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To make full disclosure work, you first have to remember that it is not a program or an effort, or a policy, says a leader at one hospital that has undergone a major change in way adverse events are discussed with patients and families. Full disclosure is more of a philosophy and an overall way of working with people, says the chief operating officer and vice president of care delivery at Childrens Hospitals and Clinics of Minnesota in Minneapolis.
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Any statement by staff that is construed as discouraging a patient from staying for treatment could be seen as an EMTALA violation.
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A woman presented to the ED of a hospital. When told there would be a two-hour wait to be seen, she tried to drive to another hospital but had to stop and call for emergency medical assistance. She was taken by ambulance back to the first hospital where, several hours she later, she was diagnosed with a perforated bowel. Rather than immediately undergo the required emergency surgery, she agreed to be transferred to another hospital. She died shortly after arriving at the receiving facility.
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The Confidentiality Coalition, a group of hospitals, health plans, drug companies, medical device manufacturers, biotech firms, health product distributors, pharmacies, employers, medical teaching colleges, and others, is asking Health and Human Services Secretary Mike Leavitt to use his authority to change the HIPAA privacy rules accounting of disclosures requirement.
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An editorial in the February Annals of Epidemiology expresses concern that HIPAAs efforts to enhance patient confidentiality by restricting access to medical records is slowing the progress of critical biomedical research.
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Risk managers know better than most people that, while living wills can be useful in some circumstances, they do not guarantee that end-of-life decisions will be simple or uncontested. The Schiavo case proves that point well, says the Chauncey Stillman Professor of Law at the University of Michigan Law School and professor of internal medicine at UM in Ann Arbor.
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Many agencies and nonprofit organizations that tout living wills are reporting a sharp increase in people seeking the documents because of the Schiavo case, so you can expect more patients to show up with questions about them or clutching a living will that they downloaded off the Internet.
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Living wills just arent worth the paper theyre printed on, say two experts who have looked at how the documents are really used.
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Disclosure is a complex process, not simply an opportunity to sit at the patients bed side and say youre sorry, says the chief operating officer and vice president of care delivery at Childrens Hospitals and Clinics of Minnesota in Minneapolis.
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While computerized physician order entry (CPOE) is expected to significantly reduce medication errors, systems must be implemented thoughtfully to avoid facilitating certain types of errors, according to a recent study.
