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January 12, 2023

Nearly 1 in 4 U.S. hospitalized patients experience harmful events, study finds

Almost 1 in 4 people who are admitted to hospitals in the U.S. will encounter damage, in accordance to a examine printed Wednesday in the New England Journal of Medicine.

The stark conclusions underscore that, in spite of decades of effort and hard work, U.S. hospitals however have a extensive way to go to increase affected person basic safety, authorities say.

“These figures are disappointing, but not surprising,” mentioned lead research writer Dr. David Bates, the chief of basic medication at Brigham and Women’s Hospital and the health-related director of medical and top quality analysis for Mass Normal Brigham in Boston. “They do display we however have a lot of perform to do.”

The study seemed at the health-related records of 2,809 sufferers who were being hospitalized in 11 Boston-place hospitals in 2018. The analyze excluded folks who were admitted for observation only or for hospice, rehabilitation, habit procedure or psychiatric care.

Hospital data showed that 663 of the patients — about 24{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} — expert at least a person party for the duration of their stays that negatively impacted their health, even quickly.

A complete of 222 adverse events were being regarded preventable, which means mistakes resulted in client harm. That interprets to about 7{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of the whole admissions the scientists analyzed. Twenty-nine folks, or 1{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of the full of people admitted, professional severe preventable adverse functions that resulted in severe hurt. 1 demise was viewed as preventable.

The vast majority of the negative outcomes, having said that, were being deemed unpreventable. They can contain acknowledged side results from sure drugs or acknowledged challenges affiliated with medical procedures.

The most frequent adverse gatherings general (nearly 40{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}) have been connected to medications given in the medical center. Surgical treatment and other treatments accounted for just over 30{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}, adopted by what the review authors identified as “patient-care occasions,” at 15{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}. They contain falls and bedsores, the two of which are considered preventable.

1 vibrant spot, industry experts said, was that bacterial infections acquired in the medical center accounted for only about 12{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of the adverse activities — a considerable decrease from a 1991 study that observed infections ended up the 2nd-most-popular adverse celebration.

The 1991 review, named the Harvard Healthcare Exercise Research I, is deemed landmark investigation. Working with info from people hospitalized in New York state in 1984, it observed that only about 4{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of hospitalized people seasoned damage. Nonetheless, the examine appeared for a scaled-down vary of adverse gatherings than the existing investigation, and hospitals have develop into a great deal greater at reporting harm when it does take place.

“It’s apparent that, at the very least, the charge is not likely down and that hurt continues to be a actually significant concern,” Bates reported.

Dr. Albert Wu, the director of the Heart for Health Providers and Investigate Outcomes at the Johns Hopkins Bloomberg Faculty of Community Overall health, reported in an electronic mail that whilst development has been created in some areas, new risks have emerged as medication has superior.

“Although we have eliminated some triggers of damage, there are new types of hurt that have been designed, affiliated with potent new medicines and new processes,” mentioned Wu, who was not included with the new investigation.

For instance, drug corporations have produced substantial advancements over the 3 many years given that the very last report was published, but with an abundance of obtainable medicines arrives extra opportunity for medicine-associated glitches.

“There are a lot of additional remedies obtainable today in contrast to 1991, and some of the medications have a scaled-down therapeutic margin, which is the gap among the therapeutic outcome and hazardous dose,” explained Dr. Donald Berwick, the president emeritus and a senior fellow at the Institute for Healthcare Advancement in Boston. Berwick wrote an editorial that was revealed Wednesday alongside the new research.

Even the technologies implemented to reduce medication problems can build new chances for mishaps.

“New technologies are often double-edged and you need to have to have extreme surveillance to keep an eye on them. You need to foresee what can go wrong and construct dykes close to the hazards,” Berwick reported.

Linda Aiken, a professor and the founding director of the Centre for Health Outcomes and Plan Exploration at Penn Nursing in Philadelphia, mentioned that at the coronary heart of the individual safety difficulty is staffing.

“Since we’ve been accomplishing analysis on individual security, we regularly discover that a person of the significant explanations for inadequate affected person results is insufficient figures of nurses at the bedside,” she claimed. “Having a ample range of nurses is a developing block for security.”

In a 2018 analyze published in the journal Well being Affairs, Aiken and her workforce interviewed nurses at 535 hospitals in the U.S. Sixty {cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} claimed that there weren’t ample nurses at their hospitals to present protected treatment. The pandemic exasperated already pressured nursing employees, primary to strikes.

Just a person state, California, has legal requirements regarding the bare minimum amount of employees customers required for basic safety in hospitals. One nurse simply cannot care for more than 5 clients at a time.

“If you in fact applied a standard like this, you could help you save a ton of life that slide less than affected person security,” Aiken explained. “These are preventable, but there are much too several nurses there to provide the variety of care that would protect against all those adverse occasions from taking place.”

Industry experts said attempts need to also be manufactured to prevent the harms that ended up classified as unpreventable, as well.

“Practices evolve so that nonpreventable errors can be prevented by modifications in observe,” Wu said. “For instance, if you completely prevent using a medicine that [has a] high price of nonpreventable adverse results, all those adverse consequences will not take place any longer.”

Dr. Peter Pronovost, the chief excellent and scientific transformation officer at College Hospitals in Cleveland, made use of to function on protecting against bloodstream infections, which ended up the moment considered “inevitable somewhat than preventable.”

“When we improved that narrative, and employed checklists, we reduced these bacterial infections that utilized to eliminate extra people today than breast or prostate cancer by 80{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809},” he wrote in an e-mail.

Wu explained patients should “keep in brain that there is the likely for damage though getting hospitalized.” He inspired individuals to strive to be active parts of their well being treatment teams, telling clinic workers about what diagnoses they have, prescription drugs they are using, allergic reactions they have and care they’ve gotten in other places.

“If you assume something could be erroneous, communicate up!” he reported.

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October 27, 2022

Surge of viruses leaves children’s hospitals scrambling to find room for patients

Every single inpatient mattress at Comer Children’s Healthcare facility in Chicago has been comprehensive for far more than 6 weeks. Unexpected emergency place volume is up extra than 150{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}.

The flow of individuals is like “a treadmill that under no circumstances finishes,” reported Dr. Allison Bartlett, a pediatric infectious health conditions specialist at Comer Children’s. As before long as a kid is discharged, their bed fills up with the subsequent kid in will need.

Nevertheless the hospital is at the same time fielding a barrage of requests to accept new patients from amenities that really don’t address kids or are overrun on their own.

“It’s scary. It would make me be concerned about my children acquiring in a motor vehicle incident and not having a area to go,” Bartlett said.

Numerous of the patients at Comer Children’s have RSV, or respiratory syncytial virus, which can cause lung infections. But health professionals are also looking at conditions of rhinovirus, enterovirus, adenovirus and quite a few coronaviruses, together with Covid.

Mainly because of this slide surge of respiratory viruses amongst young children, close to a few-quarters of pediatric hospital beds nationwide are now total, according to details from the Office of Wellness and Human Solutions.

That is forcing hospitals all around the state to vacation resort to the contingency plans reserved for these kinds of crises: They are sending ill little ones to other states to get treatment or are creating area in other wards, like specialty units or postoperative recovery regions. Some hospitals are sending ICU sufferers immediately home once their circumstances are no for a longer time acute, somewhat than to one more flooring. And many on-call nurses are performing further several hours.

NBC Information spoke with nine physicians across eight states — California, Colorado, Illinois, Maryland, Ohio, Texas, Rhode Island and Washington — about the actions their hospitals have taken to take care of this convergence of viruses.

“Almost everywhere is overcrowded, overrun and understaffed, and acquiring a really challenging time dealing with each unparalleled numbers of scenarios but also an off-year timing,” stated Dr. Michael Koster, director of pediatric infectious ailments at Hasbro Children’s Clinic in Providence, Rhode Island.

Koster explained his clinic is sending patients to Connecticut, Massachusetts and New Hampshire. But at the exact time, he included, “we have had phone calls for transports for respiratory viral ailment from Puerto Rico up to Maine.”

Dr. Kevin Messacar, an infectious disorder professional at Children’s Hospital Colorado, reported his hospital is accepting people from 5 close by states.

The surge has caught medical practitioners off guard, because scenarios of RSV and other respiratory viruses generally peak in wintertime. RSV instances this yr began climbing in the summer season. The weekly selection of constructive exams rose far more than fivefold from Aug. 13 to Oct. 15, according to the Centers for Ailment Command and Prevention.

Doctors explained masking and social distancing possible prevented children from getting exposed to respiratory viruses previously in the pandemic. Then young ones commenced to come upon new pathogens for the initial time, with tiny immune defense.

RSV, now the dominant virus in a lot of hospitals, typically seems like a common chilly. But in extreme scenarios it can direct to pneumonia or bronchiolitis, an infection in the airways. These patients could need supplemental oxygen or ventilators to breathe. Infants and youngsters with lung diseases or weakened immune techniques are most at risk.

Koster mentioned his medical center freed up further beds in a suite exactly where patients are generally witnessed for procedures requiring sedation.

“We drive people individuals out into basically the radiology hallway wherever ultrasounds are taking place and choose in excess of spaces like that for the crisis department,” he said.

Dr. Jason Custer, main of important care at the College of Maryland Children’s Clinic, claimed important sufferers in his state often wait around up to 36 hrs to be moved to an ICU. His hospital’s ICU has been at complete ability for the better element of the month, he mentioned.

People prepared to be transferred out of the ICU are sometimes discharged fairly than moved to other elements of the hospital, Custer included.

“As an alternative of sending them to the future stage of treatment, we just say, ‘Looks like you’re fantastic more than enough to go house and we want you to stick to up with your pediatrician tomorrow,'” he reported. (He clarified, however, that the hospital hasn’t modified its conditions for discharging clients.)

Koster, equally, mentioned he is showing dad and mom how to carry out suctioning — a system of getting rid of mucus from the nasal passages with a tube or syringe — at property to assure their baby can consume and consume. Sometimes, that trouble is the key cause youngsters keep in the healthcare facility.

“We have had to adapt to generating positive we’re meeting the demands of the most unwell and then seriously undertaking our ideal to deliver the ideal supportive care for youngsters who can go residence,” Koster stated.

But suctioning can be difficult for moms and dads, in accordance to Dr. Elizabeth Schlaudecker, an infectious condition specialist at Cincinnati Children’s Hospital.

“When my little ones received previous enough to identify what that suction bulb seemed like, they would make it as challenging as possible to suction out their noses,” she reported. “It can be exhausting for family members to have to do that all by on their own.”

Hospitals are continue to bracing for an anticipated wave of flu conditions that is just starting.

“If we get influenza on major of RSV, that is heading to put an additional significant pressure on the technique,” Messacar explained. “If we can get as a lot of people vaccinated as probable and protect as numerous little ones as doable to attempt to assist with the load as we’re having as a result of RSV period, that would be welcome news for all of us in pediatric drugs.”

September 28, 2022

Hospitals often reap profits in places where many patients carry medical debt : Shots

Aerial view of downtown Fort Worth, Texas. Some hospitals in Texas and around the U.S. are seeing high profits, even as their bills force patients into debt. Of the nation’s 20 most populous counties, none has a higher concentration of medical debt than Tarrant County, home to Fort Worth.

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PROSPER, Texas — Almost everything about the opening of the 2019 Prosper High School Eagles’ football season was big.

The game in this Dallas-Fort Worth suburb began with fireworks and a four-airplane flyover. A trained eagle soared over the field. And some 12,000 fans filled the team’s new stadium, a $53 million colossus with the largest video screen of any high school venue in Texas. Atop the stadium was also a big name: Children’s Health.

Business has been good for the billion-dollar pediatric hospital system, which agreed to pay $2.5 million to put its name on the Prosper stadium. Other Dallas-Fort Worth medical systems have also thrived. Though exempt from taxes as nonprofit institutions, several, including Children’s, notched double-digit margins in recent years, outperforming many of the area’s Fortune 500 companies.

But patients aren’t sharing in the good times. Of the nation’s 20 most populous counties, none has a higher concentration of medical debt than Tarrant County, home to Fort Worth. Second is Dallas County, credit bureau data show.

The mismatched fortunes of hospitals and their patients reach well beyond this corner of Texas. Nationwide, many hospitals have grown wealthy, spending lavishly on advertising, team sponsorships, and even spas, while patients are squeezed by skyrocketing medical prices and rising deductibles.

A KHN review of hospital finances in the country’s 306 hospital markets found that several of the most profitable markets also have some of the highest levels of patient debt.

Overall, about a third of the 100 million adults in the U.S. with health care debt owe money for a hospitalization, according to a poll conducted by KFF for this project. Close to half of those owe at least $5,000. About a quarter owe $10,000 or more.

Medical debt upended their lives. Here's what it took from them

Many are pursued by collectors when they can’t pay their bills or hospitals sell the debt.

“The fact is, if you walk into a hospital today, chances are you are going to walk out with debt, even if you have insurance,” said Allison Sesso, chief executive of RIP Medical Debt, a nonprofit that buys debt from hospitals and debt collectors so patients won’t have to pay it.

A community shadowed by debt

Across the Dallas-Fort Worth metro area — the nation’s fourth-largest — the impact has been devastating.

“Medical debt is forcing people here to make incredibly agonizing choices,” said Toby Savitz, programs director at Pathfinders, a Fort Worth nonprofit that assists people with credit problems. Savitz estimated that at least half their clients have medical debt. Many are scrimping on food, neglecting rent, even ending up homeless, she said, “and this is not just low-income people.”

David Zipprich, a Fort Worth businessman and grandfather, was forced out of retirement after hospitalizations left him owing more than $200,000.

Zipprich, 64, had spent a career in financial consulting. He owned a small bungalow in a historical neighborhood near the Fort Worth rail yards. His daughters, both teachers, and his four grandchildren lived nearby. He had health insurance and some savings, and he’d paid off his mortgage.

Then in early 2020, Zipprich landed in the hospital. While driving, his blood sugar dropped precipitously, causing him to black out and crash his car.

Three months later, after he was diagnosed with diabetes, another complication led to another hospitalization. In December 2020, covid-19 put him there yet again. “I look back at that year and feel lucky I even survived,” Zipprich said.

David Zipprich, a Fort Worth financial consultant and grandfather, was forced out of retirement after hospitalizations left him owing more than $200,000.

Laura Buckman for KHN and NPR

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Laura Buckman for KHN and NPR

David Zipprich, a Fort Worth financial consultant and grandfather, was forced out of retirement after hospitalizations left him owing more than $200,000.

Laura Buckman for KHN and NPR

But even with insurance, Zipprich was inundated with debt notices and calls from collectors. His credit score plummeted below 600, and he had to refinance his home. “My stress was off the charts,” he said, sitting in his neatly kept living room with his Shih Tzu, Murphy.

Overall in Tarrant County, 27{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of residents with credit reports have medical debt on their records, credit bureau data analyzed by KHN and the nonprofit Urban Institute shows. In Dallas County, it’s 22{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}.

That’s more than five times the rate in the largest counties in New York, data shows. The Texans also owe a lot more — the median amount of medical debt on credit records in Tarrant and Dallas counties is nearly $1,000, compared with $400 or less in New York.

Last year, Zipprich returned to work, taking a job in New Jersey that required he commute back and forth to Texas. He recently quit, citing the strain of so much travel. He’s now job hunting again. “I never thought this would happen to me,” he said.

This group's wiped out $6.7 billion in medical debt, and it's just getting started

Who is responsible?

Even small debts can have potentially dangerous consequences, discouraging patients from seeking needed care. Angie Johnson, a 28-year-old schoolteacher, cut short her honeymoon so she and her husband could pay off more than $1,100 she owed a physical therapy center owned by Baylor Scott & White, a mammoth Dallas-based hospital system.

Johnson said the center, where she’d gone after a knee injury, initially said her visits would cost $60. “Then they billed me hundreds,” she said. “I don’t go to the doctor unless I absolutely have to because it’s so expensive.”

Angie Johnson of Waxahachie, Texas, says the physical therapy center she went to after a knee injury initially told her visits would cost $60. “Then they billed me hundreds,” she says.

Laura Buckman for KHN and NPR

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Laura Buckman for KHN and NPR

Angie Johnson of Waxahachie, Texas, says the physical therapy center she went to after a knee injury initially told her visits would cost $60. “Then they billed me hundreds,” she says.

Laura Buckman for KHN and NPR

Hospital industry leaders blame the patient debt on health insurers, citing the rise of high-deductible plans and other efforts that limit coverage. “The last thing that hospitals want is for their patients to face financial barriers,” said Molly Smith who leads public policy at the American Hospital Association. “Hospitals are in there trying to work on behalf of patients.”

Despite repeated requests from KHN, none of the medical systems around Dallas-Fort Worth would discuss their finances or the debt carried by patients.

But Smith and other hospital leaders point to billions of dollars of free or discounted care that hospitals nationwide provide every year. “Hospitals have been pretty darn generous,” said Stephen Love, president of the Dallas-Fort Worth Hospital Council. “If other parts of the community did as much as hospitals, we wouldn’t be in this problem.”

Unlike drug companies, device makers, and many physician practices, most U.S. hospitals are nonprofit and must provide charity care as a condition of their tax-exempt status.

Regardless of tax status, medical centers in markets with high medical debt do provide more charity care, according to an analysis by KHN and the Urban Institute, a Washington think tank. That’s important, said Dr. Vikas Saini, president of the Lown Institute, a nonprofit that grades hospitals on their quality and community benefits.

But Saini asked: “Is a hospital truly serving its community if it’s pushing so many into debt?”

Around Dallas-Fort Worth, major medical systems frequently tout their commitment to the region and its patients.

When Texas Health Resources, a Dallas-based nonprofit system with more than $5 billion in annual revenue, opened a new hospital tower in Fort Worth earlier this year, Barclay Berdan, the system’s chief executive, said the building “reinforces Texas Health’s long-standing commitment to the Fort Worth community.” The nine-story, $300 million tower is one of more than a half-dozen new hospitals and major expansions around the Dallas-Fort Worth area since 2018.

The big building spree has been accompanied by big bottom lines.

From 2018 to 2021, Texas Health, which owns hospitals in North Texas, had an average operating margin of almost 6{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}, according to a KHN analysis of publicly available financial reports.

Other major systems in the area, including Baylor, Children’s Health, and HCA, the nation’s largest for-profit hospital company, did even better, KHN found. Cook Children’s, the region’s second major pediatric system, had an average operating margin of nearly 12{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}.

By comparison, profits at most of the 25 Fortune 500 companies based around Dallas-Fort Worth, such as ExxonMobil, were less than 6{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} in 2019, according to Fortune data.

Approaching a tipping point

Hospitals have thrived in other markets with high patient debt, KHN found.

In Charlotte, N.C., where a quarter of residents have medical debt on their credit reports, hospitals recorded an average operating margin of 13.6{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} from 2017 to 2019.

The average margin at hospitals in and around Gainesville and Lakeland, two central Florida markets where a quarter of residents also carry medical debt, topped 9{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}. In Tulsa, Okla., which has the same level of debt, margins have averaged 8.5{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}.

Overall, U.S. hospitals recorded their most profitable year on record in 2019, with an aggregate operating margin of 6.5{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}, according to the federal Medicare Payment Advisory Commission. Total margins, which include income from investments, were even higher.

“You might think that hospitals in communities where patients have a lot of debt would be less profitable, but that doesn’t seem to be the case,” said Anuj Gangopadhyaya, a senior Urban Institute researcher who worked with KHN on an analysis of hospital finance and consumer debt data in U.S. hospital markets.

In fact, the analysis found, there is no apparent relationship between the profits of hospitals in a market and how much medical debt residents have. So while hospitals in places like Charlotte and Tulsa may be comfortably in the black, in other places with high patient debt such as Amarillo, Texas, and Columbia, S.C., hospitals are struggling, data shows.

Industry experts say the most profitable medical centers — like those around Dallas-Fort Worth — have developed business models that allow them to prosper even if their patients can’t pay.

One key is prices. These hospitals maximize what they charge for everything from a complex surgery to a dose of aspirin. Most of those charges are picked up by health insurers, which still pay a much larger share of hospital bills than patients do, even those with the highest deductibles.

Across the country, many medical systems have strengthened their market power in recent years by consolidating, buying up smaller hospitals and physician practices, which enable the hospital systems to charge even more.

Dallas-Fort Worth has the highest medical prices in Texas, according to the Health Care Cost Institute, a nonprofit that tracks costs nationwide. And in a state where most markets have relatively low medical prices, in-patient care at Dallas-Fort Worth hospitals was 13{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} more expensive than the national median in 2020.

In addition to charging more, the most profitable hospitals frequently squeeze more savings from their operations, holding down what they pay workers, for example, and securing better contracts from suppliers. “Hospitals have had to get leaner and meaner,” said Kevin Holloran, a senior director at Fitch Ratings who tracks nonprofit health systems for the bond rating firm.

It’s unclear how much longer this business model can endure.

Across the country, many small and rural hospitals have closed in recent years. Even some larger systems are now losing money, as inflation and rising labor costs put new pressure on bottom lines.

As bills rise, hospitals are having a harder time collecting. Last year, nearly 1 in 5 patient bills generated by hospitals for people with insurance topped $7,500, according to an analysis of hospital billing records by Crowe LLP, a Chicago-based accounting and consulting firm. That was more than triple the rate in 2018.

“These are bills that fewer and fewer patients out there can afford,” said Brian Sanderson, a senior Crowe health care consultant and former hospital executive. Indeed, hospitals manage to collect less than 17{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of patient balances that exceed $7,500, according to Crowe’s analysis.

“The rates at which patient balances are growing is just unsustainable for our health systems,” Sanderson said, predicting that most will never be able to collect bills of this size. “It’s trending to the ridiculous.”

Robert Earley, a former Texas state legislator who used to head Fort Worth’s public health system, compared today’s hospitals to shrimpers in the Gulf Coast district he once represented.

“They wanted to pull so much shrimp out of the bay that they didn’t think about whether there’d be any there long term,” Earley said, recalling his constituents’ struggles. “I worry that those of us in health care aren’t asking ourselves enough if this system is sustainable.”

Diagnosis: Debt is a reporting partnership between KHN and NPR exploring the scale, impact, and causes of medical debt in America.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. It is an editorially independent operating program of KFF (Kaiser Family Foundation).

Posted on November 30, 2021
1 in 100 patients may have brain complications

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In people with severe COVID-19, central nervous system complications may be more common than initially estimated. Mental Art + Design/Stocksy

A large international study suggests that around 1 in every 100 patients hospitalized with COVID-19 have brain complications.

These include stroke, brain hemorrhage, and other potentially fatal conditions.

Many of the patients had preexisting illnesses, such as high blood pressure, heart disease, and diabetes.

Previous research has shown that some people who recover from COVID-19 have lingering neurological and psychiatric symptoms.

As the COVID-19 pandemic wears on, experts increasingly recognize that SARS-CoV-2, the virus that causes the disease, affects areas beyond the lungs. It can also infect the kidneys, gut, and blood vessels, for example.

In addition, COVID-19 can cause a range of neurological and psychiatric symptoms.

One telltale symptom is a loss of taste or smell, which indicates that SARS-CoV-2 can infect the peripheral nervous system. But the virus can also affect the central nervous system, producing symptoms such as headaches, dizziness, confusion, and seizures.

Now, a large international study led by researchers at Thomas Jefferson University, in Philadelphia, has found that around 1{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of patients hospitalized with COVID-19 develop potentially fatal brain complications.

These include strokes, bleeding, and inflammation called encephalitis.

“Much has been written about the overall pulmonary [lung] problems related to COVID-19, but we do not often talk about the other organs that can be affected,” says Dr. Scott H. Faro, a professor of radiology and neurology at the university, who also led the study.

“Our study shows that central nervous system complications represent a significant cause of morbidity and mortality in this devastating pandemic,” he explains.

The researchers presented their currently unpublished results at the annual meeting of the Radiological Society of North America, in Chicago. The study has yet to be peer reviewed, and only a summary of the results is available.

The retrospective, observational study involved almost 40,000 patients, who were hospitalized with COVID-19 at any of seven university hospitals in the United States or four in Western Europe.

The participants’ average age was 66 years, and there were twice as many men as women.

Many had preexisting conditions, such as heart disease, diabetes, or high blood pressure, which is also called hypertension.

Among those who had undergone a brain MRI or CT scan, 442 patients had brain-related complications attributable to COVID-19.

This suggests that around 1.2{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of the total patient group had a brain complication as a result of the disease.

The most frequent complications were:

ischemic stroke: 6.2{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}.

hemorrhage, or bleeding: 3.72{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}.

encephalitis: 0.47{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}.

More rare complications included inflammation of the brain and spinal cord, which is called acute disseminating encephalomyelitis, and encephalopathy syndrome, which causes symptoms similar to those of a stroke.

“It is important to know an accurate incidence of all the major central nervous system complications,” Dr. Faro says, noting, “There should probably be a low threshold to order brain imaging for patients with COVID-19.”

Overall, brain complications appeared to be about three times as common among patients in Europe, compared with those in the U.S.

The study could not explain the factors behind this disparity. However, doctors detected strokes more often in COVID-19 patients in the U.S. than in Europe.

“The one feature that is likely a contributing factor is: There was an increase in comorbidities (cardiac, diabetes, and chronic [kidney] failure) in the U.S. population [compared with] Europe,” Dr. Faro told Medical News Today.

Currently, the direct role that the viral infection of the central nervous system plays in the neurological complications is unclear.

Overactivation of the immune system, inflammation, dehydration, and low oxygen levels, an issue called hypoxia, are also likely to be important factors.

“The [central nervous system] complications of COVID-19 are multifactorial and [involve] both the direct spread of the virus from the lungs and nasal mucosa, as well as indirect autoimmune factors and physiological changes (hypoxia, inflammation, dehydration),” Dr. Faro told MNT.

“More research is needed to better [understand] this,” he added.

The acute effects of COVID-19 on the central nervous system may result in lingering neurological and cognitive symptoms.

A study published in October found that some people who recover from the infection experience cognitive impairments, such as problems with concentration and memory, often called brain fog, for several months.

There may also be long-term effects on mental health.

A study published in May found that in the 6 months after recovering from COVID-19, 13{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of participants received a first diagnosis of a neurological or psychiatric condition.

The most common diagnoses were anxiety disorders, mood disorders, substance misuse disorders, and insomnia.

Neurological diagnoses were less common, and included strokes, dementia, and brain hemorrhages.

It is unknown whether COVID-19 was directly responsible for these neurological and psychiatric conditions.

The senior author of this study, Paul Harrison, a professor of psychiatry at the University of Oxford, told MNT that he and colleagues are conducting a follow-up study to see whether the effects continue beyond the 6-month period.

“We are looking at longer-term outcomes now and hope to have [our] study completed early next year,” he said.

Posted on November 7, 2021
More than 10,000 patients caught Covid-19 in a hospital, analysis shows. They never made it out

They left with covid-19 — if they left at all.

More than 10,000 patients were diagnosed with covid in a U.S. hospital last year after they were admitted for something else, according to federal and state records analyzed exclusively for KHN. The number is certainly an undercount, since it includes mostly patients 65 and older, plus California and Florida patients of all ages.

Yet in the scheme of things that can go wrong in a hospital, it is catastrophic: About 21{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of the patients who contracted covid in the hospital from April to September last year died, the data shows. In contrast, nearly 8{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of other Medicare patients died in the hospital at the time.

Steven Johnson, 66, was expecting to get an infection cut out of his hip flesh and bone at Blake Medical Center in Bradenton, Florida, last November. The retired pharmacist had survived colon cancer and was meticulous to avoid contracting covid. He could not have known that, from April through September, 8{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of that hospital’s Medicare covid patients were diagnosed with the virus after they were admitted for another concern.

Johnson had tested negative for covid two days before he was admitted. After 13 days in the hospital, he tested positive, said his wife, Cindy Johnson, also a retired pharmacist.

Soon he was struggling to clear a glue-like phlegm from his lungs. A medical team could hardly control his pain. They prompted Cindy to share his final wishes. She asked: “Honey, do you want to be intubated?” He responded with an emphatic “no.” He died three days later.

After her husband tested positive, Cindy Johnson, trained in contact tracing, quickly got a covid test. She tested negative. Then she thought about the large number of hospital staffers flowing into and out of his room — where he was often unmasked — and suspected a staff member had infected him. That the hospital, part of the HCA Healthcare chain, still has not mandated staff vaccinations is “appalling,” she said.

“I’m furious,” she said.

“How can they say on their website,” she asked, “that the safety precautions ‘we’ve put into place make our facilities among the safest possible places to receive healthcare at this time’?”

Blake Medical Center spokesperson Lisa Kirkland said the hospital is “strongly encouraging vaccination” and noted that it follows Centers for Disease Control and Prevention and federal and state guidelines to protect patients. President Joe Biden has called for all hospital employees to be vaccinated, but the requirement could face resistance in a dozen states, including Florida, that have banned vaccine mandates.

Overall, the rate of in-hospital spread among Medicare and other patients was lower than in other countries, including the United Kingdom, which makes such data public and openly discusses it. On average, about 1.7{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of U.S. hospitalized covid patients were diagnosed with the virus in U.S. hospitals, according to an analysis of Medicare records from April 1 to Sept. 30, 2020, provided by Dr. James Kennedy, founder of CDIMD, a Nashville-based consulting and data analytics company.

Yet the rate of infection was far higher in 38 hospitals where 5{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} or more of the Medicare covid cases were documented as hospital-acquired. The data is from a challenging stretch last year when protective gear was in short supply and tests were scarce or slow to produce results. The Medicare data for the fourth quarter of 2020 and this year isn’t available yet, and the state data reflects April 1 through Dec. 31, 2020.

A KHN review of work-safety records, medical literature and interviews with staff at high-spread hospitals points to why the virus took hold: Hospital leaders were slow to appreciate its airborne nature, which made coughing patients hazardous to roommates and staff members, who often wore less-protective surgical masks instead of N95s. Hospitals failed to test every admitted patient, enabled by CDC guidance that leaves such testing to the “discretion of the facility.” Management often failed to inform workers when they’d been exposed to covid and so were at risk of spreading it themselves.

Spread among patients and staffers seemed to go hand in hand. At Beaumont Hospital, Taylor, in Michigan, 139 employee covid infections were logged between April 6 to Oct. 20 last year, a hospital inspection report shows. Nearly 7{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of the Medicare patients with covid tested positive after they were admitted to that hospital for something else, the federal data shows. A hospital spokesperson said tests were not available to screen all patients last year, resulting in some late diagnoses. He said all incoming patients are tested now.

Tracking covid inside health facilities is no new task to federal officials, who publicly report new staff and resident cases weekly for each U.S. nursing home. Yet the Department of Health and Human Services reports data on covid’s spread in hospitals only on a statewide basis, so patients are in the dark about which facilities have cases.

KHN commissioned analyses of hospital billing records, which are also used more broadly to spot various hospital-acquired infections. For covid, the data has limitations. It can pick up some community-acquired cases that were slow to show up, as it can take two to 14 days from exposure to the virus for symptoms to appear, with the average being four to five days. The records do not account for cases picked up in an emergency room or diagnosed after a hospital patient was discharged.

Linda Moore, 71, tested positive at least 15 days into a hospital stay for spinal surgery, according to her daughter Trisha Tavolazzi. Her mother was at Havasu Regional Medical Center in Lake Havasu City, Arizona, which did not have a higher-than-average rate of internal spread last summer.

The hospital implemented “rigorous health and safety protocols to protect all of our patients” during the pandemic, said hospital spokesperson Corey Santoriello, who would not comment on Moore’s case, citing privacy laws.

Moore was airlifted to another hospital, where her condition only declined further, her daughter said. After the ventilator was removed, she clung to life fitfully for 5½ hours, as her daughter prayed for her mother to find her way to heaven.

“I asked her mom and her dad and her family and prayed to God, ‘Please just come show her the way,'” Tavolazzi said. “I relive it every day.”

When Tavolazzi sought answers from the hospital about where her mom got the virus, she said, she got none: “No one ever called me back.”

Two Negative Covid Tests, Then ‘Patient Zero’

As the second surge of covid subsided last September, doctors from the prestigious Brigham and Women’s Hospital published a reassuring study: With careful infection control, only two of 697 covid patients acquired the virus within the Boston hospital. That is about 0.3{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of patients ― about six times lower than the overall Medicare rate. Brigham tested every patient it admitted, exceeding CDC recommendations. It was transparent and open about safety concerns.

But the study, published in the high-profile JAMA Network Open journal, conveyed the wrong message, according to Dr. Manoj Jain, an infectious-disease physician and adjunct professor at the Rollins School of Public Health at Emory University. Covid was spreading in hospitals, he said, and the study buried “the problem under the rug.”

Before the virtual ink on the study was dry, the virus began a stealthy streak through the elite hospital. It slipped in with a patient who tested negative twice ― but turned out to be positive. She was “patient zero” in an outbreak affecting 38 staffers and 14 patients, according to a study in Annals of Internal Medicine initially published Feb. 9.

That study’s authors sequenced the genome of the virus to confirm which cases were related ― and precisely how it traveled through the hospital.

As patients were moved from room to room in the early days of the outbreak, covid spread among roommates 8 out of 9 times, likely through aerosol transmission, the study says. A survey of staff members revealed that those caring for coughing patients were more likely to get sick.

The virus also appeared to have breached the CDC-OK’d protective gear. Two staff members who had close patient contact while wearing a surgical mask and face shield still wound up infected. The findings suggested that more-protective N95 respirators could help safeguard staff.

Brigham and Women’s now tests every patient upon admission and again soon after. Nurses are encouraged to test again if they see a subtle sign of covid, said Dr. Erica Shenoy, associate chief of the Infection Control Unit at Massachusetts General Hospital, who helped craft policy at Brigham.

She said nurses and environmental services workers are at the table for policymaking: “I personally make it a point to say, ‘Tell me what you’re thinking,'” Shenoy said. “‘There’s no retribution because we need to know.'”

CDC guidelines, though, left wide latitude on protective gear and testing. To this day, Shenoy said, hospitals employ a wide range of policies.

The CDC said in a statement that its guidelines “provide a comprehensive and layered approach to preventing transmission of SARS-CoV-2 in healthcare settings,” and include testing patients with “even mild symptoms” or recent exposure to someone with covid.

Infection control policies are rarely apparent to patients or visitors, beyond whether they’re asked to wear a mask. But reviews of public records and interviews with more than a dozen people show that at hospitals with high rates of covid spread, staff members were often alarmed by the lack of safety practices.

Nurses Sound the Alarm on Covid Spread

As covid crept into Florida in spring 2020, nurse Victoria Holland clashed with managers at Blake Medical Center in Bradenton, where Steven Johnson died.

She said managers suspended her early in the pandemic after taking part in a protest and “having a hissy fit” when she was denied a new N95 respirator before an “aerosol-generating” procedure. The CDC warns that such procedures can spread the virus through the air. Before the pandemic, nurses were trained to dispose of an N95 after each patient encounter.

When the suspension was over, Holland said, she felt unsafe. “They told us nothing,” she said. “It was all a little whisper between the doctors. You had potential covids and you’d get a little surgical mask because [they didn’t] want to waste” an N95 unless they knew the patient was positive.

Holland said she quit in mid-April. Her nursing colleagues lodged a complaint with the Occupational Safety and Health Administration in late June alleging that staff “working around possible Covid-19 positive cases” had been denied PPE. Staff members protested outside the hospital in July and filed another OSHA complaint that said the hospital was allowing covid-exposed employees to keep working.

Kirkland, the Blake spokesperson, said the hospital responded to OSHA and “no deficiencies were identified.”

The Medicare analysis shows that 22 of 273 patients with covid, or 8{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}, were diagnosed with the virus after they were admitted to Blake. That’s about five times as high as the national average.

Kirkland said “there is no standard way for measuring COVID-19 hospital-associated transmissions” and “there is no evidence to suggest the risk of transmission at Blake Medical Center is different than what you would find at other hospitals.”

In Washington, D.C., 34 Medicare covid patients contracted the virus at MedStar Washington Hospital Center, or nearly 6{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of its total, the analysis shows.

Unhappy with the safety practices ― which included gas sterilization and reuse of N95s — National Nurses United members protested on the hospital lawn in July 2020. At the protest, nurse Zoe Bendixen said one nurse had died of the virus and 50 had gotten sick: “[Nurses] can become a source for spreading the disease to other patients, co-workers and family members.”

Nurse Yuhana Gidey said she caught covid after treating a patient who turned out to be infected. Another nurse ― not managers doing contact tracing ― told her she’d been exposed, she said.

Nurse Kimberly Walsh said in an interview there was an outbreak in a geriatric unit where she worked in September 2020. She said management blamed nurses for bringing the virus into the unit. But Walsh pointed to another problem: The hospital wasn’t covid-testing patients coming in from nursing homes, where spread was rampant last year.

MedStar declined a request for an interview about its infection control practices and did not respond to specific questions.

While hospitals must track and publicly report rates of persistent infections like C. diff, antibiotic-resistant staph and surgical site infections, similar hospital-acquired covid rates are not reported.

KHN examined a different source of data that Congress required hospitals to document about “hospital-acquired conditions.” The Medicare data, which notes whether each covid case was “present on admission” or not, becomes available months after a hospitalization in obscure files that require a data-use agreement typically granted to researchers. KHN counted cases, as federal officials do, in some instances in which the documentation is deemed insufficient to categorize a case (see data methodology, below).

For this data, whether to deem a covid case hospital-acquired lies with medical coders who review doctors’ notes and discharge summaries and ask doctors questions if the status is unclear, said Sue Bowman, senior director of coding policy and compliance at American Health Information Management Association.

She said medical coders are aware that the data is used for hospital quality measures and would be careful to review the contract tracing or other information in the medical record.

If a case was in the data KHN used, “that would mean it was acquired during the hospital stay either from a health care worker or another patient or maybe if a hospital allowed visitors, from a visitor,” Bowman said. “That would be a fair interpretation of the data.”

The high death rate for those diagnosed with covid during a hospital stay — about 21{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} — mirrors the death rate for other Medicare covid patients last year, when doctors had few proven methods to help patients. It also highlights the hazard unvaccinated staffers pose to patients, said Jain, the infectious-disease doctor. The American Hospital Association estimates that about 42{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of U.S. hospitals have mandated that all staff members be vaccinated.

“We don’t need [unvaccinated staff] to be a threat to patients,” Jain said. “[Hospital] administration is too afraid to push the nursing staff, and the general public is clueless at what a threat a non-vaccinated person poses to a vulnerable population.”

Cindy Johnson said the hospital where she believes her husband contracted covid faced minimal scrutiny in a state inspection, even after she said she reported that he caught covid there. She explored suing, but an attorney told her it would be nearly impossible to win such a case. A 2021 state law requires proof of “at least gross negligence” to prevail in court.

Johnson did ask a doctor who sees patients at the hospital for this: Please take down the big “OPEN & SAFE” sign outside.

Within days, the sign was gone.

KHN requested custom analyses of Medicare, California and Florida inpatient hospital data to examine the number of covid-19 cases diagnosed after a patient’s admission.

The Medicare and Medicare Advantage data, which includes patients who are mostly 65 or older, is from the Medicare Provider Analysis and Review (MedPAR) file and was analyzed by CDIMD, a Nashville-based medical code consulting and data analytics firm. The data is from April 1 through Sept. 30, 2020. The data for the fourth quarter of 2020 is not yet available.

That data shows the number of inpatient Medicare hospital stays in the U.S., including the number of people diagnosed with covid and the number of admissions for which the covid diagnosis was not “present on admission.” A condition not “present on admission” is presumed to be hospital-acquired. The data is for general acute-care hospitals, which may include a psychiatric floor, and not for other hospitals such as Veterans Affairs or stand-alone psychiatric hospitals.

KHN requested a similar analysis from California’s Department of Health Care Access and Information of its hospital inpatient data. That data was from April 1 through Dec. 31, 2020, and covered patients of all ages and payer types and in general, private psychiatric and long-term acute-care hospitals. Etienne Pracht, a University of South Florida researcher, provided the number of Florida covid patients who did not have the virus upon hospital admission for all ages at general and psychiatric hospitals from April 1 through Dec. 31, 2020. KHN subtracted the number of Medicare patients in the MedPAR data from the Florida and California all-payer datasets so they would not be counted twice.

To calculate the rate of Medicare patients who got covid or died, KHN relied on the MedPAR data for April through September. That data includes records for 6,629 seniors, 1,409 of whom, or 21{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}, died. California data for all ages and payer types from April through December shows a similar rate: Of 2,115 who contracted covid after hospital admission, 435, or 21{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}, died. The MedPAR data was also used to calculate the national nosocomial covid rate of 1.7{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}, with 6,629 of 394,939 covid patients diagnosed with the virus that was deemed not present on admission.

Data on whether an inpatient hospital diagnosis was present on admission is used by Medicare for payment determinations and is intended to incentivize hospitals to prevent infections acquired during hospital care. It is also used by the U.S. Agency for Healthcare Research and Quality to “assist in identifying quality of care issues.”

Whether covid is acquired in a hospital or in the community is measured in different ways. Some nations assume the virus is hospital-acquired if it is diagnosed seven or more days after admission, while statewide U.S. data counts cases only after 14 days.

Medical coders who examine medical records for this inpatient billing data focus on the physician’s admission, progress and discharge notes to determine whether covid was present on admission. They do not have a set number of days they look for and are trained to query physicians if the case is unclear, according to Sue Bowman, senior director of coding policy and compliance at the American Health Information Management Association.

KHN tallied the cases in which covid was logged in the data as not “present on admission” to the hospital. Some covid cases are coded as “U” for having insufficient documentation to make a determination. Since Medicare and AHRQ consider the “U” to be an “N” (or not present on admission) for the purposes of payment decisions and quality indicators, KHN chose to count those cases in the grand total.

In 409 of 6,629 Medicare cases and in 70 of 2,185 California cases, the “present on admission” indicator was “U.” The Florida data did not include patients whose “present on admission” indicator was “U.” Medical coders have another code, “W,” for “clinically undetermined” cases, which consider a condition present on admission for billing or quality measures. Medical coders use the “U” (leaning toward “not present on admission”) and “W” (leaning toward “present on admission”) when there is some uncertainty about the case.

The Medicare MedPAR data includes about 2,500 U.S. hospitals that had at least a dozen covid cases from April through September 2020. Of those, 1,070 reported no cases of hospital-acquired covid in the Medicare records. Data was suppressed for privacy reasons for about 1,300 hospitals that had between one and 11 hospital-acquired covid cases. There were 126 hospitals reporting 12 or more cases of covid that were not present on admission or unknown. For those, we divided the number of hospital-acquired cases by the total number of patients with covid to arrive at the rate of hospital-acquired cases, as is standard in health care.