HEALTH CARE - Top 10 World’s Largest Pharmaceutical Companies 2013

Article by Rinu Chacko

The world “Pharmaceutical” comes from Greek word “Pharmakeia” with the modern translation as “Pharmacia”. We all are aware of many existing pharmaceutical companies as we have used many of their medicines during our sickness phases. Many people owe their lives to many life saving medicines without which they might not have seen another day in their life. Pharmaceutical companies are responsible for discovering new drugs, marketing them and getting them licensed for their use as medications. All drugs so produced have to go through a strict process of patenting and testing and are subjected to all sorts of safety checks and a variety of laws and regulations. These pharmaceutical companies not only play a very important role in the medicine industry but also play a significant role in the revenue industry and the development of a nation. It employs thousands of people per plant and thus helps in the GDP of a country. The Indian pharmaceutical industry stands at the third position in terms of volume and 14th in terms of value. Though United states is still the largest pharmaceutical market in the world. According to a report by IMS Health the global market size of pharmaceuticals is expected to reach nearly $1.1 trillion in 2014. Though the world might face recession but the pharmaceutical industry is more likely to shine through it and grow more rapidly.

Pharmaceutical industry is growing fast and many industries are emerging more prominently among others with their peaking sales and healthcare revenues. Here is the list of top 10 world’s largest pharmaceutical companies.

10. Lilly

Eli Lilly and Company is an American global pharmaceutical company. It has its headquarters in Indianapolis, Indiana in the United States. It was founded by Eli Lilly in 1876 and John C. Lechleiter is the present chairman, president and CEO of the company. The world owes Lilly for the first mass-production of Penicillin, Salk Polio vaccine and insulin and is the largest producer and distributor of psychiatric medications in the world. Other drugs produced by Lilly are namely Arzoxifine, Efient, Olanzapine, etc.

9. Abbott Laboratories

Abbott Laboratories is a US based global pharmaceuticals and health care products company employing about 90,000 employees. Its headquarters is located in Abbott Park, North Chicago, Illinois. It was founded by Dr. Wallace Calvin Abbottin 1888 and was then known as Abbott Alkaloidal Company. It produces many pharmaceutical products, medicinal devices,nutritional and animal healthcare products. Miles D. White is the chairman and CEO of the company. Its leading drug is a blocker drug called Humira.

8. Johnson & Johnson

Johnson & Johnson is a US based multinational company which manufactures medicinal devices, pharmaceuticals and consumer packaged goods. It was founded in 1886 by Robert wood Johnson I, James Wood Johnson and Edward Mead Johnson. The Company’s headquarters is located in New Brunswick, New Jersey. Johnson & Johnson is a leading name in many household items like Johnson & Johnson baby products, Neutrogena skin and beauty products, Band-Aid, Clean and clear facewashes, etc. Risperdal, the anti-psychotic medication was the highest seller drug at $4.7 billion. It has gross sales of $24.9 billion and net income of $10.6 billion. The other drugs manufactured by it are Bapineuzumab, ceftobiprole, dacogen, procrit, rivaroxaban, topamax, etc.

7. AstraZeneca

AstraZeneca plc founded on 6th April 1999, through the merger of the Sweden-based Astra AB and the UK-based Zeneca Group, is a Swedish-British multinational pharmaceutical and biologics company. It specializes in Prescriptive medicines including Carbocaine, Naropin, Betaloc, Zestril, lexinor, Cubicin, Zomig, Tomudex, and a variety of other medicines in the areas of oncology, neuroscience, gastrointestinal, etc. The acid reflux medication called Nexium is its leading product at $5.2 billion. It has the gross sales of $28.7 billion and net income of $8 billion. It is also the manufacturer of drugs for cholesterol treatment called Crestor and antipsychotic drug called Seroquel.

6. Roche

Hoffmann-La Roche is a Swiss global healthcare company founded by Fritz Hoffmann-La Roche after whom the company is named, in 1896. Its main headquarters is located in Basel, Switzerland. The other companies owned by Roche are Genentech, Chugai pharmaceuticals and Ventana. It was the first company to produce synthetic vitamin C at a large scale under the brand name of Redoxon. Its leading drug is Herceptin a medication for breast cancer at $2.8 billion. It has gross sales of $22 billion with net profit of $9.5 billion. The various drugs produced by Roche include Accutane, Bactrium, cellcept, herceptin, invirase, tamiflu, Rohypnol, etc. It also manufactures a range of Diabetes management products under the brand name Accu-check.

5. GlaxoSmithKline

GlaxoSmithKline plc is a multinational company based in the United Kingdom dealing in the fields of pharmaceutical, biologics, vaccines and consumer healthcare. GSK was formed by the merger of Glaxo Wellcome plc and SmithKline Beecham plc in the year 2000. It manufactures products for various diseases including mental health, diabetes, asthma, cancer, virus control, etc. GSK also manufactures nutritional products, drinks and other healthcare goods like Horlicks, sensodyne, Boost, etc. Its top selling drug at $7 billion is Advair used for asthema and chronic obstructive pulmonary disorder treatment. It has maintained its leading status with its pharmaceutical sales of $38.5 billion and net income of $10.6 billion.

4. Merck

Merck & Co., Inc. is an American pharmaceutical company with its headquarters located in Whitehouse Station, New Jersey. Kenneth Frazier is the chairman, president and CEO of the company and it was founded in 1891 as a subsidiary of Merck KGaA. It came out as an independent company in 1917 after being confiscated by US Government during World War I. Merck is also the publisher of world’s largest selling medical textbook called the Merck Manual of diagnosis and therapy and a series of other medical reference books. The various drugs manufactured by it are Vioxx, Mectizan, Cordaptive, isentress, etc. The company is been sued for its drug called Propecia whose side effects include persistent sexual dysfunction, loss of libido, Peyronie’s disease, etc. of which the patients were not forewarned.

3. Sanofi-Aventis

Sanofi-Aventis, a French multinational pharmaceutical company has its headquarters in Paris, France. It is involved in research and development and manufactures pharmaceutical products to be sold primarily in the prescription market. Over-the-counter medicines are also developed by the company. Its leading drug at $3.6 billion is the thrombosis medication Lovenox. Sanofi-Aventis has gross sales of $38.5 billion and a net income of $9.7 billion. The various drugs manufactured by the company are aflibercept, jevtana, Humenza vaccine, iniparib, otamixaban, etc. in the various areas of oncology, cardiology and virology. Sanofi-Aventis was formed in 2004 by the merger of Aventis and Sanofi-Synthélabo and later in 2011 changed the name to Sanofi. Its various companies in other sectors include Sanofi Pasteur in Vaccine business and Merial in animal healthcare.

2. Novartis

Novartis International AG, a multinational pharmaceutical company is based in Basel, Switzerland. Novartis has been on the face of the pharmaceutical industry for about 250 years owing to its formation by merger of Swiss companies Ciba-Geigy and Sandoz Laboratories in 1996. Novartis produces a range of products including vaccines, contact lenses, over-the- counter drugs, veterinary medicines, etc. Novartis is a manufacturer of drugs including clozapine, diclofenac, carbamazepine, valsartan (Diovan) and Glivec. Diovan is the highest selling medication by the company used for hypertension medication at $ 5 billion and had pharmaceutical sales of $25.5 billion and a net income of $12 billion. Novartis is involved in various controversies, the biggest of them being the alleged launching of a court case against India in 2006 seeking the prohibition of development of generic medicines based on patented medicines. Novartis claimed that the company needed a new patent to protect its investment on the anti-cancer medicine called Glivec which was refused by IPAB. It has been found that the generic medicines cost only Rs. 8500 as opposed to Glivec that costs the cancer patients about Rs. 130,000 per month. Also it committed sexual discrimination against 12 female sales representatives which was criticized worldwide.

1. Pfizer

Pfizer is the world’s largest research-based pharmaceutical industry based in the United States of America. Its research headquarters is located in Groton, Connecticut. Pfizer has developed many medicines and vaccines like Sutent, Zithromax, apixaban, Macugen, Lyrica, latreperdine, etc. in the areas of oncology, infections and infestations, cardiology, opthamalogy, neurology and psychiatry. The Pfizer Company’s top selling drug is the cholesterol drug namely Lipitor at $12.7 billion. Pfizer has $44.4 billion in pharmaceutical sales and has gained a net profit of $8 billion. The company was founded in 1849 in New York City by cousins Charles Pfizer and Charles Erhart. The discovery of Terramycin in 1950 paved the pathway of the company’s growth from a small-scale chemical company to becoming the world’s largest pharmaceutical industry. Pfizer also was involved in quite many controversies including lawsuits that were filed against it for illegal marketing of the arthritis drug Bextra, experimenting a new drug during a cholera outbreak in Nigeria on children which led to the death of about 50 children and one of its acquired companies called Quigley which sold asbestos-containing insulation products for years; a settlement deal is being negotiated till date between the asbestos victims and Pfizer.

HEALTHCARE - Operation on a Friday? Why patients are 24% more likely to die if they have to recuperate in hospital at the weekend

Operation on a Friday? Why patients are 24% more likely to die if they have to recuperate in hospital at the weekend

• - Major survey found patients more likely to die after Friday operation
• - Lack of staff and fewer tests being done contributed to problem
• - Majority of hospital doctors said weekend care was worse than weekdays
• 
  

By CHRIS PLEASANCE

PUBLISHED: 15:34 GMT, 8 December 2013 | UPDATED: 15:34 GMT, 8 December 2013

Patients who have operations on a Friday are 24 per cent more likely than those who have surgery during the week because of poor weekend care.

A major survey by statistics firm Dr Foster has shown that weekend patients are less likely to get treatment, less likely to have tests done, and are less likely to have follow-up surgery within two days.

A poll of 5,500 doctors contained in the survey revealed that 68 per cent believe weekend patients receive a poorer standard of care.

A major survey has found that patients who have surgery on a Friday are 24 per cent more likely to die because of poor weekend care

Poor access to tests was a factor uncovered in the study, with 42 per cent fewer MRI scans being done on weekends, and 40 per cent fewer endoscopies - where a camera on a metal tube is inserted into the body.

The report also found that 68 per cent of doctors believed weekend care was worse than weekday care

Eight trusts were named as having higher death rates at the weekend than on weekdays, including Lancashire Teaching Hospitals NHS Foundation Trust and Colchester Hospital University NHS Foundation Trust, which is currently at the centre of a scandal involving waiting times for cancer patients.

Trusts in Doncaster and Bassetlaw and East Kent were among those who had the most patients returning after being discharged, while another eight were singled out for patients waiting longer for a hip transplant, including the East and North Hertfordshire trust.

The study showed that, overall, those admitted on either Saturday or Sunday had a 20 per cent higher chance of dying, and a 4 per cent chance of having to be readmitted to the emergency room after being discharged.

Dr Foster director of research Roger Taylor said: 'We have now looked at many different aspects of quality of care. Every indicator we look at shows that patients who come to hospitals on weekends get worse care and worse outcomes.

'We are pleased that the NHS has made addressing this issue a priority and there is evidence that these efforts are already starting to yield benefits for patients with shorter waits for operations at weekends and, in some cases, lower mortality rates.'

King's College Hospital (pictured) was among the best for weekend mortality rates, while Colchester Hospital was among the worst

The report had good news for Londoners, however, as six of the eight hospitals with the lowest mortality rates for both weekday and weekend were in the capital, including Guy's and St Thomas's, Imperial and King's College.

The findings come as medical director Professor Sir Bruce Keogh prepares to publish his report on seven-day working in the NHS.

THE BEST OF THE TRUSTS

Higher weekend death rates:

Colchester Hospital

Lancashire Teaching Hospitals

Mid Cheshire Hospitals

Northumbria Healthcare

Nottingham University Hospitals,

Royal Berkshire

Royal Devon and Exeter

United Lincolnshire Hospitals

Most patients readmitted:

Doncaster and Bassetlaw Hospitals

East Kent Hospitals

Mid Staffordshire

Poole Hospital

University Hospital of North Staffordshire

Warrington and Halton Hospitals

Wrightington, Wigan and Leigh

Patients waiting longer to have a broken hip repaired:

Bradford Teaching Hospitals

East and North Hertfordshire

Imperial College Healthcare

Lancashire Teaching Hospitals

University Hospitals Birmingham

THE WORST OF THE TRUSTS

Lowest mortality rates:

Airedale

Ashford and St Peter’s Hospitals
Guy’s and St Thomas’

Imperial College Healthcare

King’s College Hospital 

North West London Hospitals

Royal Free London

University College London Hospitals

Lowest redmission rates:

Airedale

Basildon and Thurrock University Hospitals

Chelsea and Westminster Hospital

Leeds Teaching Hospitals

Northern Lincolnshire and Goole Hospitals

University Hospitals Bristol

Shortest wait times for a broken hip:

East Sussex Healthcare 

Norfolk and Norwich University Hospitals 

North Bristol 

Northumbria Healthcare 

Royal Surrey County Hospital 

Surrey and Sussex Healthcare 

The Dudley Group 

The Newcastle Upon Tyne Hospitals 

West Suffolk

HEALTH CARE - 40% of doctors think inquiries into NHS failings such as Mid Staffs will not have any positive impact on the way their hospital is run

40% of doctors think inquiries into NHS failings such as Mid Staffs will not have any positive impact on the way their hospital is run

• - A third of doctors admit to witnessing poor patient care, but did not report it
• - Less than half said concerns where addressed when they did report them
• - Two fifths of doctors had little or no confidence in recent NHS inquiries
• 
  

By HAYLEY O'KEEFFE

PUBLISHED: 01:43 GMT, 27 November 2013 | UPDATED: 01:43 GMT, 27 November 2013

Four out of 10 doctors do not think inquiries into NHS failings - such as at Mid Staffs - will have a positive impact on the way their hospital works.

Almost half also remain fearful of the personal consequences of raising concerns about poor patient care, a poll of 800 hospital doctors for the Medical Protection Society found.

Around a third admit to having witnessed poor patient care that they did not report but now wish they had.

Four in ten doctors do not think that inquiries into NHS failings will have a positive impact on their hospital

When asked why they did not report the incident, 67 per cent worried that they would not be supported by management, 48 per cent worried they would not be supported by their colleagues and 49% feared raising concerns would have an impact on their career.

Of the 371 who raised concerns about a colleague, 47 per cent said their concerns were addressed.

But for the 178 who raised concerns about their organisation, only 18 per cent found their concerns were addressed and 43 per cent said nothing happened at all.

Two-fifths of all doctors surveyed have 'little or no confidence' that the recent inquiries into failings in healthcare will have a positive impact on the culture of their health trust.

And 65 per cent said imposing criminal sanctions on staff for wilful neglect would create a culture of fear.

Dr Stephanie Bown, director of policy and communications at the Medical Protection Society, said: "The Medical Protection Society has long argued that better care for patients in the NHS would come through creating the right culture; this cannot be achieved through legislation.

Mid Staffordshire NHS Trust was the subject of a damning inquiry into standards of care

'By creating a culture of openness and learning, we believe doctors, nurses and other healthcare professionals will not only be in a position to raise patient safety concerns with confidence that they will be supported, but they will also be in a position to drive continuous improvement in standards of care.

'Whilst introducing a new criminal offence for wilful neglect may seem like a strong measure, our survey of hospital doctors shows many believe it is more likely to create a greater climate of fear with the risk of less focus on patients, not more. This is not what the NHS needs.'

HEALTHCARE - Million A&E patients are needlessly put in wards: one in five could be treated in casualty before being sent home

Million A&E patients are needlessly put in wards: one in five could be treated in casualty before being sent home

• - Of the 5.3m admitted to wards last year, a fifth could have been sent home
• - Report finds that people taking up beds for 'too long' costs NHS billions
• - Lack of out-of-hours GP services blamed for surge of patients to A&E
• 
  

By SOPHIE BORLAND

PUBLISHED: 00:52 GMT, 31 October 2013 | UPDATED: 00:54 GMT, 31 October 2013

Last year 5.3m patients were admitted to a ward after going to casualty, but one in five could have been treated and sent home, the report found

More than a million A&E patients a year are being needlessly kept in hospital, according to a report.

Last year 5.3million patients were admitted to a ward after going to casualty, but one in five could have been treated and sent home.

Many, particularly the elderly, end up staying in hospital ‘far too long’, taking up precious beds and costing the NHS billions, the report found.

Over the past decade the number of patients turning up in A&E has soared by a third. There were 21.7million such attendances last year.

The staggering rise has partly been blamed on a failure of GP out-of-hours services, which has left patients with nowhere else to go, as well as a rise in the elderly population.

As a result, when casualty units are very busy there are fewer doctors available to properly assess patients so staff will be more inclined to send them onto a ward as a precaution, rather than send them home – even if they do not need a hospital stay.

Last year a quarter of patients who turned up in emergency departments were subsequently admitted to a hospital ward compared with 19 per cent in 2003-04.

But the National Audit Office report warns that admitting so many patients unnecessarily is costing the NHS billions every year.

It calculates that the NHS spends £12.5billion annually treating patients admitted from A&E – meaning that if one in five do not need to be there, more than £2billion is wasted.

Amyas Morse, head of the National Audit Office, said: ‘Many emergency admissions to hospital are avoidable and many patients stay in hospital longer than is necessary.

‘This places additional financial pressure on the NHS as the costs of hospitalisation are high.

‘Growth in emergency admissions is a sign that the rest of the health system may not be working properly. 

The elderly in particular were found said to be kept too long on wards with staff less willing to send them home

'Making sure patients are treated in the most appropriate setting and in a timely manner is essential to taking the pressure off emergency hospital admissions.’ 

Professor Keith Willett, Director for Acute Episodes of Care for NHS England, said: ‘We are determined to provide the best possible care for every patient but the increase in emergency admissions is a growing concern, and must be a concern for the whole health and care system not just for hospitals.

The findings comes as Secretary of State for Health Jeremy Hunt announced the downgrading of two A&E units in London to urgent care centres

‘We are an ageing population and the majority of those requiring emergency admission are our elders and those who are frail; very often they have increased care needs as much as a medical need.’ 

Yesterday the Health Secretary, Jeremy Hunt, announced that two A&E units in London would be downgraded into urgent care centres.

From next spring the casualty departments at Hammersmith and Central Middlesex hospitals will become 24/7 care centres run by GPs rather than consultants.

HOSPITAL - Common Problems Patients Face in the Hospital

Understand your hospital risks and ask these vital questions -- to keep those risks in check.

WebMD Feature Archive

By R. Morgan Griffin
WebMD Feature

Reviewed by Brunilda Nazario, MD

It's a fact of life: people checking into the hospital face risks. Expecting to get better, some actually wind up getting worse.

We've all heard the horror stories about hospital risks after surgery. There's the danger of medical complications, like bleeding or infection. Then there are the human errors, like getting the wrong drug or dosage. "Even though you've got a lot of well-trained people in a hospital working very hard, they're still people," says Fran Griffin, RRT, MPA, a director at the Institute for Healthcare Improvement in Cambridge, Mass. "And people sometimes make mistakes."

All these hospital risks can seem far beyond your control. It can leave you feeling pretty helpless.

But experts say that's not the case. "Patients are just too passive when they check into the hospital," says Peter B. Angood, MD, vice president and chief patient safety officer of the Joint Commission in Oakbridge Terrace, Ill. According to Angood and other experts, taking an active role in your health care can reduce many of these hospital risks. While you mightfeel out of control when you go into the hospital, you're really not.

So what can you do to cut your risks? Here's a list of the six top hospital risks and -- more importantly -- what you can do to avoid them.

Hospital Risk No. 1: Medication Errors

"Far and away, the most serious hospital risk is a medication error," says Carolyn Clancy, MD, director of the Agency for Healthcare Research and Quality (AHRQ) in Rockville, Md. "All it takes is for someone to miss a decimal point and you could have a life-threatening mistake."

A 2006 report from the Institute of Medicine estimated that every year, there are 450,000 injuries resulting from medication errors in hospitals, and perhaps many more that are unreported. What's especially frightening about these hospital risks is they "seem" completely beyond your control. How would you even know what medicines you need, or how much, or how often? How can you stop a doctor's poor handwriting on a prescription from being misread by a pharmacist or nurse?

But there are things you can do to reduce this hospital risk. Before surgery, you need to make sure that your doctor, your surgeon, and everyone else involved in your care know about every single medicine -- whether prescription, over-the-counter, or herbal supplement -- that you use. To make it easier, you can just stick all of your medicines in a bag and bring them to the hospital.

Then, after surgery, ask questions. When a nurse comes to give you medicine, ask what it is and why you need it, says Dale Bratzler, DO, MPH, medical director at the Oklahoma Foundation for Medical Quality in Oklahoma City. Make sure the nurse checks your ID bracelet against the name on the prescription.

"If you ever feel like something's wrong, you have to speak up," says Griffin. She's talked to nurses who said that they were about to administer the wrong medication or dose and were only stopped because the patient asked them to double-check." Just by saying something, they averted what could have been very serious medication errors," Griffin says.

Hospital Risk No. 2: MRSA and Other Hospital-Acquired Infections

Another top hospital risk is infection with bacteria or a virus. Hospitals are loaded with nasty bugs. According to the CDC, there are 1.7 million health-care-associated infections every year; 22% are infections of surgical wounds. Even more -- 32% -- are urinary tract infections. The rest are infections of the lungs, blood, and other parts of the body.

One of the most frightening hospital infections you can pick up is MRSA(methicillin-resistant Staphylococcus aureus) -- a type of staph infection that's resistant to many antibiotics. A 2007 study by the Association for Professionals in Infection Control and Epidemiology (APIC)suggested that almost one out of every 20 hospital patients is either infected with MRSA or carries it.

"The risk of MRSA is growing," says Clancy. "It's getting more common and more resistant to antibiotics."

So what can you do? First, ask whether you'll be getting antibiotics before and after surgery to lower your risk. Then after surgery, the best protection is simple: don't let people touch you until you have seen them wash their hands. That goes foreveryone -- including doctors and nurses.

Now of course, you might feel intimidated by the idea of scolding your doctor for his bad hygiene. But experts say that your doctor or nurse shouldn't have any problem with it -- especially if you ask nicely.

Hospital Risk No. 3: Pneumonia

Although some might think of pneumonia as a minor complication, it can be quite serious. After urinary tract infections and wound infections, it's the most common hospital acquired infection. According to the CDC, estimates of hospital pneumonia's mortality rate are as high as 33%. It's most common in people who are in the intensive care unit or on ventilators.

Pneumonia is a common hospital risk after surgery for several reasons. During recovery, you might naturally take shallow breaths, since you're on your back and breathing deeply may be painful. After surgery, many people also have a partial collapse of the lung tissue -- called alectasis -- which further weakens lung function. All of this can make it easier for bugs that cause pneumonia to gain a foothold.

So what are some ways to avoid this hospital risk? Deep breathing is one. "I recommend that people try to take 10 to 15 really big breaths every hour," says Angood. If you smoke, you should quit or at least stop for a week or two before surgery, says Clancy. Just a short break can make a big difference in the health of your lungs.

Aspiration pneumonia has a more specific cause. It develops when you breathe in fluids, like vomit. This can happen after anesthesia because your normal coughingreflexes may be suppressed. The best way to avoid this type of pneumonia is to follow your doctor's advice about not eating or drinking after midnight the day before your surgery. If you don't have anything in your stomach to vomit up, the danger of aspiration pneumonia is quite low.

Hospital Risk No. 4: Deep Vein Thrombosis (DVT)

"DVT, it clearly ranks as one of the more significant risks after surgery," Clancy tells WebMD.

DVT -- or deep vein thrombosis -- is the development of a blood clot, typically deep in the veins of the leg. If the clot breaks free and travels through the bloodstream, it can get lodged in the arteries of the lungs, cutting off the blood's supply of oxygen. This complication, called a pulmonary embolism, can be fatal.

Surgery significantly increases your risks of DVT for several reasons. If you're immobile in bed, your circulation gets worse. That makes the blood more likely to pool and clot in your legs. Also the blood vessels in your legs can become very "relaxed" during the anesthesia used for surgery and the blood can slow down its movement enough to form a clot, especially if the vessel has had prior damage (for example, by way of a previous history of a broken leg) . The trauma of surgery itself also increases the blood's clotting tendency.

Without preventative treatment, the odds of getting DVT after a prolonged major surgery are 25%. For some surgeries, like joint replacement, the odds of DVT are more than 50%.

Fortunately, careful use of blood thinners can slash the risk of DVT without increasing your risk of bleeding. But as effective and safe as this preventative treatment is, studies have shown that these precautions are often ignored. So you should always ask about it.

"Never be afraid to ask about the risk of DVT after your specific surgery," says Angood. "Ask whether you will be getting preventative treatment and for how long."

Another method of DVT prevention is something you can do on your own. "The sooner you can start moving around, the lower your risk of DVT," Clancy says. Stretching and -- when your doctor gives you the OK, getting up and walking -- will get your circulation back to normal.

Hospital Risk No. 5: Bleeding After Surgery

While clotting is a risk for DVT, uncontrolled bleeding after surgery causes problems of its own. However, there's good news. "Bleeding after surgery is not as much of a problem as it once was," Griffin says, thanks to improved surgical techniques. Still, you should make an effort to lower the risks further.

That starts with making certain that your doctor knows every medication -- vitamins, supplements, or homeopathic medication -- that you use. Common medicines -- like the painkillers aspirin and ibuprofen -- can thin your blood, increasing the risk of bleeding. Your doctor will probably tell you to stop taking any medicine that might have this effect a week or two before surgery, Clancy says.

If you forget and take one of these drugs, say something. "There's a simple blood test that can be done to check if your blood is too thin for surgery," says Griffin. "But your doctor might not think to do the test unless you tell him or her."

Also mention if you've ever had excessive bleeding before, even for something minor, like the removal of wisdom teeth. "The biggest predictor of serious bleeding after surgery is having bled after surgery before," says Clancy. If your surgeon knows, he or she can take precautions.

Hospital Risk No. 6: Anesthesia Complications

While many patients still worry about anesthesia, experts say that it's really quite safe these days. "There's no doubt that the biggest advances in improving surgical safety have been in anesthesiology," Clancy tells WebMD. "They've made enormous strides."

But while the risk of problems is now low, there are still precautions you should take. First, ask to meet with your anesthesiology team to discuss your options. Some only need a local or regional anesthetic, while others will need full general anesthetic. Go over the benefits and risks of each one.

Although rare, some people have allergies to certain anesthetics. Rare genetic conditions can also trigger anesthesia complications. "It's always worthwhile to check and see if any other family members have had a bad reaction to anesthesia," Clancy says. If you suspect you might be at risk, you may have testing done before the surgery.

Speaking Up Lowers Hospital Risks

When you're in the hospital, it's very easy to feel intimidated. While you lie in bed, groggy and disheveled in a sweaty johnny-coat, you may feel pretty powerless compared to the brisk, lab-coated doctors who appear at your bedside. What could your puny opinion matter to all these experts? It may be tempting to give up control, to lie back and just hope that your doctors and nurses will remember everything.

But you should never give up responsibility for your own health. The advice from all the experts is to pay attention and ask questions.

"In the old days, good patients were the ones who didn't make any noise and were grateful," says Clancy. "It turns out that those patients don't do so well. The ones who do well are the ones who ask questions."

So to lower your hospital risks, you have to be an active and involved patient. Not only will it give you a feeling of control over your situation, but it may even improve your care. If you're too dazed after surgery to pay attention, your family members should be asking questions on your behalf.

"Questioning authority is never easy," says Nancy Foster, vice president of quality and safety policy at the American Hospital Association in Chicago. "But remember it's your body, your health, and your life. If you ever have questions or concerns about anything during your hospital stay, you have to speak up."

HOSPITALS - 5 Common Hospital Problems — and Suggestions for How to Fix Them

5 Common Hospital Problems — and Suggestions for How to Fix Them

Written by Rachel Fields

Talk to hospitals around the country, and you'll hear about the same problems: crowded halls, provider shortages and sloppy patient hand-off. Mina Ubbing, president and CEO of Fairfield Medical Center in Lancaster, Ohio, and chair of the board of trustees at the Ohio Hospital Association, discusses five common dilemmas facing U.S. hospitals and some suggestions to combat them that worked for her hospital.   

1. Problem: Too many avoidable patient days. 
Suggestions: When Ms. Ubbing brought in an outside group to look at her hospital's inefficiencies, the group found that the number one opportunity for cost-cutting was in avoidable patient days. Patient days can add up quickly if providers aren't focused on moving patients to other facilities or their homes once appropriate. She says the hospital took several approaches to decrease patient days. They worked with nursing homes and extended care facilities to make sure patients could be transferred on weekends, to avoid keeping a patient in the hospital until Monday when they were ready to be moved on Saturday. The hospital also worked with physicians on length of stay and showed data that demonstrated how each physician stacked up compared to his or her peers. 

Ms. Ubbing says the hospital's nurse leaders also introduced a concept called "full capacity protocol." A hospital might be at "full capacity" for various reasons: Perhaps so many patients are in isolation that second beds in semi-private rooms are unavailable, or perhaps all the beds in the hospital are actually full. Sometimes a patient waiting for discharge will occupy a bed when there is no medical necessity — simply because it's easier to stay in the bed than to go home. "What we do is we move the patient awaiting discharge to a hall bed, and we put the sicker patient in the room to begin care there," she says. "It's pretty amazing how soon that patient awaiting discharge finds a way home."

2. Problem: Desire for physician integration but very few employed physicians.
Suggestions: Ms. Ubbing's hospital employs around 10 percent of its physicians, meaning the vast majority of the facility's providers are independent. This echoes the traditional model of physician practice, but it can mean hospitals struggle to integrate physicians in order to take advantage of bundled payments. Ms. Ubbing says the hospital may eventually move toward a greater percentage of employed physicians, but for now, she uses co-management of hospital service lines to involve her independent physicians in hospital operations. The hospital first implemented co-management of the orthopedics service line and then moved to the cardiovascular and thoracic service line. 

When structuring the co-management of the cardiovascular line, Ms. Ubbing says the hospital brought together diagnostic and interventional cardiologists, thoracic surgeons and radiologists — but also primary care physicians and nephrologists, two groups that might seem out of place. "If you step back and think about it and look at 30-day readmissions, the care between hospitalizations rests in those [primary care] offices, not in the hospital," she says. "That's where primary care comes in, and that's where nephrology comes in with vascular cases." 

She says the hospital placed its trust in the independent physicians by saying, "If you want to run how clinical care is delivered in our hospital, come on down." Co-management helps integrate physicians with the system, she says. "Unlike the independent physician, who's doing his care for his patients the way he wants to, he [now] has the opportunity to be part of an institute where the incentives are for the whole group to perform at the highest level," she says. 

3. Problem: Unhealthy community. 
Suggestions: Under the healthcare reform law, FMC is required as a non-profit hospital to perform an annual healthcare needs assessment of its community. "One of our big issues is around healthy lifestyles, and more specifically, obesity and the disease stream it leads to," she says. Even as the insurance coverage expands, she says community members still have to make the effort to visit a physician and keep themselves healthy. In 2010, the hospital targeted drug and opiate addiction in the community, and in 2011, the hospital plans to target obesity. To fight drug addiction issues, the hospital required every employed physician to register with the Ohio Automated Rx Reporting System, an Ohio database that shows physicians a patient's prescription drug history. "There are some pretty persuasive stories that show you don't know what you don't know," Ms. Ubbing says. "One surgeon got a referral from a primary care physician for surgery, and when [he looked up the patient in OARRS], he found the patient didn't have one doctor — he had two. He was getting identical prescriptions from both." The hospital also dedicated a newsletter to issues around drug abuse and provided copies to anyone who wanted them. 

In 2011, the hospital will focus on obesity, a huge problem for many communities in the United States. The community has raised money to sponsor local residents to ride their bicycles at designated events where the courses run from 5-100 miles.  Because the hospital is located in a farming area, administration is trying to bring more local, fresh produce to community members and ensure nutritionally balanced meals in the hospital cafeteria. Ms. Ubbing has been amazed by the willingness of community members to participate in these initiatives: "People have come forward and said, 'I want to be part of this,'" she says. 

4. Problem: Poor communication between providers.
Suggestions: Fairfield Medical Center recently added a new role to its facility: clinical nurse leader. "A clinical nurse leader is the first new role in nursing in 40 years, and this is a post-masters trained nurse who is on track like an advanced practice nurse, except their training puts them in the hospital at the bedside," Ms. Ubbing says. She says the hospital has assigned a clinical nurse leader to micro-units of around 12 beds throughout the hospital, where the CNL acts as a liaison between physicians and patients and mentors other nurses. "[We think] this will reduce length of stay, eliminate some rework and get better information flowing faster for decisions to be made," she says. By installing a nurse leader to increase communication between providers, she thinks patients will have a better healthcare experience with fewer redundancies, and physicians will have a better understanding of what happens to a patient when another provider takes over.

5. Problem: Physician and nurse shortages. 
Suggestions: Hospitals across the country are preparing themselves for predicted provider shortages. To offset physician and nurse shortages in southeastern Ohio, Fairfield Medical Center has partnered with Mount Carmel Health System in Columbus, Ohio, to bring a satellite college of nursing campus to the Fairfield facility. "[Mount Carmel] has a college of nursing that rewards a BSN degree, among others, and they ran out of bricks and mortar space. The cost of that is expensive," Ms. Ubbing says. "They came to us because of the vast majority of their students outside Columbus come from here — Fairfield County." Together, the hospitals installed a branch campus of Mount Carmel's nursing school at FMC. 

About two miles away from FMC, Ohio University runs a branch campus — Ohio University Lancaster. Ms. Ubbing says the nursing students from Mount Carmel do their first year of classroom work at OU Lancaster and spend the next three years doing clinical work at FMC. "There are up to 24 allowed in the class, and we're on our third class this year," she says. "We have the benefit of developing more nurses, and we have a three-year relationship with those nurses [by the time they graduate]." The project benefits everyone: Mount Carmel doesn't have to build more space, Fairfield County students avoid a 50-mile drive and FMC has the opportunity to "grow their own" nurses.

The hospital has employed a similar tactic to "grow" future physicians. The hospital currently has a family practice residency program and is hoping to build an internal residency program as well.