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Clinical Laboratories and Pathology Groups

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Clinical Laboratories and Pathology Groups

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Stanford University Researchers Finds Physician Burnout as Big a Threat to Patient Safety as Unsafe Hospital Conditions; Exhausted Providers Twice as Likely to Make Medical Errors

Pathologists might be able to help overburdened doctors by adding medical laboratory support services that assist providers in selecting the right tests and identifying the best therapeutic options for patients

In a new Stanford University School of Medicine study published in the July 9, 2018, issue of Mayo Clinic Proceedings, researchers indicate that physician burnout may be as big a cause of medical errors as unsafe healthcare environments. This highlights an opportunity for clinical laboratory professionals and pathologists to help physicians improve both diagnostic accuracy and the selection of the most appropriate therapies.

The study found that exhausted providers were twice as likely to report making a medical error. However, it’s a complex problem with no easy solutions.

“Just trying to fix the setting of healthcare environments in order to prevent errors is not sufficient,” Stanford University’s Daniel Tawfik, MD, MS, the study’s lead author, told Reuters Health. “We also need to address the actual underlying human factors that contribute to errors—specifically looking at physician burnout.”

Nevertheless, while there is no one-size-fits-all solution to physician burnout, clinical laboratory managers and pathologists potentially could help overburdened providers reduce burnout and fatigue by adopting new lab testing support services designed to assist physicians in selecting the right tests and identifying the best therapeutic options for their patients.

Medical Errors Third-Leading Cause of Death in America

Stanford researchers wanted to learn how physician burnout contributes to medical errors which, according to Johns Hopkins, is the third-leading cause of death in the US. They surveyed 6,695 physicians from across America. Of the respondents:

  • More than 54% reported symptoms of burnout­;
  • 33% experienced excessive fatigue;
  • Nearly 7% had thoughts of suicide; and,
  • Roughly 4% reported a failing safety grade in their primary work area.

Even in medical units judged to have excellent safety records, the study found rates of medical errors nearly tripled when physicians working in those units had high levels of burnout. The prevalence of errors became similar to a non-burned-out physician working in a unit with a safety grade of “acceptable” or “poor.”

“We found that physicians with burnout had more than twice the odds of self-reported medical error, after adjusting for specialty, work hours, fatigue, and work unit safety rating,” Tawfik noted in a Stanford news release. “We also found that low safety grades in work units were associated with three to four times the odds of medical errors.”

According to the study, overall, 10.5% of physicians surveyed acknowledged in the prior three months making:

  • An error in judgment;
  • A wrong diagnosis;
  • A technical mistake during a procedure;
  • Prescribing a wrong drug/dosage; and/or,
  • Ordering medication/intervention for the wrong patient.

While more than half of mistakes (55.4%) did not affect patient outcomes, or only caused a temporary problem (22.6%), more than 5% of errors did lead to major permanent health problems and 4.5% resulted in a patient death, the study found.

Radiologists, neurosurgeons, and emergency medicine specialists had the highest prevalence of error rates, with more than 21% of providers in each of those fields acknowledging recent mistakes.

Physicians reporting errors were more likely to have symptoms of overall burnout (77.6% versus 51.5%), as well as fatigue (46.6% versus 31.2%), than error-free providers. Physicians reporting recent errors also had a higher prevalence of suicidal thoughts (12.7% versus 5.8%), the study found.

Ted Hole, MD, a family practice physician in Ventura, Calif., is not surprised by the correlation between medical mistakes and overall well-being. “If your brain isn’t working right, you’re going to make errors,” Hole told the Ventura County Star. “That’s what burnout does. It makes your brain not work right.”

Stanford Connects Physician Burnout and Poor Workspace Safety Ratings

In their paper, the Stanford researchers argue a “combination of physician-targeted burnout interventions and unit-targeted patient improvement measures” are needed to tackle the problem of medical errors. Physicians who gave their work units an excellent, very good, or acceptable safety grade were less likely to make a medical error than those who described workplace safety as poor or failing.

Of the physicians who reported a poor or failing work unit safety grade, nearly 25% reported a recent error. Errors were incrementally lower for work units with higher safety grades regardless of physician burnout levels.

“This indicates both the burnout level as well as work unit safety characteristics are independently related to the risk of errors,” Tait Shanafelt, MD, Director of the Stanford WellMD Center and Associate Dean of the School of Medicine, noted in a Stanford statement.

“Today, most organizations invest substantial resources and have a system-level approach to improve safety on every work unit,” he said in the Stanford news release. “We need a holistic and systems-based approach to address the epidemic of burnout among healthcare providers if we are truly going to create the high-quality healthcare system we aspire to.”

Tait-Shanafelt-MD

Tait Shanafelt, MD (above), is Director of the Stanford WellMD Center, Associate Dean of the School of Medicine, and an author of the Stanford study. He maintains the “epidemic of burnout” among healthcare providers should receive as much attention as safety issues. Shanafelt became Stanford Medicine’s first Chief Wellness Officer in 2017. (Photo copyright: Stanford School of Medicine.)

Burnout Among Physicians Increasing

Other studies, including Medscape’sLifestyle Report 2017: Race and Ethnicity, Bias and Burnout,” confirm an upward trend in burnout rates among US physicians. In the Medscape study, 51% of physicians surveyed reporting being “burned out,” defined as a loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment. Since the Medscape Lifestyle Report first queried physicians about burnout in 2013, the number of providers reporting burnout has increased 25%.

Physician burnout has been attributed to a variety of factors, including:

  • Excessive workloads;
  • Financial stress;
  • Extra hours spent on clerical work or EHR-related tasks; and,
  • Loss of human-to-human interaction between physician and patient.

Robert Lum, MD, an Oxnard, Calif.-based radiation oncologist, blames the shift to corporate-owned medical practices for some of the reported increases in burnout among physicians. Lum told the Ventura County Star he stays upbeat by never losing sight of why he became a physician.

“If you focus on the reason you went into medicine in the first place, which is to help people and marvel at the miracles modern medicine is able to do, then you’ll have less burnout,” he said.

Nevertheless, other solutions also can help. Clinical laboratories play a key role in maximizing physician/patient encounters. By extension, physicians and laboratories are linked in unique ways that enable labs to reduce physician burden and ensure positive healthcare outcomes.

—Andrea Downing Peck

Related Information:

Physician Burnout, Well-being, and Work Unit Safety Grades in Relationship to Reported Medical Errors

Study Suggests Medical Errors Now the Third Leading Cause of Death in the U.S.

Medical Errors May Stem more from Physician Burnout than Unsafe Health Care Settings

Study Says Rising Doctor Burnout Means Rising Medical Errors

In a First for U.S. Academic Medical Center, Stanford Medicine Hires Chief Physician Wellness Officer

Medscape Lifestyle Report 2017: Race and Ethnicity, Bias and Burnout

Physician Burnout a Key Driver of Medical Errors

 

Clinical Laboratories and Pathology Groups May See Fewer Fee-For-Service Payments as More Hospitals and Health Systems Become Self-Insured

As national health insurers push more risk to hospital systems and medical groups, many hospital administrators become more interested in establishing their own health insurance companies

New modes of provider reimbursement—such as bundled payments and budgeted payments—are motivating hospitals and health systems to reconsider their existing relationships with health insurers. Hospital administrators want to control the dollars they save by improving patient care, instead of allowing insurance companies to capture that money.

To accomplish these goals, more and more hospitals and health systems across the country are making one of three moves:

• Funding their own health plans;
• Partnering with health insurance companies; or,
• Buying health insurance companies.

As this trend gathers momentum, it will put the medical laboratories of hospitals in a much better position to regain access to patients. It can be expected that hospital administrators will include their own clinical laboratories and anatomic pathology providers in their own health insurance provider networks. (more…)

Harvard Researchers Demonstrate a New Method to Deliver Gene-editing Proteins into Cells: Possibly Creating a New Diagnostic Opportunity for Pathologists

This technology has potential to create a demand for pathologists to do genetic analysis as a companion diagnostic in support of physicians treating patients with gene-editing proteins

Researchers at Harvard University have demonstrated a new method to deliver gene-editing proteins into cells. This breakthrough could eventually trigger a demand for pathologists to do genetic analysis as the companion diagnostic needed to help clinicians select appropriate gene-editing therapies for their patients.

Of course, it will be several years before such a scenario is feasible. The related example are the companion diagnostic tests that clinical laboratories perform to guide a physician’s decision on an appropriate therapeutic drug. Continued development of gene-editing therapies has the potential to increase the need for pathologists and medical laboratory scientists to do genetic analysis as a companion diagnostic for patients who would benefit from a gene-editing therapy.

The Harvard University researchers used commercially available cationic lipids to deliver genome-editing proteins into cells. The system works on living animals and humans, and the technology enables scientists to precisely and easily change DNA sequences at exact locations. The full study was outlined in an October Nature Biotechnology article. (more…)

More Hospital Closed Due to Empty Beds as Providers Succeed in Reducing Hospital Admissions: Pathologists Should Respond with Outpatient/Outreach Services

With patient care shifting to outpatient clinics and home-based medical care, clinical laboratory managers should beef up outreach lab testing services

Declining patient volume is shuttering hospitals across the United States as hospitals lose patients to ambulatory care centers and home-based medical care. This trend directly impacts the pathologists and medical technologists who work in the clinical laboratories of these hospitals.

Empty Beds Indicator of Failing Hospitals

Most pathologists are unaware that, between 2008 and 2013, nearly 130 community hospitals closed. That left 4,974 hospitals operating in the United States, according to American Hospital Association (AHA) 2015 Hospital Statistics, which are based on data from the 2013 AHA Annual Survey.

It is no surprise that below-average occupancy rates are a common denominator of most failed hospital, noted the Medicare Payment Advisory Commission (MedPAC). The 14 hospitals that closed in 2013 had an average occupancy rate of 34%. This is lower than the 48% average occupancy rate of the hospital nearest to the closing hospital, MedPAC stated in its March 2015 report to Congress. (more…)

Understanding Today’s Trends in Healthcare and the Clinical Laboratory and Pathology Testing Marketplace

Recent White Papers detail solutions for implementing new payment strategies for medical laboratories and pathology groups

Clinical diagnostic laboratories, pathology groups and healthcare institutions are carrying significant and potentially unsustainable levels of unreimbursed services. Although bad debt and uncompensated care in the healthcare industry are not new, they have been increasing at the same time that downward pressure is being applied to reimbursement.

Medical laboratories and pathology groups are also facing enormous levels of change in their clinical, regulatory and financial environments. As the Affordable Care Act is implemented, laboratories see downward pressure on reimbursement at both the federal and payer level, coupled with increased emphasis on efficiency and quality.
(more…)

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