:726-733.

Yu HT, Dylan ML, Lin J, Dubois RW. Hospitals’ compliance with prophylaxis guidelines for venous thromboembolism. Am J Health Syst Pharm. 2007;64:69-76.

VTE

Recommendations for Reducing Death and Disability among Stroke Victims to be released at International Stroke Conference 2015

Guidelines Poised to Change Standard of Care for Stroke Treatment and Help Caregivers Lower Incidences of Venous Thromboembolism (VTE) in Ischemic and Hemorrhagic Stroke Patients

To reduce death and disability among stroke victims – and help healthcare providers lower rates of life-threatening venous thromboembolism (VTE) in ischemic and hemorrhagic stroke patients – leading neurological health and patient safety experts will release Stroke VTE Safety Recommendations during the International Stroke Conference (ISC) 2015, February 11-13 in Nashville.

Created by a group of leading neurological health and patient safety experts brought together by the Physician-Patient Alliance for Health & Safety, the Stroke VTE Safety Recommendations will be presented at a special luncheon taking place on the opening day of ISC 2015 – Wednesday, February 11 – from 12:50-1:30pm – CV Expert Theater, Booth 636.

Presenters will include:

  • Mark J. Alberts, MD (Clinical Vice-Chair for Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center)
  • Laurie Paletz, BSN, PHN, RN-BC (Stroke Program Coordinator, Cedars-Sinai Medical Center)
  • Michael Wong, JD (Executive Director, Physician-Patient Alliance for Health & Safety)

The recommendations take direct aim at reducing VTE, commonly referred to as blood clots, which is a common and preventable cause of death and illness in hospital patients. Each year in the United States, an estimated 300,000 cases of VTE occur.[i] Mortality can be as high as 3.8 percent in patients with deep vein thrombosis (DVT) and 38.9 percent in those with pulmonary embolism (PE). [ii] VTE is associated with a high risk of death in the United States and Europe, with an estimated incidence rate of 1 in 1,000 patients. [iii] VTE is particularly common after a stroke. Approximately 20 percent of hospitalized immobile stroke patient will develop DVT, and 10 percent a PE.[iv]

Culminating many months of lively dialogue and intensive research among the members of the Stroke VTE Safety Recommendations Working Group, the guidelines incorporate the landmark CLOTS 3 study – a groundbreaking study of nearly 3,000 stroke patients in the United Kingdom that compared the efficacy and safety of intermittent pneumatic compression (IPC) therapy against routine care (hydration, aspirin, graduated compression stockings and/or anticoagulants). Sponsored by the University of Edinburgh and the National Health Service, the randomized study found a 29-percent reduction in life-threatening deep vein thrombosis — and a 14 percent reduction in overall mortality — for patients receiving IPC therapy.[v]

CLOTS 3 was led by Martin Dennis, MD (University of Edinburgh, Western General Hospital), a member of the VTE Safety Recommendations Working Group, who predicts the study will transform the clinical practice to prevent DVT in stroke patients.

“CLOTS 3 showed for the first time that thigh-length IPC reduces the risk of DVT after stroke, and moreover improved survival,” Dr. Dennis said. “Therefore, I would expect its use to increase rapidly. Certainly in the UK, there are national programs to introduce IPC into all stroke units (and) national stroke audits are monitoring its use.”

The ISC 2015 luncheon is sponsored by the Covidien Group of Medtronic, the global leader in medical technology – alleviating pain, restoring health and extending life for millions of people around the world.

“The presentation of the Stroke VTE Safety Recommendations at the International Stroke Conference 2015 represents not only a landmark event in the advancement of patient safety, but also an incredible opportunity for clinicians throughout the world to significantly reduce the incidence of DVT in ischemic and hemorrhagic stroke patients,” said Michael Tarnoff, MD, vice president and chief medical officer, Covidien Group, Medtronic. “As a company, improving patient safety underscores everything we do and we are truly honored to be associated with this milestone occasion.”

[i] Furie, KL, MD, MPH, FAHA, et al. Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. 2011.

[ii] Bosson JL. Deep vein thrombosis in elderly patients hospitalized in subacute care facilities: a multicenter cross-sectional study of risk factors, prophylaxis, and prevalence. Arch Intern Med. 2003 Nov 24;163(21):2613-8.

[iii] Venous thromboembolic diseases: the management of venous thromboembolic diseases and the role of thrombophilia testing. NICE Guidelines. August 2014. http://www.nice.org.uk/guidance/CG144

[iv] Dennis MS, Sandercock P, Reid J, et al. Effectiveness of Intermittent Pneumatic Compression in Reduction of Risk of Deep Vein Thrombosis in Patients Who Have Had a Stroke (CLOTS 3): a Multicenter Randomized Controlled Trial. The Lancet. Published online May 31, 2013.

[v] Dennis MS, Sandercock P, Reid J, et al. Effectiveness of Intermittent Pneumatic Compression in Reduction of Risk of Deep Vein Thrombosis in Patients Who Have Had a Stroke (CLOTS 3): a Multicenter Randomized Controlled Trial. The Lancet. Published online May 31, 2013.

Patient Monitoring

Vanderbilt University Medical Center Improves Health Outcomes and Financial Performance Through Continuous Monitoring of Low-acuity Patients

by Michael Wong, JD (Executive Director, Physician-Patient Alliance for Health & Safety)

Vanderbilt University Medical Center (VUMC) is a highly respected comprehensive healthcare facility in the Mid-South region of the United States. Leaders like VUMC lead the way for safer patient care and improved health outcomes.

So, when Brian Rothman, MD (Associate Professor, Division of Multispecialty Adult Anesthesiology and Medical Director of Perioperative Informatics) recently spoke at the inaugural meeting of the National Coalition to Promote Continuous Monitoring of Patients on Opioids about VUMC’s experience with continuous monitoring of low-acuity patients, I took the opportunity to interview him about this experience and what advice he would give to other healthcare facilities looking to similarly improve patient safety and outcomes.

Dr. Rothman told me that “Currently, monitoring of patients on the general care floor is continual (at regular intervals), not continuous. This means that a nurse assesses a particular patient on an intermittent basis. To me, checking on a patient every 4 or 6 hours is like checking to see if the fridge light is on.”

Checking Fridge Light

http://www.niemanlab.org/images/smart-refrigerator.jpg

To read a full copy of the article, please click here.