Barry Meisenberg, MD, chair for quality improvement and healthcare systems research, recently submitted a letter to the editor to the New York Times regarding “Treatment Cost Could Influence Doctors’ Advice” article (April 18, 2014). His letter was published in the April 27, 2014 New York Times–continuing the dialogue on Choosing Wisely. Read his letter here.
By Henry Sobel, MD, Chair, Women’s and Children’s Services
The FDA recently issued an advisory strongly discouraging the use of uterine power morcellators. Read the MedPage article with the advisory and ACOG comment here. The FDA’s specific recommendation to physicians is highlighted. Leading hospitals around the country are taking either of two approaches: banning use of the morcellator or having its use restricted to within bags in the abdomen to protect against the risk of spread of potentially malignant tissue. This controversy was the subject of our February Women and Children’s M&M Conference.
Since that discussion efforts have been made to assure that we have the necessary high quality surgical bags, and we do. The use of the power morcellator, the incidence of leiomyosarcoma, and the impact of surgical technique on survival are each of some small increment. Balanced against that risk is the benefit of the decreased morbidity of the minimally invasive techniques allowed by the use of morcellation. More informed high level conversation is coming from national medical thought leaders, including ACOG.
With that expectation, having seen different responses at other hospitals, and having gotten differing opinions within our service, at this time I see the prudent action to be the more conservative one of requiring the use of collection bags to isolate the tissue from spread within the abdomen at time of morcellation.
Further, the FDA’s discussion points (highlighted in yellow within the attachment) should be considered as imperatives in any pre-operative discussion where morcellation may be a possibility. And that should be documented.
Due to the small number of patients impacted by this controversy, the potential for stirring up fear and worry and the fact that we are simply responding to published recommendations, I do not view this as something justifying increased local publicity. It is a subject you should be familiar with, expect questions about and be able to discuss in an informed manner. If contacted by a reporter, the best response is to refer them to the AAMC PR department for comment.
Your comments are welcome. Thank you.
Our triennial Joint Commission survey occurred the week of November 18. The surveyors were overwhelmingly positive about what they saw and heard. They are taking several AAMC best practices back to the Joint Commission, and named AAMC a “role model” for other hospitals and health systems around the country – an incredible tribute to our employees and medical staff. Our survey results reflect the high-quality, safe care we provide to our patients daily. Thank you for your unending commitment to excellence in quality and safe patient care.
The James and Sylvia Earl Simulation to Advance Innovation and Learning Center (SAIL), is a world-class medical simulation and training facility in the Health Sciences Pavilion at AAMC. The Center serves not only the medical profession but also provides tours and educational opportunities for area school children, the community, patients, families, and organizations dedicated to healthcare improvement and patient safety. Here are a few upcoming events at the Earl SAIL Center:
- Orthopedics Cadaver Lab: September 24
- OB/GYN Simulation Training: September 26
- Patient Care Technician Education: September 27
- Women’s Conference and Tour: October 16
- GYN Pelvic Floor Reconstruction Cadaver Lab: November 1
- Breast Surgery Lab: November 1
- Biomedical and Allied Health Students from Anne Arundel County Public Schools and Glen Burnie High School Tours: November 15 and December 12
What kinds of simulation and learning opportunities can the Earl SAIL Center offer you and your team? Contact Ann Casamento, RN, simulation coordinator, at x4880 or acasamento@AAHS.org.
AAMC has been awarded the Quality Excellence Award from the Delmarva Foundation, an independent, not-for-profit health care quality improvement organization. AAMC was one of 16 hospitals statewide to receive the prestigious award. This is the first time AAMC has earned the award.
“Delmarva is proud to recognize Anne Arundel Medical Center as a recipient of the Delmarva Foundation Excellence Award for Quality Improvement,” said Columbus Giles, MD, Delmarva Foundation’s chief medical officer. “Recipients of this award possess a strong commitment to excellence and to improving the quality of care for their patients. We commend their achievements and look forward to continuing our collaboration with them to improve the health of Maryland’s Medicare beneficiaries.”
The award honors individual hospitals that excel in patient safety and quality improvement. To receive the Delmarva Foundation Excellence Award, the hospital must meet specific performance improvement criteria on 14 measures in four national inpatient clinical areas: acute myocardial infarction (heart attack), heart failure, surgical care improvement, and pneumonia.
“This excellence award directly reflects the quality of care delivered to patients as we continue to set higher standards for delivering expert care,” says Shirley Knelly, AAMC’s vice president of quality and patient safety.
For more information about the Delmarva Foundation award, visit www.mdqio.org.
In an unprecedented public health initiative during an era of diminishing resources, 35 medical professional organizations have joined forces with consumer groups to promote safe and responsible utilization practices, i.e. Choosing Wisely, for both patients and physicians.
Each partner organization has created or will create a list of five medical tests, procedures or medication indications that are of low value and associated with causing harm. Examples include early use of imaging for low back pain (in the absence of red flags), routine pre-operative chest x-rays, antibiotics for acute sinusitis, and screening DEXA scans in subjects at low risk for osteoporosis. There are 45 such recommendations at present with more to come in 2013 as additional organizations join the campaign.
Recognizing that demand for low-value tests often originates from the public, the Choosing Wisely campaign has gained broad credibility in the lay media by partnering with prominent entities that enjoy loyal consumer following, including Consumer Reports and AARP. Cogent, patient-friendly information resources from Choosing Wisely can be used in your practice to help patients understand why more tests or more medications aren’t always the best plan.
The unambiguous statements by professional societies recommending against certain tests in certain situations set a clear “standard of care” that should provide a comfort level to physicians when having discussions with patients and families about tests of questionable value and potential harm.
The website ChoosingWisely.org contains links to each of the current 45 Choosing Wisely recommendations, and the evidence used to develop them. It also lists the professional societies that are due to create their lists in 2013. Patient resources, such as well-written one-page discussions of the recommendations, may also be downloaded from the site.