Civil Litigation and the Opioid Epidemic: The Role of Courts in a National Health Crisis.

The devastating impact of the national opioid epidemic has given rise to hundreds of lawsuits. This article details the extremely broad range of legal claims, compares the opioid cases to other public health litigation efforts, including tobacco, and describes the special mechanism - a multidistrict litigation - through which more than 700 opioid-related cases have been consolidated thus far, with settlement almost certain to follow.

Efficiency of electronic signout for ED-to-inpatient admission at a non-teaching hospital.

Admission handoff is a high-risk component of patient care. Previous studies have shown that a standardized physician electronic signout ("eSignout") may improve ED-to-inpatient handoff safety and efficiency in teaching hospitals. This model has not yet been studied in non-teaching hospitals. The objectives of the study were to determine the efficiency of an eSignout platform at a community affiliate hospital by comparing ED length of stay (LOS) for a 5-month period before and after implementation and to compare the quality assurance (QA) events among admitted patients for the same time period. A retrospective, interventional study was conducted with the main outcome measures including ED LOS with calculation of 95% CI, mean comparison (t test), and number of QA events before and after implementation of the eSignout model. Prior to eSignout implementation, 1045 patients were admitted [mean ED LOS 330.0 min (95% CI 318.6-341.4)]. Following implementation, 1106 patients were admitted [mean ED LOS 338.9 min (95% CI 327.4-350.4, p = 0.2853)]. Nine pre-implementation QA events and six post-implementation events were identified. Use of a physician eSignout in a non-teaching hospital had no statistically significant effect on ED LOS for the admitted patients. The effect of an electronic interdepartmental handoff tool for patient safety and clinical operations in the non-teaching setting is unclear.

The disruptive orthopaedic surgeon: implications for patient safety and malpractice liability.

Disruptive physician behavior imperils patient safety, erodes the morale of other health care providers, and dramatically increases the risk of malpractice litigation. Increasing patient volume, decreasing physician reimbursement, malpractice litigation, elevated stress, and growing job dissatisfaction have been implicated in disruptive behavior, which has emerged as one of the major challenges in health care. Because the aging patient population relies increasingly on orthopaedic services to maintain quality of life, improving professionalism and eradicating disruptive behavior are urgent concerns in orthopaedic surgery. Although many steps have been taken by The Joint Commission to improve patient care and define disruptive behavior, there is further room for improvement by physicians. Barriers to eliminating disruptive behavior by orthopaedic surgeons include fear of retaliation, lack of awareness among the surgeon's peers, and financial factors. Surgeons have a duty to address patterns of negative peer behavior for the benefit of patient care. This manuscript addresses the causes and consequences of disruptive physician behavior as well as management strategies, especially in orthopaedic surgery.

Outcomes after ischemic stroke for hospitals with and without Joint Commission-certified primary stroke centers.

BACKGROUND: The Joint Commission (JC) began certifying primary stroke centers (PSCs) in the United States in 2003. We assessed whether 30-day risk-standardized mortality (RSMR) and readmission (RSRR) rates differed between hospitals with and without JC-certified PSCs in 2006. METHODS: The study cohort included all fee-for-service Medicare beneficiaries ≥65 years old discharged with a primary diagnosis of ischemic stroke (International Classification of Diseases, ninth revision, Clinical Modification 433, 434, 436) in 2006. Hierarchical linear regression models calculated hospital-level RSMRs and RSRRs, adjusting for patient demographics, comorbid conditions, and hospital referral region. Hospitals were categorized as being higher than, no different from, or lower than the national average. RESULTS: There were 310,381 ischemic stroke discharges from 315 JC-certified PSC and 4,231 noncertified hospitals. Mean overall 30-day RSMR and RSRR were 10.9% ± 1.7% and 12.5% ± 1.4%, respectively. The RSMRs of hospitals with JC-certified PSCs were lower than in noncertified hospitals (10.7% ± 1.7% vs 11.0% ± 1.7%), but the RSRRs were comparable (12.5% ± 1.3% vs 12.4% ± 1.7%). Almost half of JC-certified PSC hospitals had RSMRs lower than the national average compared with 19% of noncertified hospitals, but 13% of JC-certified PSC hospitals had lower RSRRs vs 15% of noncertified hospitals. CONCLUSIONS: Hospitals with JC-certified PSCs had lower RSMRs compared with noncertified hospitals in 2006; however, differences were small. Readmission rates were similar between the 2 groups. PSC certification generally identified better-performing hospitals for mortality outcomes, but some hospitals with certified PSCs may have high RSMRs and RSRRs whereas some hospitals without PSCs have low rates. Unmeasured factors may contribute to this heterogeneity.

The impetus for legislation revoking the Joint Commission's deemed status as a Medicare accrediting agency.

A change in the Medicare law in 2008 removed the "deeming" status of the Joint Commission and forced the accrediting body to formally apply to the Centers for Medicare & Medicaid Services for its continued authority to determine a hospital as eligible for participation in federal programs. This legislation was reportedly justified by a critical concern about the Joint Commission's ability to ensure patient safety through its hospital accreditation program. This article provides a comprehensive evaluation of the issues surrounding congressional legislation revoking the Joint Commission's special authority and calls into question the validity of that concern for the safety of hospitalized patients based on the Joint Commission's performance. The legal history of the Centers for Medicare & Medicaid Services' oversight of hospital accreditation is considered. The 2004 US Government Accountability Office report that triggered the relevant section of the Medicare Improvement for Patients and Providers Act of 2008 is closely examined for validity. Once these relevant factors are reviewed, the reader may conclude that the legislation revoking Joint Commission's deemed status was not adequately justified.

Disclosing medical errors in Missouri: how to say "I'm sorry".

Most physicians and patients agree that errors should be disclosed to patients and their families. A major barrier to disclosure is fear of litigation on the part of the physician. Some states, now including Missouri, have adopted so-called "apology laws", which are designed to facilitate disclosure by making certain statements of apology inadmissible as evidence in a court case. Some institutions have implemented "full-disclosure" programs with reportedly promising results. This article will review apology law in Missouri, and will discuss its implications for medical practice and for the disclosure of errors.

Medicare and Medicaid programs; approval of the Joint Commission for continued deeming authority for hospices. Final notice.

This final notice announces the approval of a deeming application from the Joint Commission for continued recognition as a national accreditation program for hospices that request participation in the Medicare or Medicaid programs.

A template for spiritual assessment: a review of the JCAHO requirements and guidelines for implementation.

Growing consensus exists regarding the importance of spiritual assessment. For instance, the largest health care accrediting body in the United States, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), now requires the administration of a spiritual assessment. Although most practitioners endorse the concept of spiritual assessment, studies suggest that social workers have received little training in spiritual assessment. To address this gap, the current article reviews the JCAHO requirements for conducting a spiritual assessment and provides practitioners with guidelines for its proper implementation. In addition to helping equip practitioners in JCAHO-accredited settings who may be required to perform such an assessment, the spiritual assessment template profiled in this article may also be of use to practitioners in other settings.