O Ministro da Saúde quer a divulgação mensal do desempenho de hospitais e centros de saúde, no que respeita a atendimento em urgências, consultas e reinternamentos. Quer também conhecer os tempos de espera e os índices de poupança das mesmas.
via Saúde – Hospitais e centros de saúde vão ter de divulgar taxas de atendimento – RTP Noticias, Vídeo.
Na categoria Azimutes | Com as tags Saúde, SNS | Deixar um Comentário »
Hoje vota-se (em) Portugal. Talvez digam os experts na matéria (e tantos os há – os que são e os que pensam que são), que estas serão porventura as eleições mais renhidas mas igualmente as mais condicionadas.
De qualquer forma, caberá ao Povo a escolha daqueles que quer ver à frente da gestão na Nação nos próximos 4 anos. Dos programas políticos disponibilizados à leitura atenta dos cidadãos, subjazem linhas de acção sempre condicionadas pela “externalização” do financiamento do país. Pessoalmente preocupa-me mais como lidaremos com a estrutura de custos do país do que com o facto de pedirmos ajuda ao exterior. É tudo uma questão de compromisso: em primeiro lugar connosco próprios e depois com os outros. O Compromisso é a palavra com a qual sempre nos habituámos a viver (ou não…) e o seu bom ou menos bom entendimento conduzir-nos-á a uma boa ou menos boa imagem e credibilidade junto dos nossos parceiros.
Hoje, mais do que esquerda ou direita, mais do que o Sr. A ou Sr. B para Primeiro Ministro, é o momento de todos os que desde sempre se manifestaram, por tudo e por nada, por isto ou por aquilo, se apresentarem às urnas e participar nesta decisão.
Pessoalmente, subscrevo as palavras do nosso Presidente. Definitivamente, não reconhecerei moral, direito à manifestação e legitimidade para opinarem nos próximos 4 anos se hoje não exercerem um dos mais basilares direitos fundamentais do nosso estado democrático – o do Voto.
Na categoria Azimutes | Com as tags Cidadania, Política | Deixar um Comentário »
Co-responsabilizar todos os stakeholders da saúde pela qualidade dos cuidados prestados implica monitorizar eventos adversos e erros evitáveis à luz das boas práticas baseadas na evidência.
E se em última análise, aos incentivos ao bom desempenho fossem acrescentadas penalizações pelas más práticas e pelo incumprimento? Mais, e se, existindo, as colocássemos de facto em prática?
Veja-se no caso Medicaid.
By Phil Galewitz
KHN Staff Writer
Medicaid will stop paying for about two dozen “never events” in hospitals, such as operations on the wrong body part and certain surgical-site infections, federal officials said today.
Currently, about 21 states have such a nonpayment policy. The 2010 federal health law, in effect, expands the ban nationwide. The rule published today gives states until July 2012 to implement it.
Medicaid is a joint state-federal program for the poor and disabled. Under the rule, Medicaid funds can’t be used to pay doctors and hospitals for services that “result from certain preventable health care-acquired illnesses or injuries,” the officials said.
A similar regulation has been in place for Medicare, the federal health program for the elderly, since 2008.
“These steps will encourage health professionals and hospitals to reduce preventable infections, and eliminate serious medical errors,” said Donald Berwick, administrator of the Centers for Medicare and Medicaid Services. “As we reduce the frequency of these conditions, we will improve care for patients and bring down costs at the same time.”
Some physician groups have concerns about the new policy. “Simply not paying for complications or conditions, that, while extremely regrettable, are not entirely preventable, is a blunt approach that is not effective or wise for patients or the Medicare or Medicaid program,” Dr. Michael Maves, CEO of the American Medical Association, said in written comments to CMS in March.
He said the medical association has “grave concerns” about states extending the non-payment policy beyond the conditions considered by Medicare. The American Hospital Association expressed similar reservations.
Responsing to complaints from hospitals, CMS gave states additional time — until July 2012 — to implement the new policy.
Cindy Mann, deputy director of CMS and director of Medicaid, said the rule gives states the option to expand the nonpayment policy to health care settings besides hospitals and to add other types of “never events.”
She said the policy would help improve patient care and drive down costs in the $364 billion program. “All (health care) payers are looking to gain better value for the dollars they spend and Medicaid is no different,” she said.
But the costs savings from the change is relatively modest. According to the proposed rule, Medicaid would save about $35 million over the next five years from stopping pay for such medical mistakes. Medicare has saved about $20 million a year under its policy.
“It’s a welcome first step into the national debate on quality,” said Matt Salo, executive director of the National Association of Medicaid Directors. “Clearly many states have already moved ahead, although that should never be taken as rationale for forcing the rest of them to do … well, anything. But improving quality in a coordinated fashion between Medicare and Medicaid is important.”
This is list of preventable conditions that Medicaid will no longer pay for:
Na categoria Azimutes | Com as tags Administração, Qualidade, Saúde | Deixar um Comentário »
Conforme calendário estabelecido, a Administração Central do Sistema de Saúde (ACSS) publica em 31 de Maio os dados da execução económico-financeira do Serviço Nacional de Saúde (SNS) referente a Março de 2011.
As contas do SNS relativas ao primeiro trimestre de 2011 revelam uma melhoria do saldo de 130,4 milhões de euros, face ao período homólogo do ano transacto. Com um decréscimo de 0,4% na receita, em resultado do OE, o SNS registou uma poupança na despesa de 5,7%, o que permitiu passar a ter um saldo de -3,2M€.
Em termos da Despesa, com um decréscimo acentuado de cerca de 128M€, salienta-se a contribuição da diminuição dos Subcontratos, em especial dos medicamentos adquiridos (-20,0%), nas Despesas com o Pessoal (-7,9%) e na contratualização de serviços com as Entidades Públicas Empresariais com uma redução de 2,7%.
Em termos mais desagregados, registe-se que a demonstração de resultados relativa às Administrações Regionais de Saúde (ARS) apresenta uma melhoria considerável no resultado líquido, sendo de 28,3M€ no 1.º trimestre de 2011,comparativamente ao prejuízo de -21,8M€ no mesmo período de 2010.
Quanto às Entidades Públicas Empresariais (EPE), verifica-se uma ligeira melhoria de 2,2%. Os proveitos totais decresceram 1,8% e os custos totais demonstraram alguma contenção, tendo diminuído 1,9%, sendo que o resultado operacional é de -105M€.
Os Hospitais do Sector Público do Estado (SPA) demonstram uma forte redução no prejuízo do 1.º trimestre de 2011 para -2,5M€, com uma redução dos custos totais em 5,7%.
Os Serviços Autónomos tiveram um bom desempenho económico no 1.º trimestre de 2011, apresentando um resultado líquido positivo de 22,6M€, face aos 15M€ obtido em 2010.
Na categoria Azimutes | Com as tags Administração, SNS | Deixar um Comentário »
Cellphones used in hospitals may spread nasty germs
By Shari Roan, Los Angeles Times / For the Booster Shots blog
Cellphones are everywhere. Perhaps one place they shouldn’t be is at hospital bedsides. According to a new study, cellphones used by patients and visitors are twice as likely to contain potentially dangerous bacteria compared with the mobile phones used by healthcare workers. Previous studies have focused on the threat of germs on the phones of healthcare workers but not others who visit hospitals.
The authors of the study, conducted in Turkey, took swabs from 200 cellphones. About one-third of the phones belonged to healthcare workers and the rest belonged to patients and visitors. They found almost 40% of the patients’ and visitors’ phones tested positive for germs that can lead to hospital-acquired infections, including the bacteria that cause MRSA — methicillin-resistant Staphylococcus aureus.
About 1.7 million hospital-acquired infections are reported in U.S. patients each year, causing about 100,000 deaths. Hospitals have worked mightily in recent years to enact standards and practices to reduce the spread of infections. But germs on cellphones won’t be easy to address, the authors of the study noted. Liquid disinfectants and heat, usually used to kill germs, can’t be used on cellphones without some risk of damaging the phone. Alcohol-wipes and hand-washing could reduce some germs as well as special cellphone covers. But it may be necessary to restrict cellphone use in parts of the hospitals, they said.
The study was published Tuesday in the June issue of theAmerican Journal of Infection Control.
http://www.latimes.com/health/boostershots/la-heb-hospital-cellphones-20110531,0,7189588.story
Na categoria Nortadas | Com as tags Hospitais, Saúde | Deixar um Comentário »
Tuning In to Patients’ Cries for Help
By TARA PARKER-POPE
Tom Kerr of Pittsburgh will never forget the long-distance call from his elderly mother, who was in a hospital in the Cleveland area with a broken leg.
She phoned her son, more than 100 miles away, because no one in the hospital was answering her call button.
Mr. Kerr quickly called the hospital operator, tracked down the floor nurse and asked for someone to check on his mother.
“She had to call me long distance, and then I had to call the hospital long distance,” he recalled recently. “I complained to the hospital about the lack of a response to her call button and received an apology. There was obviously no defense.”
Whether it’s a request for ice water, help getting to the bathroom or a plea for pain relief, an unanswered call light leaves hospital patients feeling helpless and frustrated. And for nurses, often the first responders to these calls, the situation is frustrating too: Short staffing and a heavy workload often make it impossible to respond as quickly as they would like.
Now some hospitals around the country are starting programs to deal with the problem.
Presbyterian Healthcare Services, which operates three hospitals inAlbuquerque, began focusing on improving the efficiency of its call light system after hearing complaints from focus groups of nurses and patients.
The company discovered that requests could be handled far more efficiently if call-button calls were sent to a central operator.
That operator can summon support workers via text message to take care of simple requests, like pillows or help with the television remote, freeing nurses to deal with bigger problems like pain relief or tangled IV lines. The hospitals now use the system in 13 units with a total of 400 beds, with plans to expand it further.
“We’ve really fundamentally changed the way we interact with our patients around their needs,” said Lauren Cates, the hospitals’ chief operating officer. “If you press a call light you have no idea if anyone is listening. Now we interact with the patient much more quickly.”
In national patient satisfaction surveys, Presbyterian has moved from the 40th percentile in call response promptness to the 75th percentile. And the company says it has seen a 92 percent reduction in patient complaints about lack of communication.
Moreover, of the 1,400 patient calls the system receives each day, about 10 percent are mistakes, caused by rolling over on the button or mistaking it for the television remote.
“Think about how much wasted time, with 140 errors a day, for our nurses who had to drop what they were doing and respond,” Ms. Cates said. “It’s made a real difference in the productivity of our staff.”
In one case, a patient gasping for air hit the call button, which the operator answered in a matter of seconds. When the operator heard the patient’s distress, she alerted an emergency response team, which rushed to the bed and performed CPR, saving the patient’s life.
At Montefiore Medical Center in the Bronx, a program called No Passing Zone trains all hospital workers — maintenance people, secretaries, volunteers, security officers and, yes, doctors — to stop what they are doing, if possible, and look in on a patient when they see the call light illuminated.
“The call bell is the patient’s lifeline,” said Jeanne DeMarzo, clinical director of nursing. “We need to act quickly and promptly to respond to the patient’s concern.”
As the Albuquerque system found, many call-light requests can be handled by nonmedical staff. When the patient has a medical need, the responder immediately tracks down a qualified employee to take care of it.
In addition, under a “rounding” program, a nurse, administrator or hospital aide must stop by each patient’s room once an hour, regardless of whether the call light is on. “Rounding proactively to address patient needs helps avoid use of the call bell,” said Joanne Ritter-Teitel, vice president and chief nurse executive.
Even doctors sometimes answer patient calls. “Bedpans are certainly one of the things I would happily reach for if a patient needed one,” said Dr. William Southern, chief of hospital medicine at Montefiore. “Call bells are something that me and my entire staff think it’s important to answer. It’s extraordinarily important to patients and their families.”
For patients, changes like these can’t come soon enough.
Walter Rhett, 59, of Charleston, S.C., spent time in the hospital last year for thoracic surgery and needed assistance going to the bathroom after being given laxatives. The cord to the call button device was tangled in the various tubes connected to hospital machines. After ringing for the nurse he waited and waited, but no one arrived. Finally, unable to wait any longer, he soiled his bed and rang the nurse again to be cleaned up. That time, the nurse showed up quickly, he said.
When Liz Farrar, 30, of Austin, Tex., was trying to breast-feed her day-old son last year, she called the nurse repeatedly for help.
Gestational diabetes during pregnancy had put the baby at risk, and when she did not get immediate help with breast-feeding and, later, a bottle, the baby’s blood sugar dropped and he wound up in the neonatal intensive care unit for five days.
“After the first night, every nurse and doctor were very helpful,” said Ms. Farrar, whose son has fully recovered. “But it makes my temperature rise just thinking about the first night.
“Bottom line, never leave anyone in the hospital overnight by themselves immediately after a procedure or birth, even if they tell you it’s O.K.”
http://well.blogs.nytimes.com/2011/05/30/tuning-in-to-patients-cries-for-help/?ref=health
Na categoria Azimutes | Com as tags Qualidade, Saúde | Deixar um Comentário »
Ao ler este artigo não consegui deixar de o aqui colocar. Um retrato social da classe médica americana que valerá a pena ler.
by Setu Mazumdar, MD
Everywhere I go I see unhappy doctors.
All everyone does is complain about rising malpractice premiums, more paperwork, declining pay, and 60 hour workweeks. This includes physicians just graduating from residency and physicians who’ve been practicing medicine for several decades.
All of those complaints are legitimate, but one question I always have in my mind about the physicians who are in their 50s is, “Why are you still practicing medicine full time?”
I keep hearing about the “golden age” in medicine. I don’t know what that means, but I assume it has something to do with making more money than we do now.
Suppose you’re a 55 year old physician and you’ve been practicing medicine for 25 years full time. If you absolutely love it, that’s great. It’s your passion so go for it. But for the rest of you (which is the majority I think) who are in your 50s, who experienced the “golden age” in medicine and are still practicing full time and complaining, I’ve got to be blunt: you have failed miserably in your investment career.
What do I mean by this? Let’s say you graduated from residency in June 1985 and started making some money. Suppose you socked away on average $25,000 per year in the US stock market each year for the past 25 years starting in January 1986. The US stock market as represented by the S&P 500 index had an average annual return of 9.9% in that period. So over 25 years your investment portfolio should be at least $2.5 million.
And that’s with putting away only $25,000 a year on average. Bump that up to $50,000 every year — which is an entirely reasonable and attainable amount for a physician to invest every year — and you should have at least $5 million in the bank.
Even if you invested only in bonds you’d have about $1.7 million saving $25,000 a year and nearly $3.5 million saving $50,000 a year. This is based upon the US aggregate bond market index.
How many of you actually have that? Sure a few you might, but I’d bet that the vast majority of you don’t. And I also bet that the reason you’re working full time right now is because you realize you didn’t save enough and invest well. Common reasons why you have a meager portfolio value are:
Now you feel trapped in your current situation.
So if you are a physician in your 50s or older and are complaining about your situation, you completely blew a phenomenal time to invest and really don’t have anything to complain about except your missed opportunity. You should have enough to walk away if you want. If you don’t and unless you jump up and down in joy every time you go to the hospital or when you’re on call, it’s time to crack the whip and get moving because the next 25 years are going to be a challenging environment to practice medicine to say the least. And if the chatter I’m hearing is accurate, I don’t think you want to practice medicine full time until you’re 80.
Setu Mazumdar is an emergency medicine physician and President of Lotus Wealth Solutions. This post originally appeared in Freelance MD.
http://www.kevinmd.com/blog/2011/05/physicians-blame-unhappy-medicine.html
Na categoria Nortadas | Com as tags Profissões, Sociedade | Deixar um Comentário »
Quem disse que era difícil criar um bébé?? Desprovido de qualquer experiência na matéria em análise, farei unicamente voz dos tantos que comigo falam acerca deste tema…
Assim, para esses, os problemas acabaram (?). A Apple lançou por intermédio do criativo Bruno Soulez o “Baby Manager”. Um aplicativo para iPhone, iPad e iPod que promete dar a resposta às perguntas mais difíceis dos pais.
Depois de descarregar o aplicativo da iTunes Store, diria que “criar um bebé” nunca foi tão barato (0,79 €).Após inserir os dados solicitados poderá começar a utilizar as diferentes ferramentas. O horário de amamentação, a média de biberões consumidos por dia, as fraldas que foram necessáras trocar, são os recursos mais banais. À semelhança de qualquer sistema de informação, o “Baby Manager” disponibiliza um recurso de análise que permitirá aos pais mais exigentes saber qual dos dois, pai ou mãe, é o mais rápido a mudar a fralda….
É caso para se dizer que, não bastará adoptar a tecnologia, seria interessante saber a opinião do próprio “visado” no sentido de perceber se “rapidez” é sinónimo de “qualidade”….
Na categoria Azimutes | Com as tags iPhone | Deixar um Comentário »
O erro em saúde é cada vez mais uma preocupação ao nível da gestão dos cuidados. Não faltarão por certo contributos que atestem a necessidade da adoção de políticas e práticas consistentes com os melhores resultados.
Também é certo que a dificuldade assenta na transição dos orientações dos níveis estratégicos e táticos para o nível operacional. Envolver e co-responsabilizar todos os intervenientes, accountability e transparência na apresentação de resultados.
Os nossos utentes merecem isto e muito mais.
Um em cada dez doentes internados em hospitais foi vítima de erros de saúde – Sociedade – PUBLICO.PT.
Na categoria Nortadas | Com as tags Qualidade, Saúde | Deixar um Comentário »
Valerá sempre a pena ver.
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João Gomes