When HHS inspector generals office asked the Lincoln (Neb.) Surgical Hospital for its staffing schedule for November 2006, the seven-bed physician-owned hospital complied. Staff sent everything over that was requested. But in so doing, it wound up getting cited in the inspector generals recent report, Physician-Owned Specialty Hospitals Ability to Manage Medical Emergencies, for violating Medicares rule requiring that a physician be on call at all times. Specifically, the report noted that the hospital was Missing a physician on call for all shifts on Nov. 23, 2006.
We had a doctor on call and the on-call doctor was here making rounds, says hospital CEO Robb Linafelter, noting that the day in question was Thanksgiving.
The problem is that instead of formally listing the on-call physician for that day, Linafelter says a secretary marked the holiday by inserting a picture of a turkey and the words Happy Thanksgiving.
They just assumed we didnt have a doctor on call, Linafelter says. There werent further follow-up calls. They just made massive leaps and assumptions from the data that was collected.
Linafelter says its hospital policy to have a doctor on call 24 hours a day, seven days a week, every week of the yearjust as Medicare requires. He adds that, from now on, its also hospital policy that there will be no pictures on the on-call schedule where names should be.
Mohels looking for work may want to steer away from the West Coast.
A new report released last week by the Agency for Healthcare Research and Quality found that circumcision is more prevalent in other parts of the country.
In its analysis of hospital-based circumcisions in 2005, AHRQs report found that only 31% of newborn boys in Western states were circumcised that year compared with 75% in the Midwest, 65% in the Northeast and 56% in the South.
AHRQ cited regional variations in racial, ethnic and immigrant populations, as well as insurance coverage, as the reasons for the wide discrepancies in circumcision rates.
In the West, for example, immigration from Latin America and other areas where circumcision is less common, and insurance coverage, may be the reasons for the low circumcision rates.
Nationally, about 56% of newborn boysabout 1.2 million infantswere circumcised in 2005. Some groups, such as the American Academy of Pediatrics, claim there is insufficient evidence that routine circumcision is medically necessary, but other research suggests that the procedure reaps some health benefits such as a lowered risk of developing penile cancer, urinary-tract infections in newborns and HIV transmission.
A nine-line provision in the 3,417-page omnibus spending bill signed by President Bush last month has big implications for medical journals, which will now have to post federally funded research articles for free viewing by the general public.
The little-noticed provision requires researchers to turn over to the National Institutes of Health their peer-reviewed articles, which would then be made public for free within a year of publication. The effective date of the rule is April 7.
While well-funded publications like the New England Journal of Medicine and the Journal of the American Medical Association already offer free versions of their articles after a six-month period, other smaller or not-for-profit scientific publications could struggle under the new law.
Journals published in the U.S. have strong markets abroad; indeed, in some fields of research, most sales are to institutions and individuals outside the United States, says Allan Adler, vice president of legal and government affairs at the Association of American Publishers. A government policy requiring these works to be made freely available for international distribution is inherently incompatible with the maintenance of global markets for these highly successful U.S. exports.
Latex may be one of the most reliable contraceptive materials, but the medical staff at Baltimores Johns Hopkins Hospital is ready to part ways with the prophylactic substance.
The prestigious institution has removed all latex surgical gloves and nearly all other medical products containing rubber from its supply chain, says spokesman Eric Vohr. The hospitals surgeons are already using sterile neoprene or synthetic polyisoprene gloves during procedures, and purchasing officials are on the prowl for other latex substitutes.
Hospital officials are taking the steps in an effort to reduce the growing incidence of allergic reaction among workers and patients who come in contact with latex. Research shows roughly 15% of healthcare workers and 6% of the general population are allergic to latex. Reactions can range from mild irritation to anaphylactic shock similar to the type experienced by people with food or bee-sting allergies, and can even result in death.
It is perhaps fitting that Johns Hopkins is the first to implement a total ban on latex. William Halsted, a founding physician at the facility, was among the first to introduce rubber gloves into the operating room, in 1890, because his scrub nurses hands were chapped from harsh antibacterial soap.
Then, more than a century later, two Johns Hopkins immunologists conducted pioneering research showing the proteins in latex rubber were allergens.
Latex hospital gloves were invented here, so its only fitting that Johns Hopkins take the initiative to promoting alternatives, says Robert Brown, an anesthesiologist and chairman of the hospitals latex task force.
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