In August, a whistleblower inside the UC Irvine Medical Center released information to the Centers of Medicaid and Medicare Services (CMS) of anesthesiology reports that had been signed in advance to confirm full surveillance up and until the release of patients before any monitoring had occurred.
The CMS investigation on Aug. 21 indicated that the falsified reports were made in 2005 and 2006.
In 2007, the UCI Medical Center refused to renew the contract for current head of the Department of Anesthesiology Dr. Peter Breen, and sought a director in line with its new vision. Dr. Zeev Kain, executive vice chair of anesthesiology at Yale University School of Medicine, accepted UCI Medical Center’s offer in October 2007 and assumed responsibilities in March 2008.
However, according to Dr. Kain, the Department of Anesthesiology had begun to reorganize its priorities, including updating the recording system well before CMS had filed its reports. Upon Dr. Kain’s employment, the Department of Anesthesiology was renamed the Department of Anesthesiology and Perioperative Care to represent the department’s emphasis on developing its perioperative care system, which concerns the anesthesiological care of the patient from admittance to the ward, anesthesia, surgery and recovery.
“All these issues, that came up [in] 2005 and 2006 came up long before many of us were here. We didn’t need somebody to tell us what needed to be fixed – we were fixing them,” said Dr. Maura B. Hofstadter, associate chair of the Department of Anesthesiology and Perioperative Care.
Hofstadter emphasized her concern with the pre-documentation taking place.
“There were issues that we were unaware of, and that was this whole pre-documentation and filling out the records wrong. That was something that we were unaware of when CMS brought it up, and there’s been a very intensive education campaign for our whole department about how that is completely unacceptable and cannot happen,” Hofstadter said. “With our new electronic record-keeping system, it’s almost impossible because it’s a computer that time stamps everything.”
Dr. Kain explained that the new computerized documentation system automatically feeds vital signs into a compiled report. The report time stamps the records to simultaneously track vitals across time and prevent the falsification of reports that precipitated the CMS report.
“It’s [fully installed] now in parts of the operating room. Part of the system is up and running for the entire operating room; the other part of the system is in the process of implementation,” Kain said. “We think that by the end of this month, all the parts of the system will be implemented.”
The automated vitals recording system is only used by less than 5percent of hospitals in America, according to Dr. Kain, because installation runs around 1.5 million dollars.
“A condition of me coming to UCI was [the purchase] of that machine,” Dr. Kain said.
Although other publications have emphasized the possibility of patient endangerment from the falsified reports, Dr. Kain strove to clarify that the problems were strictly paperwork-related.
“There was no potential for patient harm from the surgery reports. It was a question of paperwork. That’s it. This has nothing to do with the medical part of the chart,” Dr. Kain said.
Although Dr. Kain was confident that his timely responses to publications explaining the issue had “really negated any damage,” some were not so confident. Richard Moore, a third-year graduate medical student, felt the negative attention was ill-deserved.
“I’m a little bit annoyed,” Moore said. “It seems like it’s not really a concern for patient safety, and when you take a look at it, it’s kind of an attack on our department,”
Pam Hockert, a third-year medical student, supported Moore’s opinion. “It’s hard for a department to face things that are coming up in the news and all the negative stuff is what makes for a better story, so that’s what gets in the papers and on the television … People have been really strong, supporting each other and talking about the issues and bringing in food to keep morale up,” Hockert said.
Both Moore and Hockert had only been involved with the anesthesiology department for three weeks, having finished the requisite two years of theory classes on classrooms on the main UCI campus. Both started their third year this fall and had chosen to take “elective” classes in anesthesiology, in which both had expressed interest in pursuing as a career focus.
When asked if the negative attention would deter him from pursuing training in the Department of Anesthesiology and Perioptive Care, Moore said, “I think it’s irrelevant. I’m interested in anesthesiology because of the science involved and what we get to do as anesthesiology; this record-keeping part of it is really a small part.”
Hockert approved of UCI’s effort to improve the Department of Anesthesiology and Perioperative Care.
“It’s been really impressive, from my perspective, how much time and effort and money and how many people have come together to fix any holes [in the department],” Hockert said, “[They] have tried to make the department the best it can be.”
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