Surgery News - February 2008 - (Page 1)

VOL. 4 • NO. 2 • FEBRUARY 2008 FLORIDA IOM Committee Looks Into Safety Of Work Schedules ACS is developing recommendations. BY CHRISTINE KILGORE INSIDE Opinion Meeting Expectations ACS Executive Director Thomas R. Russell shares last year’s successes and this year’s goals. • 8 LESLIE HARLIN/UNIVERSITY OF Else vier Global Medical Ne ws Many tumors termed unresectable in the past are amenable to resection with current therapies, said Dr. Alan W. Hemming. Expertise Can Extend Liver Resectability B Y J E F F E VA N S Else vier Global Medical Ne ws H O T S P R I N G S , VA . — An aggressive approach to liver tumor resection that incorporates skills from surgical oncology and liver transplantation may, in expert hands, redefine what is considered unresectable, according to Dr. Alan W. Hemming. Liver resection has “to some degree been standardized” with an operative mortality of 1% over the past decade for operations such as right and left lobectomies, said Dr. Hemming, an ACS Fellow who is professor and chief of the division of transplantation and hepatobiliary surgery at the University of Florida, Gainesville. With the development of new treatment modalities in the past 2 decades, some surgeons have tried to extend liver resection to manage tumors previously considered unresectable. These techniques include active chemotherapy, combined resection and ablation, and vascular resection and reconstruction for tumors involving the vascular structures of the liver, as well as portal vein embolization or staged resection when too little or too much of the liver would be left behind in a standard resection, Dr. Hemming said. “Many of the tumors that were termed unresectable in the past are now amenable to resection,” See Liver • page 18 WA S H I N G T O N — Five years after the establishment of across-specialty rules to limit resident work hours, the issue of trainee schedules in teaching hospitals is again under the microscope as a continuing threat to patient safety—and this time an Institute of Medicine committee has been forewarned that specific “workable” solutions are needed. The schedules in teaching hospitals “belie virtually all the tenets of providing good health care. How can we profess to provide the best possible quality of care when we know we have staff members who are operating at levels of sleep deprivation so severe that they are similar to someone driving under the influence of alcohol?” asked Dr. Carolyn Clancy, director of the federal Agency for Health Care Research and Quality. “If we don’t give members of Congress some workable solutions, they’ll come up with their own,” she told members of an IOM Committee on Optimizing Graduate Medical Trainee Hours and Work Schedules. The committee, which held the first of four workshops in December, was formed at the request of Rep. John D. Dingell (D-Mich.) and colleagues on the House Committee on Energy and Commerce as part of an investigation into preventable medical errors. The IOM will publish a report including strategies and actions for implementing safe work schedules in February 2009. In response to the IOM initiative, Dr. Gerald B. Healy, a Fellow and president of the American College of Surgeons (ACS), has convened a special task force. “The body of evidence considered by the committee up to this point may not See Work Schedules • page 3 Drug Developments Silver Lining A silver-coated endotracheal tube for airway management has been shown to reduce the incidence of VAP. • 1 1 News From the College HOD on Health The House of Delegates has addressed several health policy initiatives. • 1 2 Transplant Longer Liver Life? Early data on an extracorporeal liver assist device have prompted ‘cautious enthusiasm.’ • 1 9 Report Faults Specialty Hospitals’ EDs B Y A L I C I A A U LT Else vier Global Medical Ne ws VITAL SIGNS specialty hospitals are largely unprePhysician-ownedemergencies pared to handle and should be more closely tracked by the government to ensure that they comply with Medicare rules, according to a report from the Inspector General of the Department of Health and Human Services. The IG’s office reviewed written policies for managing medical emergencies, staffing schedules, and staffing policies for 8 days at 109 physician-owned facilities that were identified from a list provided by the Centers for Medicare and Medicaid Services. There are an unknown number of physician-owned specialty hospitals, according to the Majority of Specialty Hospitals With Emergency Departments Have Only One Emergency Bed 2-5 beds (17%) 1 bed (58%) 6-8 beds (15%) IG, which is urging the CMS to begin compiling a list. Of the 109 hospitals surveyed, 66 were surgical, 23 were orthopedic, and 20 were cardiac hospitals. Eighteen of the cardiac hospitals had an emergency department; only 11 of the 23 orthopedic hospitals and 31 of the surgical hospitals had an ED. Thirty-three of the 109 hospitals were in Texas, 15 were in Louisiana, 9 in Oklahoma, 9 in SURGERY NEWS Kansas, and 8 in South Dakota. The rest were spread across other states. Half of the physician-owned hospitals surveyed had an emergency department, but more than half of those EDs only had a single bed, and only 45% had a physician on site at all times. Ninety-three percent of the hospitals met Medicare staffing See Specialty Hospitals • page 2 Presorted Standard U.S. Postage PAID Permit No. 384 Lebanon Jct. KY ELSEVIER GLOBAL MEDICAL NEWS 9-10 beds (8%) Other* (2%) 60 Columbia Rd., Bldg. B Morristown, NJ 07960 CHANGE SERVICE REQUESTED *Shares the emergency beds of an adjacent hospital. Note: Based on 2007 data for 60 physician-owned specialty hospitals with emergency departments. Source: Department of Health and Human Services

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Surgery News - February 2008 Contents IOM Committee Looks Into Safety Of Work Schedules Expertise Can Extend Liver Resectability Report Faults Specialty Hospitals' EDs Meeting Expectations Silver Lining HOD on Health Longer Liver Life?

Surgery News - February 2008

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