The Joint Commission has released its latest Sentinel Event Alert, targeting disruptive behavior by healthcare providers. Disruptive behavior was considered as a possible National Patient Safety Goal for 2008 but was not selected. The Joint Commission has stated in this most recent alert that rudeness, unpleasant language, hostile attitudes and other bad behaviors not only create an unpleasant environment but are detrimental to patient safety and quality of care. This alert ties into new standards going into effect January 1, 2009, which will require healthcare organizations to create a code of conduct defining acceptable and unacceptable actions as well as crafting a process for dealing with poor behavior. The Sentinel Event Alert provides 11 steps to curbing disruptive behavior. These include providing education and training for healthcare providers about professional behavior and appropriate interactions with coworkers; creating accountability for maintaining appropriate behavior; establishing a zero tolerance policy for disruptive behaviors and a means for enforcing this policy; and crafting non-confrontational methods for reporting and addressing inappropriate behavior. The Joint Commission’s Sentinel Event Alert can be found online here.

A new study published in the Annals of Internal Medicine says that patients who were interviewed after being discharged from a hospital stay reported double the number of adverse events had occurred during their stays than were indicated in their medical records. Patients were interviewed as a part of this study to see if their medical records accurately reflected their care. Of the 998 patients interviewed, 1 adverse event was identified in the medical records of 11% of the group. When interviewed, 23% of patients in that same group reported having experienced 1 adverse event while undergoing care. Interviews also uncovered a higher number of serious events than indicated in medical records. The study recommends placing questions about adverse events in patient’s postdischarge interviews. To read the abstract, click here. (subscription is required to read full version)

The Government Accountability Office (GAO) is suggesting that Medicare consider using prior authorization for MRIs and CT scans as a means of cutting costs, reports the Wall Street Journal Health Blog. Medicare has already tried cutting costs related to imaging by looking through data for unnecessary claims and educating practitioners about only using imaging when necessary. However, the GAO suggests that Medicare implement prior authorization, which would require that physicians get permission from a patient’s insurer to cover the imaging. Recent trends show that use of imaging is up, and that some physicians make a large amount of money from the Medicare revenue related to imaging. Many physicians, however, say this practice may lead to more physicians circumventing the system and sending their patients to the ER instead. Blogger KevinMD feels that way. To read the blog article, click here.

Certain patients at emergency rooms (ER) across the country are being known as ’super users’—those patients who have visited the ER frequently and cost the healthcare system an increasing amount of money each year. The Newark Star-Ledgerreports that some super users visit the ER dozens to hundreds of times a year. This phenomenon is weighing heavily on patient flow throughout the hospital and adding to emergency department overcrowding. In Camden, New Jersey, the top 1% of super users cost the healthcare system $46 million over the past five years. Researchers are focusing on this 1% of patients, examining data to see who they are and why they are so frequently visiting the ER. To read the story, click here.