The New Parts...PO Day 150

If you watch a lot of television, like I do, you probably know one way the detectives identify "the body" is by serial numbers on some body part implant. Well, as far as I can tell, there are no serial numbers on artificial joint implants. It would seem that there would be but I can't find any evidence on the web.

There have been some "recalls" by joint manufacturers. The couple I found were not for the joint parts themselves but rather for one of the very specialized instruments used in fitting or assembling the parts at the time of surgery. It would be very upsetting to have an implanted part of your artificial shoulder recalled if you were doing fine! Could you be required to have surgery to remove it? I wouldn't think so.

There are reasons that a re- operation is necessary but they do involve problems with the existing shoulder. Instability or dislocation are two main reasons a patient may be looking at repeat surgery. While these situations are not common early on, instability  due to wearing of the liner of the glenosphere is one reason the surgery is said to "last", depending on who is talking, seven to ten to twenty years. RTSA patients who use their new shoulder in more physically demanding ways, in sports or physical labor, face this problem earlier. Chronic, recalcitrant infection, when it simply will not respond to antibiotic treatment, can necessitate surgery.

Rarer is base plate failure. In fact, it might be a problem that has been resolved with design changes as it is seldom mentioned in current literature. I hope so. But, having just said that, I found an article that says it is the biggest post operative complication. I can't tell when the article was written, this is the problem with web research. Let's hope it has been resolved. Periprosthetic fracture of the humerus and acromiom fractures can occur but do not require surgery as far as I can tell.

I am counting on none of these really bad things happening. I suppose there is no avoiding the relentless march  of time and the normal wear and tear of life. I expect ten years and hope for twenty. Dr. Kai is young, I hope he will still be around when I need him.

http://youtu.be/qy1A5KQhq28


Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--

Patient hand washing 101..PODay 144

So, after tattling on hospital staff who don't wash their hands as often as they should, here comes a study by a Canadian group published in Infection Control and Hospital Epidemiology that looks at patients who are in the hospital. The team tracked 279 adults who were patients in an organ transplant ward.  They found only about 30% washed their hands during bathroom visits, 40% at mealtime, 3% while using patient kitchen facilities, 3% on entering their hospital rooms but amazingly, 7% washed their hands when exiting their rooms.

Women were more likely to wash their hands and more likely to use soap than men. For some strange reason all patients were more likely to wash their hands later in the day than in the morning.

It looks like we patients are doing a much poorer job than the hospital staff. But we are the ones paying the price. The U.S. CDC ( Centers for Disease Control and Prevention)  reports that one in twenty-five hospital patients will contract at least one hospital related infection and in 2011 there were 722,000 cases of hospital acquired infection, some serious or life threatening.

Hand washing is very effective in preventing transfer of infections and it is a simple, inexpensive thing to do. We all know we should do it, are we just lazy? Are we rebelling against our mother's voice in our head? Are we in too big a hurry? Whatever the psychological explanation, the physical effects of not washing hands is real and risky. Not only do we need to nag the hospital staff, our guests and even our doctors, we need to look at ourselves as a source of contamination and change our habits! Since infection is a lifelong risk to the total shoulder replacement surgery patient, we need to be especially attentive to the little things like unwashed hands that put us at risk as well as the big things like a purulent wound on a cut foot.

http://www.youtube.com/watch?v=BoHssZ_jBTc&sns=em

Penalties for readmission.PO Day 133

So I told you about the Hospital Compare site in Post 130. It sounded so benign and like the whole purpose was to be supportive of hospital and patient alike. It turns out the government gives and the government takes away.

Compiling all those statistics about readmissions to the hospital and educating patients and hospital staff to recognize little problems before they turn into big ones to prevent those readmissions has a more punitive  outcome. Since 2010 data has been being compiled about readmittance rates for patients who were in hospital for heart attack, heart failure and pneumonia. Hospitals are fined for patients who are readmitted within 30 days of discharge. Now hip and knee replacement surgery patients have been added to the list.

Hospitals can be penalized as much as 3% of their medicare charges. 2610 hospitals across 29 states will be penalized these year. More  hospitals are being fined this year because of the addition of the joint replacement surgeries even though they have reduced the readmission rates for other conditions. Hospitals are in a "catch 22" situation as the financial gain of readmission outpaces the fines for too high a rate of readmissison. What to do?

I suppose eventually shoulder replacement surgery will be added to the list of conditions for which hospitals can be fined. I am so glad that has not happened yet or I would be one of those patients who are part of the problem! In some weird way I do feel like a "bad" patient for developing complications that  put me back in the hospital. I am just glad that at this stage I don't count.

Hospital compare site...P O Day 130

CMS, the government administrative arm of Medicare, has created "the Hospital Compare" data base. This allows the Medicare patient to compare the rate of unplanned readmissions or deaths within 30 days of being in the hospital of their choice with the rate of those unfortunate events at other hospitals locally or nationwide. The purpose is to improve the quality of care with a measurement  that is easy for the consumer to understand. The goal for the hospital is to anticipate and prevent problems that lead to readmission or even death following hospitalization for certain conditions.

"Hospital Compare" records and reports instances when the patient is readmitted to the hospital within 30 days of discharge if they were initially treated for 1. heart attack, 2. heart failure, 3. pneumonia, 4. hip/knee replacement surgery, or 5. hospital-wide readmission to include internal medicine, surgery/gynecology, cardiorespiratory, cardiovascular and neurology services.

Also reported is the 30 day death rate from heart attack, heart failure or pneumonia.

They keep track of surgical complications such as: pneumothorax, blood clots, postoperative wound dehiscense, accidental puncture or laceration, pressure sores, venous catheter related infections, postoperative hip fracture due to a fall, and postoperative sepsis.

Ultimately this data serves two purposes: First, the patient can go to the Hospital Compare Home Page and compare the record of three hospitals of their choosing. This rate is also compared to national averages. Second, Hospital Compare is part of the Hospital Quality Initiative whose intent is to help improve hospitals' quality of care by distributing objective, easy to understand data on hospital performance. both for the benefit of the patient and the hospital.

This is a great way to be able to compare your local hospital with other nearby facilities and even nationwide statistics. To go to the Home Page of Hospital Compare by clicking on this link
http://www.medicare.gov/hospitalcompare/search.html:

I briefly mentioned this medicare site on P O Day 83 so if you have already checked it out thoroughly, forgive the repetition.

Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--