Fri, 26 Feb 2010 07:31:03 +0000

This is a rebroadcast, a repost of important information from UMMC's Emergency Command Center. Updated Mon, 2-8, 3PM.

To All UMMC Employees:

We are expecting another winter storm event this Tuesday and Wednesday. In order to ensure that we're prepared, we are asking staff to:

Be prepared: Make sure your vehicle is storm ready and you have made arrangements with your family

Talk to your manager about his or her expectations

If you're scheduled to work Tuesday evening or during the day on Wednesday, please make sure that you're prepared to arrive early or stay longer if needed

All Staff are considered essential and are expected to come in. If you have any concerns about your ability to make it in, you should come in before the storm.

Preparations that we are working on:

Parking -- Parking for staff is available at the following locations:

UMMC Garage (no charge beginning 3 p.m., Tuesday or earlier depending on weather conditions)

Pratt Garage, Grand Garage, Penn Street Garage (open until midnight), and Plaza Garage

There may be a charge for UMB parking. Current permit holders may use their passes. More parking instructions: Please do not park on the streets; any car left on a snow emergency route (all of the streets surrounding the Medical Center) will likely be towed. There will be no parking shuttles running.

Transportation -- We are working to set up a ride sharing program to facilitate transportation of employees. If you would like to participate by bringing in or taking home employees who live in your area, please contact Customer Connect at 8-5174. In the interim, if you already know of someone that you can share a ride with, please do so.

Lodging -- We are offering a limited number of in-house accommodations to staff. If you would like one of these beds, please contact the patient Placement Center at 8-7533. If you would like a hotel room, we are implementing a new process to make it easier to obtain a room. Please contact Nicole Bailey/Guest Services at 8-5473 or 8-6400. You will need to provide the name of the person holding the room and say how long you would like the room. You are responsible for all costs. If your needs change, please let Nicole Bailey/Guest Services know as soon as possible.

Meal Vouchers -- Details on meal vouchers for the next storm are being worked out. Meanwhile, plan to bring in snacks that you enjoy to have on hand.

This page updates at http://www.umm.edu.

The death Monday of Rep. John Murtha (D-Pa.) after complications from gallbladder surgery raises questions about whether the lawmaker was among the nearly 100,000 people who die in U.S. hospitals annually due to preventable medical errors.

With the ongoing debate in Washington about the nature of health care reform, Murtha's passing shines light on one area that hasn't had enough scrutiny, how to make our health care system safer. As the American health care system has been labeled by some as the most advanced in the world, others are critical of the fact that so many people die in hospitals annually due to preventable medical errors.

It's not just about the cost to the health care system to deal with the errors, but the needless number of lives lost. This system-wide failure was highlighted over a decade ago in the Institute of Medicine (IOM) report "To Err Is Human: Building a Safer Health System."

Questions about circumstances surrounding the death of Murtha, the longtime Defense Appropriations chairman and confidante to House Speaker Nancy Pelosi - viewed from afar without specific knowledge of his medical condition - are likely to heighten a long-running debate among medical practitioners and others.

According to the Washington Post, Murtha had elective laparoscopic gallbladder surgery performed at the Bethesda Naval Hospital and fell ill shortly afterwards from an infection related to the procedure. Murtha was hospitalized to Virginia Hospital Center in Arlington, Va., to treat the post-operative infection. His care was being monitored in the intensive care unit (ICU), a sign that suggests that not only was the infection becoming widespread but also that vital organ systems were shutting down.

Was his death preventable or simply unavoidable? A 2009 study by the University of Maryland Medical Center notes that when gallbladder surgery is performed electively "the mortality rates are very low. (Even in the elderly, mortality rates are only 0.7 - 2%.)"

Perhaps Murtha, 77, was one of the unlucky 2 out of 100 to have died from this elective surgery. It is also equally likely that he died of a medical error or omission.

As Dr. Atul Gawande notes in his newest book, "The Checklist Manifesto," in his experience a simple list has helped prevent less-than-optimal surgical outcomes. One item on the list was whether or not IV antibiotics were given at the time the surgeon began the opening incision. You would think this would be obvious, as in the operating room there is a surgical team that as a group is responsible for the patient's care. Do they work as a highly functioning team? Are there clear lines of communications between the surgeon, anesthesiologist, nurses, and surgical techs?

Sadly, communications are not as clear as they need to be. As Gawande notes, a simple two minute checklist not only forced communications (something as basic as an introduction to the surgical team – "Hi, I'm Dr. Gawande general surgeon") but also verified that critical tasks were completed. As a result, the checklist decreased the complication rates by 36 percent and death rate by half. Disappointingly only 20 percent of American hospitals have adopted these types of checklists. 

Bethesda Naval Hospital, as a government institution, is not included in surveys by the respected Leapfrog Group, an organization that works to reduce preventable medical mistakes and rates hospitals on their processes to keep patients safe. (Leapfrog Group was founded by large employers, who purchase health insurance, to evaluate the care their employees receive from hospitals).

Virginia Hospital Center, where Murtha was hospitalized, didn't submit any information either even though it is listed in the Leapfrog Group database. Specifically, Virginia Hospital Center declined to respond to the survey on how they are doing to keep medical errors from occurring. Questions include whether there is adequate ICU staffing, processes to reduce ICU infections, and steps to prevent harm. Gawande notes in his earlier New Yorker piece that even intensive care units errors of omission and missed opportunities happen that can be avoided with checklists.

Even now, as Gawande points out, getting doctors and hospitals to improve patient safety with something as basic as a checklist has been extraordinarily difficult. And it's symptomatic of a broader problem in our health care system, unforced errors that can be fatal.

Davis Liu, M.D., is a practicing board-certified family physician in Roseville, Calif., and author of "Stay Healthy, Live Longer, Spend Wisely – Making Intelligent Choices in America's Healthcare System."