Monday, February 01, 2010

500,000 British hospital patients sent home too soon every year (and 1,500 a day readmitted for emergency care)

More than 500,000 patients every year are readmitted to hospital after apparently being sent home too soon, alarming figures reveal. Labour's waiting-time targets have been blamed for the 50 per cent rise in emergency readmissions of patients within days of them being discharged. Critics said it was a scandal that almost 1,500 a day were apparently being released before they are well enough, harming their recovery. They say the targets put pressure on hospitals to discharge people early to free up beds and have turned the NHS into a 'revolving door'.

Elderly patients are particularly vulnerable if they are sent home too soon, charities warned. There are also fears hospitals are trying to cash in from being paid twice to treat the same patient.

The figures, obtained by the Conservatives, show the numbers readmitted through A&E within 28 days of being sent home from hospital has risen steadily in the past 12 years. In 1998, the figure was 359,719, but it has risen every year since then, reaching 546,354 in 2007-08. A large number of those affected are vulnerable elderly patients, with 159,134 being over the age of 75, up from 94,283 in 1998.

Under Labour's strict target regime, hospitals must ensure no patient waits more than 18 weeks for treatment after being referred by their GP. However, in recent years, the number of NHS beds has been cut by around 20,000, or 10 per cent of the total, meaning many are being discharged too soon from crowded wards to make way for new patients. This is despite a Government pledge to increase beds, as well as a tripling in health spending.

NHS trusts trying to save money have also cut back on community services. As a result a large number of patients do not receive the support they need in their own homes - and often end up back in hospital.

Conservative health spokesman Andrew Lansley said a Tory government intended to change NHS rules so hospitals are not paid for treating patients they have recently discharged. 'It's staggering that there has been such a huge increase in the number of patients having to be readmitted to hospital as emergencies almost as soon as they've been allowed home,' Mr Lansley said. 'It's also a deeply worrying sign that the quality of care in hospitals is being undermined. 'This raises real concerns that patients are routinely being discharged too soon. Hospitals should not have an incentive to discharge patients quickly and then get paid by the taxpayer a second when they have to be readmitted. 'I will ensure that through our payment for results approach, hospitals have to meet any costs arising from emergency readmissions themselves.'

Experts blame a number of factors for emergency readmissions, including early discharge, poor treatment, infections and badly organised rehabilitation and support services.

The figures show hospitals that send patients home more quickly than others - with lower than average lengths of stay for first admission - have higher readmission rates. There is also evidence that patients who have to be readmitted actually stay in hospital longer than after their first admissions.

Patients Association director Katherine Murphy said: 'The pressure on getting beds cleared to meet treatment targets should never be allowed to compromise patient care. It's indefensible that this might be happening and nothing is being done about it.'

A Department of Health spokesman said: 'Patients are only discharged from hospital if the clinicians involved consider it safe and in their best interests. 'Some patients might require readmission if their health deteriorates, but the numbers are small. Only about 5 per cent of patients discharged from hospital are readmitted within seven days of their discharge.'

However, the spokesman added: 'A high rate of emergency readmission after elective surgery is a matter of concern --so we are encouraging hospitals to measure the trends in order to improve the quality of care they provide.'


Australia: Training fails to prepare new doctors

An increased emphasis on "social" education has left less time for teaching such basics as anatomy. Many medical schools also now have a bias against very bright students in the name of "equality"

MEDICAL students are emerging from the nation's universities feeling inadequately prepared to deal with crucial tasks such as calculating safe drug doses and writing prescriptions.

In a challenge to Kevin Rudd's twin promise to improve university education and doctor shortages, a government study has also revealed that medical supervisors feel the abilities of hospital interns fall short of their expectations. The study reveals just 36 per cent of junior doctors think they have been adequately or well-prepared to do wound management. And only 29 per cent of final-year medical students feel they have been adequately prepared to calculate accurate drug doses.

The landmark review of the nation's medical education system was finalised 19 months ago but released only on Friday. Medical leaders warn that the extra influx of students since the Education Department commissioned the research has made the failings it describes even worse.

News of the concerns about medical education comes before today's release of a new Intergenerational Report warning that the nation's ageing population will impose extreme pressure on the health system, including the medical workforce. It also comes as The Australian has learned a Rudd government program aimed at addressing the drastic shortage of nurses in the nation's aged-care facilities has failed, attracting just 138 nurses in two years, against a target of 400.

In the past decade, the quality of medical training has come under increasing scrutiny, particularly since chronic doctor shortages have sparked an increase in medical school intakes and the creation of medical schools in regional universities. In 2007, The Australian revealed that almost three out of four medical students said they were taught too little anatomy during their medical degree, while more than a third questioned their own competence in the workings of the human body.

Such findings led the Howard government to commission the Department of Education, Science and Training to do a two-year study, conducted between 2005 and 2007, to find out how best to train the nation's doctors. The report found medical students feared for their skills in a number of key areas, including knowledge of basic sciences, while hospitals increasingly struggled to make time for effective teaching in the face of packed waiting rooms.

Only 48 per cent of final-year students and 64 per cent of junior doctors thought they were adequately or well prepared to write prescriptions. Interpreting X-rays was a concern for 69 per cent and 77 per cent respectively. And just 44 per cent of medical students and 48 per cent of junior doctors felt they had been properly trained to insert a tube through the nose and down the throat of a patient.

Health Minister Nicola Roxon refused to comment on the detail of the report late yesterday. Instead, she blamed it on Opposition Leader Tony Abbott, a health minister in the Howard government. "Tony Abbott failed to plan for the health workforce needs of Australia and even capped the number of people allowed to train as GPs - a cap that this government has lifted," Ms Roxon said.

The medical community warned that the situation had deteriorated since the report was completed. Australian Medical Association president Andrew Pesce said more needed to be done to properly fund medical training. "Nationally, there will be 2920 domestic graduates from medical schools by 2012, and over 500 international graduates - many of whom will want to stay in Australia," Dr Pesce said. "This will swamp the existing number of intern places - with only 2030 currently available across the country."

The executive director of surgical affairs for the Royal Australasian College of Surgeons, John Quinn, said the report was "a missed opportunity" to demand decisive action. Dr Quinn said the RACS was particularly disappointed, given it had been "vociferous about the dwindling and now inadequate teaching of anatomy" in all medical schools. "This would seem to be a failure to recognise the problem, and to propose some solutions to a problem that has been well-identified previously," Dr Quinn said.

Associate Professor Paul McKenzie, the president of the Royal College of Pathologists of Australasia, said the report was a "disappointment" for failing to recommend improvements to undergraduate science training.


Obama Admits CBO Cost Estimates of ObamaCare Are Incomplete

Yesterday — day #224 of the ObamaCare Cost-Estimate Watch — President Obama told House Republicans: "You can’t structure a bill where suddenly 30 million people have coverage and it costs nothing."

And just like that, the president admitted that the official Congressional Budget Office estimates of his health care plan do not reflect its full costs.

Both the House and Senate versions of ObamaCare would cover millions of uninsured Americans by requiring them to purchase private health insurance. As President Obama notes, even if you force people to spend their own money on health insurance, it still costs something to cover them. And if the government partly subsidizes those premiums, the remaining mandatory premium is still part of the cost of covering them.

Yet Democrats have systematically blocked the CBO from including those costs in its official cost projections. The Senate bill’s estimated price tag of $940 billion, for example, includes only the costs that bill would impose on the federal government. By my count, that’s only 40 percent of total costs. By Mr. Obama’s admission, that’s not the full cost of the bill.

Now that the President of the United States has acknowledged that the CBO’s cost estimates are incomplete, could we maybe get a complete cost estimate? Maybe just for the Senate bill?


Obama’s Not Alone In Thinking We’re Too Dumb To Appreciate Him

The Los Angeles Times reports today that Democrats are conspiring behind closed doors on methods to revive and pass health reform. You may be forgive for thinking the LAT didn’t put it quite that way, but I don’t believe I’ve mischaracterized their report. You decide:
President Obama’s campaign to overhaul the nation’s healthcare system is officially on the back burner as Democrats turn to the task of stimulating job growth, but behind the scenes party leaders have nearly settled on a strategy to salvage the massive legislation.

They are meeting almost daily to plot legislative moves while gently persuading skittish rank-and-file lawmakers to back a sweeping bill.

This effort is deliberately being undertaken quietly as Democrats work to focus attention on more-popular initiatives to bring down unemployment, which the president said was a priority in his State of the Union address on Wednesday.

And what of the often-promised but now forgotten “transparency that was supposed to accompany health reform? Again, Obama is not the only one who’s forgotten it.
In a 24-hour news cycle, with the Internet and bloggers and cable news, sometimes a lot more can be accomplished, especially with healthcare, when it happens behind closed doors,” said Drew Altman, a healthcare policy expert who heads the nonprofit Henry J. Kaiser Family Foundation.

Among those plotters behind closed doors is Arkansas Sen. Mark Pryor, described by the LAT as “a conservative Democrat who was among a group of centrist Democrats from the House and Senate” who’ve been meeting. “Formerly conservative” or “a Senator who would like to be thought of by his constituents as conservative” might be more accurate, but whatever his political coloration at the moment Pryor believes he has plumbed the depths of human nature, and he’s discovered that people, or at least voters, are not as smart as he is.

“A little bit of time and quiet could help,” he said.
“Human nature being what it is, it's always easier to be against something than to be for it. And if you create any uncertainty with change, opponents can jump on that and just try to scare people. . . . That has been hard to overcome politically,” Pryor said. “Maybe over time, people will have a chance to understand what is in the legislation.”

In other words, we were too dumb to understand what Obama explained to us in 29 (or was it 39?) speeches and endless snippets from them on TV. But maybe if they just keep quiet about it for a while and bring it up later, we will have forgotten that we don’t like it.

Democratic leaders do not reserve their condescending scorn for voters who disagree with them; they have similar contempt for many of their own skittish followers (or not) in Congress who were, for some reason, “rattled by Brown’s winning campaign in Massachusetts.”
House Speaker Nancy Pelosi (D-San Francisco) and Senate Majority Leader Harry Reid (D-Nev.) particularly want to give members time to recover from the shock of Republican Scott Brown’s victory in the Massachusetts Senate race two weeks ago. The election cost Democrats their filibuster-proof Senate majority.

But in the coming weeks, Pelosi and Reid hope to rally House Democrats behind the healthcare bill passed by the Senate while simultaneously trying persuade Senate Democrats to approve a series of changes to the legislation using budget procedures that bar filibusters.

But why should they recover from the shock? Will the threat to Democrats intent on passing unpopular legislation implicit in the message of Brown’s election lessen over time?

The Dem leaders thus assume not only that voters are too dumb to appreciate the wisdom of the Dems’ health reform but also that they are so dim they will forget their opposition, thus allowing the “rattled” Democrats in Congress to recover from their Brown-induced “shock” and stick by their former willingness to impose massively unpopular legislation on a forgetful public.


No comments: