A recent report may lead some to question whether such efforts to lower the cost of medical malpractice insurance are really necessary. A release from A.M. Best, a company that provides insurance ratings and information, states that the medical malpractice insurance sector continues to generate strong profits.

The release went on to explain that last year the MPLI sector had underwriting and operating results which outpaced other insurance sectors. MPLI insurers also showed stable investment returns and consistent increases in surplus.

This information seems to indicate that the medical malpractice insurance sector is strong and highly profitable. This is contrary to claims made by some advocates for tort reform that there is a crisis; and actions need to be taken to lower medical malpractice insurance premiums in order to keep health care costs down.

In reality, tort reform efforts may only serve to deprive victims of medical malpractice of the funds they need and deserve, while further increasing the profit margins of the already highly profitable malpractice insurers.

Source: AM Best, Medical Professional Liability Outperforms, But Is This Sustainable, 2 May 2012

A recent study published in the Annals of Internal Medicine has shown that patients may benefit when their medical records are openly shared and easily accessible. Such an approach encourages patients to be more engaged in their health and wellbeing.

Jan Walker, from Beth Israel Deaconess Medical Center and the study's lead author explained, "Knowledge is power....A patient goes to the doctor only once in a while but in between visits, you're making all kinds of decisions that affect your health every single day."

By creating more of a collaborative environment, patients may take more ownership of their health and therefore make better decisions. Patients may better understand treatment plans, avoid medication errors and remember to follow-up about various conditions. Additionally, patients may notice if their physician misunderstood them, or if there are inaccuracies in their medial record.

Since early research seems to indicate that patients having access to their medical records is beneficial, hopefully this type of open collaboration between doctors and their patients will continue and expand.

Source: The New York Times, Project Puts Records in the Patients' Hands, Roni Caryn Rabin, 9 January 2012

As medical records have become electronic, and hospitals have heavily invested in technologies to reduce medical errors, more health care providers have access to devices that can be useful, but also cause distraction leading to medical malpractice. Doctors can be distracted by computers, smartphones, iPads and any number of technological gadgets they now frequently have within reach.

Dr. Peter J. Papadakos, from the University of Rochester Medical Center, published an article in the journal Anesthesiology News on the subject of "electronic distraction". He stated that "My gut feeling is lives are in danger," he added that "We're not educating people about the problem, and it's getting worse."

At least one hospital has taken action and enacted a policy making operating rooms "quiet zones" and banning all activities not directed at patient care. Hopefully more hospitals will follow suit in the interests of preventing distracted doctoring and promoting patient safety.

Source: The New York Times, As Doctors Use More Devices, Potential for Distraction Grows, Matt Richtel, 14 December 2011

The Federal Drug Administration lists several common causes of the errors, including poor communication, poor procedures or techniques, confusing packaging and ambiguities in product names or abbreviations. Unfortunately, many medication errors can be traced to the same route cause - medical professionals who make mistakes because they are stressed-out, exhausted or distracted.

"Quiet Zone" an Intentional Response to Dangerous Errors

A new initiative at Egleston children's hospital in Atlanta is attempting to reverse this trend. The hospital has set up a dedicated quiet zone that nurses can use to place medication orders without being interrupted. Hospital leaders created the zone two years ago after noticing that distracted staff members were making potentially dangerous errors when ordering medicine.

Since the zone has been implemented, medication errors at the hospital have been reduced by two-thirds.

Egleston's example is being held up by Medicare and Medicaid chief Dr. Donald Berwick as an example for the rest of the nation to follow - not only because it will reduce costs and promote efficiency, but because it will save lives. Dr. Berwick has witnessed dangerous medication mistakes at even the most renowned hospitals. In fact, as a young resident he mistakenly gave the wrong transfusion to a baby, nearly killing the child.

Dr. Berwick attributed his error to the sleep-deprived schedule most young residents continue to face. There is mounting evidence to show that fatigue plays a huge role in medication errors. In studies, fatigue and sleep deprivation have been linked to decreased vigilance, poor memory, delayed reaction time, slower information processing and poor decision making. In relation to those performance measures, staying awake for 24 hours has been found to be the equivalent of having a blood alcohol level of .10 percent.

Hopefully, the increased awareness of issues of fatigue and distraction combined with innovative responses, such as Egleston's quiet zone, will help increase patient safety throughout the country.

Source: Los Angeles Times, Pressing for better quality across healthcare, Noam N. Levy, 4 October 2011

Due to differences in how much doctors are paid by private insurance companies and public insurance programs, there is concern that doctors give scheduling priority to patients who have private insurance. According to the New York Times, many doctors refuse to take Medicaid recipients as patients due to the low payments for services and repeated threats to cut Medicaid fees.

To check if doctors truly gave scheduling preference to patients with private insurance, the Obama Administration proposed randomly auditing doctors from around the country. Often called "doctor shopping," the audit would consist of calling doctors' offices with callers posing as new patients looking to schedule an appointment. Using a script, two calls would be made -one stating the caller had private insurance and one stating the caller had public insurance - both would give the offices symptoms of conditions that require "urgent" evaluation.

A recent New England Journal of Medicine (NEJM) study confirms what the Obama Administration may have feared, that doctors really due give scheduling preference to patients with private insurance. Specifically, the study found that children on public insurance who required urgent care or evaluation had a longer average wait for an appointment than children with private insurance. Longer waits may lead to delayed diagnosis with potentially severe consequences.

With more Americans set to receive Medicaid in 2014, when the new health care law takes effect, making sure that Americans receiving public insurance have access to doctors is important. Doctor shopping/audit studies, as argued by Time, are a method that the government and other health care advocates can use to ensure that everyone has access to quality care in an equal manner.

Source: Time, Why Secret Doctor Shopping Studies Are Necessary, Dr. Zachary F. Meisel and Dr. Jesse M. Pines, 15 August 2011

Unfortunately, medical errors are not at all uncommon in America's health care system. Surgical errors, considered highly preventable, still occur roughly once in every 75,000 surgeries. Considering how many surgeries take place in the United States each day, many patients are being harmed.

On the bright side, some health care systems have been successfully tackling the problem of medical errors. According to a recent study, the Veterans Health Administration (VHA), the nation's largest integrated health care organization, has made a number of improvements which have contributed to a decrease in medical errors.

Overall, during the four year time frame, there were 101 actual errors and 136 close calls. The most frequent medical errors were wrong-patient and wrong-side procedures.

In order to decrease medical errors the VHA focused on checklists and creating a team focused approach to health care, stressing cooperation, communication and speaking up about possible mistakes.

Although the success of the VHA in decreasing medical errors is a step in the right direction, even one mistake is too many when patients' lives are at stake. Hopefully ongoing awareness and prevention efforts will continue to improve health care at the VHA and around the country.

Source: Medical errors down at U.S. veterans' hospitals

What caused the sudden change in Genesis' health? - A huge overdose of sodium chloride. How did it happen? The wrong data was entered into a computer program by a pharmacy technician processing an electronic IV order. The automatic alerts built into the IV compounding machine were not activated.

Although not the first time new medical technologies have contributed to potential medical malpractice, the case of baby Genesis highlights some of the problems as technology is being more heavily integrated into hospitals.

Unfortunately medical errors related to computers and electronic data are not uncommon. Although these technologies aim to prevent adverse events by taking human errors out of the equation, technology also has the potential to cause medical errors in other ways. These include: software bugs, computer crashes, user error due to inadequate training, and problems as information is transferred from one electronic system to another.

In just the voluntary reports submitted to the U.S. Food and Drug Administration, there were 370 reports of problems with health information technologies since the beginning of 2008. These errors were responsible for multiple patient injuries and deaths. For example, a patient died after a network problem delayed the transmission of a critical diagnostic image. Other problems included vital signs disappearing from monitors, and patients' allergy information not being carried over during a computer update.

Dr. Ashish Jha, an associate professor from Harvard University's School of Public Health, highlighted the concern, "Technologies can be enormously helpful, but what is emerging is that when implemented poorly, they can be harmful."

The importance of this issue is only likely to grow. The federal government is providing $23 billion in incentives to encourage medical providers to purchase new technologies to implement electronic medical records or automate drug orders.

Source: Baby's death spotlights safety risks linked to computerized systems

The survey, conducted by medical professional associations and a global training and consulting firm, focused on operating-room and critical-care nurses. The survey found that there is often a breakdown in communication among medical teams, resulting in hospital errors.

More than half of the nurses surveyed-58 percent-reported being in situations where they felt it was not safe to speak up or where they did speak up but could not get anyone to listen to their complaints. According to the report, there are three main concerns with this communication breakdown: dangerous shortcuts, incompetence and disrespect.

Nineteen percent of the nurses interviewed said that they had worked with someone whose incompetence or lack of necessary skill harmed a patient. Twenty percent of the respondents reported that they are treated disrespectfully and are considering leaving the profession as a result.

While many nurses turn to their managers for assistance with these issues, less than half of the 832 nurse managers interviewed had brought the complaints to the attention of the individuals responsible. While 41 percent reported speaking to those accused of taking dangerous shortcuts, only 38 percent of the managers had brought up the issue of disrespect. Incompetence, arguably the most serious of the issues, was discussed by a mere 28 percent of the managers with the individuals alleged to be incompetent.

One out of every three hospital patients suffers a medical error or accident. One way this number could be reduced is by improving medical team communication in hospitals. It is imperative that teams create an environment in which members feel comfortable discussing whatever issues arise in order to ensure patient safety.

Source: Report: Communication Breakdown Leads to Hospital Errors