“Health care is not only a civil right, it’s a moral issue,” said Representative Patrick J. Kennedy, Democrat of Rhode Island, who invoked the memory of his father, Senator Edward M. Kennedy, Democrat of Massachusetts, a lifelong champion of health care for all.
In reading through the study, I remembered how people who work in hospitals often ask, “When is the worst time to be a patient in the hospital?” But a non-doctor friend reminded me recently that it’s a question patients spend a lot of time thinking about, too. “I thought about it all the time when I was pregnant,” she said. “I didn’t want to deliver on the weekend or a holiday or when my doctor wasn’t around.”
Facing united and intense Republican opposition, Democrats pushed on toward a final set of votes on Sunday evening, hoping to wrap up action on the legislation in the House and send one remaining aspect of it to the Senate for action as soon as this week. At least 218 Democrats had made public commitments to support the legislative package, two more than necessary for final House passage.
The result of this interplay, according to a study published this month in the journal Medical Care, is that each hospital has a unique threshold — its own “fingerprint,” according to one of the study authors — beyond which patient safety becomes compromised. One hospital may find that a four-to-one patient-to-nurse ratio and 70 percent occupancy borders on hazardous, whereas another hospital that serves a healthier population will work efficiently at the same staffing ratio until at least 90 percent of the beds are occupied.
Previously, when a system was under cyber attack, the only solution to mitigate the threat was to take the server offline. However, there may now be another option. MIT researchers have developed a system that allows servers and computers to continue to operate even while under cyber attack.
The research, predominately funded by the U.S. Defense Department’s Defense Advanced Research Projects Agency (DARPA), has stood up to outside testing. DARPA hired outside security experts to attempt to bring down the system. According to Martin Rinard, an electrical engineering and computer science professor who led the project, the system exceeded DARPA’s performance criteria in each test.
During normal operations, the system developed by the MIT team monitors any programs running on computers connected to the Internet. This allows the system to determine each computer’s normal behavior range. When an attack occurs, the system does not allow the computers to operate outside of the previously determined range.
“The idea is that you’ve got hundreds of machines out there,” Rinard says. “We’re saying, ‘Okay, fine, you can take out six or 10 of my 200 machines.’” But, he adds, “by observing what happens with the executions of those six or 10 machines, we’ll be able to deploy patches out to protect the rest of the machines.”
Angelos Keromytis, an associate professor of computer science at Columbia University, finds the MIT approach to be novel. However, he feels that most web developers might be reluctant to implement the new technology in the near future.
“They’re wary of a system that changes another system automatically,” Keromytis said. “When they manually make changes to their systems, they break them, so they think that automatically doing it is going to be worse.”
Nevertheless, Keromytis believes this new approach has its merits. “This is probably one of the most successful exercises that I have seen,” he said.
Furthermore, the amount of money DARPA spent on testing shows how committed they are to the project, Keromytis said. “They think it’s close enough to a rough prototype that works, which is more than one can say for most academic research.”
Dr. Matthew Davis, an associate professor of pediatrics, internal medicine and public policy at the University of Michigan and senior author of the study, suggested that patients get their seasonal flu vaccinations and speak to their doctors about the timing of their procedure or admission, particularly in relation to the hospital’s overall work flow. “I think that would be a particularly good conversation for people planning to have elective surgery,” Dr. Davis said. “Not all of this improvement in safety has to happen within the fours walls of a hospital.”
kinds of discussions can have other implications for patients. “Death is the most grim outcome measure,” said Dr. Peter L. Schilling, lead author of the study and a resident in orthopedic surgery at the University of Michigan. “But it’s not hard to imagine how all of these things could also affect a patient’s experience.”
To learn more about factors influencing in-hospital mortality risks and what can be done about them, read my column, “When Is the Worst Time to Go to the Hospital?” and then please join the discussion below. Have you ever thought about the worst time to be a patient in a hospital?