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Boutique; concierge; retainer. These are all words used to describe physician practices that charge patients an annual fee for access. And while there don't appear to be firm numbers on such practices, some say they are meeting an important need in a broken health care system.
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[Editor's note: This is Part 2 of an article that appeared in the April 1, 2009, issue of Medical Ethics Advisor.]
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(Editor's note: Janiak has served as an emergency medicine medico-legal consultant for more than 30 years, and he has reviewed hundreds of malpractice cases. In the process, he has recognized common patterns and mistakes that emergency physicians make that set them up to be sued. With his tongue firmly planted in his cheek, Janiak points out the following potential mistakes and ways that lawsuits are created.)
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Among the most challenging standards from The Joint Commission for the first half of 2008 was standard IM.6.50 "Designated qualified staff accept and transcribe verbal or telephone orders." According to the organization, 40% of hospitals were not in full compliance.
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The Joint Commission has released a monograph titled "Measuring Hand Hygiene Adherence; Overcoming the Challenges," to help health care organizations target their efforts in measuring hygiene performance.
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Several EDs across the country have initiated policies to encourage patients who don't face "true" emergencies to seek care elsewhere in the community and to find "medical homes," but none have been met with the outrage that descended upon the University of Chicago Medical Center recently.
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The senior emergency center at Holy Cross Hospital in Silver Spring, MD, may be a rarity, but based on the responses of patients and staff not to mention our increasingly aging population perhaps more EDs should consider creating a separate unit for older patients.
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A new program in Houston that involves tight teamwork between The University of Texas Medical School at Houston, the Memorial Hermann Heart and Vascular Institute Texas Medical Center, and the Houston Fire Department EMS, as well as an experimental "cocktail" given in the ambulance to patients meeting certain criteria, has dramatically reduced Percutaneous Coronary Intervention (PCI)-to-balloon time and improved survival rates.
