Published 7/1/2010

Second Look—Advocacy

If you missed these Headline News Now items the first time around, AAOS Now gives you a second chance to review them. Headline News Now—the AAOS thrice-weekly, online update of news of interest to orthopaedic surgeons—brings you the latest on clinical, socioeconomic, and political issues, as well as important announcements from AAOS.

Lapses in infection control common at ASCs
A study published in the Journal of the American Medical Association (June 9, 2010) finds lapses in infection control at ambulatory surgery centers (ASCs). Of 68 ASCs inspected in Maryland, North Carolina, and Oklahoma, 46 had at least one lapse in infection control, and 12 had lapses in three or more of five infection control categories. The most common lapses included using single-dose medication vials for more than one patient, failing to adhere to recommended practices regarding reprocessing of equipment, and lapses in handling of blood glucose monitoring equipment.

Interruptions reduce clinical time
According to a study published online in Quality and Safety in Health Care, interruptions reduce the amount of time physicians spend on clinical tasks, and some tasks may be abandoned. The prospective observational time and motion study conducted in the emergency department of a 400-bed teaching hospital included observing 40 clinicians over 210.45 hours. On average, physicians were interrupted 6.6 times per hour; 11 percent of tasks were interrupt-ed, and 3.3 percent were interrupted more than once. Physicians multitasked 12.8 percent of the time. Overall, the mean time on task (TOT) was 1:26 min, and interruptions were associated with a significant increase in TOT. Additionally, physicians failed to return to 18.5 percent of interrupted tasks.

NIH beefs up disclosure rules
The National Institutes of Health (NIH) has proposed guidelines that tighten conflict-of-interest restrictions on researchers who receive federal funding. The new rules reduce the minimum payment that researchers must report from $10,000 to $5,000. Any institution employing researchers who take NIH funds must monitor compliance with the reporting rule, and funding information must be posted on a public Web site.

FDA revises labels for PPIs
The U.S. Food and Drug Administration (FDA) is revising the prescription and over-the-counter labels for proton pump inhibitors (PPIs) to include new safety information about a possible increased risk of fractures of the hip, wrist, and spine with the use of these medications. FDA’s review of several epidemiologic studies found that individuals who received high doses of PPIs to treat heart burn or used them for one year or more are at greatest risk for these fractures. Most studies evaluated individuals 50 years of age or older, and the increased risk of fracture primarily was observed in this age group. FDA recommends that healthcare professionals prescribing PPIs should consider whether a lower dose or shorter duration of therapy would adequately treat the patient’s condition.

Physicians sue to overturn healthcare reform provision
HealthLeaders Media
reports that Physician Hospitals of America (PHA) and Texas Spine & Joint Hospital have filed suit against the federal government to overturn Section 6001 of the Patient Protection and Affordable Health Care Act, which limits the development of new physician-owned hospitals or the expansion of existing ones unless key requirements are met. According to the PHA, the law “treats physicians different than any other class of citizen.” Physicians may face an uphill battle because they will have to show that no legitimate justification for the restrictions exists.

More physicians becoming hospital-employed
Data released by the Medical Group Management Association finds that 65 percent of established physicians and 49 percent of physicians hired out of residency or fellowship were placed in hospital-owned practices during 2009. According to the data, specialists were guaranteed a median income of $240,000 in hospital-owned practices, compared to $230,000 guaranteed by other practices. The report also finds that the gap between primary-care and specialist compensation is shrinking.

Government funding for medical liability projects
The Wall Street Journal reports that the U.S. government has begun distributing $25 million in grants to fund demonstration programs designed to examine ways to reduce medical liability premiums. The grants will fund a series of demonstration projects covering areas such as alternative dispute resolution, medical error disclosure, development of evidence-based guidelines, and definition of a legal standard of care for healthcare providers.

Hospira expands product recall
Hospira, Inc. (Lake Forest, Ill.)has expanded a voluntary recall of several injectable products because some of the containers may contain particulate matter, primarily made up of subvisible inert stainless steel particles. The particulate contaminants do not dissolve in blood and could potentially act as emboli and impede blood flow. This expanded recall, which began in November 2009, affects additional lots of propofol and Liposyn distributed during a wider timeframe to capture all product that might currently be in customer inventories. The FDA recommends that all existing inventories of these products be quarantined and returned to the manufacturer.