Friday, October 21, 2016

The moon and hospital admissions

A few days ago we had a full moon. A lengthy discussion about the effect of a full moon on hospital admissions took place on Twitter.

Many papers say admissions increase and odd things happen, and many others have found there is no relationship between the phases of the moon and anything that goes on in hospitals.

Someone sent me a link to a paper that a lot of devotees of astrology like to quote. It's called "The influence of the full moon on the number of admissions related to gastrointestinal bleeding," and it appeared in the International Journal of Nursing Practice in 2004.

Wednesday, October 12, 2016

A brief tale of an 18th century Irish surgeon's demise

On my recent trip, I had the pleasure of visiting the Royal College of Surgeons in Ireland in Dublin. Its 200-year-old main building is steeped in history. During the 1916 uprising that led to Ireland's independence, the rebels used it as a billet. Pockmarks from British bullets are still visible on its front columns.

Today the RCSI houses a medical school with a diverse international student body. Thanks to my gracious host, vascular surgeon Sean Tierney, I was able to tour the college's modern classrooms. I also saw a well-equipped simulation laboratory and took part in some virtual reality exercises.

In one of the many beautifully appointed rooms is a statue of William Dease, a noted surgeon who was one of the founders of the RCSI in 1784 and its fifth president. He was also a member of the Society of United Irishmen which started the Irish Rebellion of 1798.

Although the circumstances surrounding Dease's death are somewhat unsettled, the most popular version of the story is that in June 1798 he learned he was about to be arrested because of his association with the United Irishmen and committed suicide by slicing open his femoral artery.

In 1886 his grandson donated a statue of Dease to the college. Some years later the statue developed a crack in a most unusual location. The photograph below shows why.

Monday, October 10, 2016

Incidence of speech recognition errors in the emergency department

Speech recognition errors occurred in 71% of emergency department notes and 21.1% of notes with errors were judged as critical with potential implications for patient care says a recent study in the International Journal of Medical Informatics.

Investigators looked at a random sample of 100 dictated notes and found 128 errors or 1.3 errors per note.

More than half of the errors were ascribed to speaker mispronunciation. Although when I use speech recognition software, it sometimes does not accurately discern what I am clearly saying.

Other errors involved deleted and added words, nonsense, and homonyms.

An example of a nonsense error was "patient up been admitted for stable gait."

Some of the critical errors (with possible interpretations) were as follows:

Friday, October 7, 2016

About that $39.35 charge for holding a newborn baby

By now you've probably heard about the hospital that charged $39.35 for a woman who just had a cesarean section to hold her baby.

The baby's father posted a copy of the bill on Reddit, and it drew over 11,800 comments. The story was also widely circulated on Twitter.

At least one labor and delivery nurse on Reddit and a spokesperson for Utah Valley Hospital where the baby was born stated that the charge was not for holding the baby, but rather it was because an extra nurse had to be brought into the room to watch the baby while the first nurse took care of the mother.

I'm not buying it. The only way to justify charging for the presence of a second nurse would be if she had to be called in from home. If the nurse was already in the hospital which I'm sure she was, the five or so minutes that it would take for her to stand by while the mother holds the baby would surely not take her away from the routine duties of a labor and delivery nurse.

This is especially true for Utah Valley Hospital which delivers about 3600 babies per year. Only about 30% of them or about three per day are born by cesarean section.

And who says a second nurse is even required? Most cesarean sections are performed under epidural or spinal anesthesia. The mothers are awake and perfectly capable of holding a newborn child. An anesthesiologist or nurse anesthetist is always in the room and is primarily responsible for caring for the mother anyway.

Like most hospital charges, the $39.35 figure appears to be the product of some bean counter's imagination. Why $39.35? Why not $39.95 or $68.87?

Apparently Intermountain Healthcare (a system which includes Utah Valley Hospital) has some other interesting billing practices. This is what one Reddit commenter had to say:

Hey, I know this world: we had to pay $700 for our son to stay in my wife's room. Here, I'll explain: my wife was billed $700 per night after her c-section, and my son was also billed $700 per night for his room.

Here's the kicker: they shared the same room!! So, I thought it was a mistake, right? So I called the horrible people at Intermountain Healthcare to point out that they had billed two charges for the same room. They're
[sic] response? "We bill each patient for the full room charge." Yep, they billed my wife $700 for her room, and my baby $700 for the same room. They also doubled the nurse charges (even though, again, my baby didn't have his own nurses.)

He refused to pay, and the bill was sent to a collection agency.

Congratulations on the birth of your son.

Tuesday, September 27, 2016

Vacation Notice

The majestic 700 ft. Cliffs of Moher, one of my favorite places in Ireland.
I will be in Ireland with possibly limited Internet access for the next 7 days.

Please browse my list of previous posts and read a few if you have time.

Any comments you submit may take a day or so to appear so please be patient.

Thank you for visiting my blog site and for reading my musings.

Monday, September 26, 2016

Social media solves a medical riddle

This foreign body was removed from a non-healing abdominal wall incision in an elderly lady with many comorbidities and previous operations. It was a rigid plastic tube which was 7 cm long and 2-3 mm in diameter. There were four transverse grooves at either end.
Physicians caring for her were unable to identify it. One of them emailed me the photos and asked for help. I didn't know what was, but I knew where to look for the answer.

I tried a Google image search, but the brownish discoloration of the object was interpreted as wood by the algorithm. None of the many images on Google resembled the foreign body.

Friday, September 23, 2016

Review: Online question bank for med students and residents

I just finished evaluating a study aid for National Board of Medical Examiners shelf examinations. It’s called ExamGuru, an online question resource for the major specialty rotations encountered by a third-year medical student.

The surgery shelf exam has a total of 395 questions. You can create your own multiple-choice tests of any length, timed or not, and you can focus on the subsections of surgery you want to emphasize.

What makes this set of examinations unique is that you not only get the answer, you also can see whether the question is easy or difficult and how you compare to your peers who have answered the question previously.

Questions that are too hard or too easy are revised or replaced.