Time to Rethink Separating Out the Psychiatric Record?

Time to Rethink Separating Out the Psychiatric Record?Traditionally, most hospitals have separated out the psychiatric record from a patient’s medical record. This was done historically because of the stigma and discrimination associated with psychiatric concerns — and the serious lack of training in medical school for physicians to understand such information in proper context.

As hospitals move to electronic records, the default behavior has been to simply keep things as they are — so no more processes than necessary have to change at the same time. This means keeping the psychiatric information in the electronic record segregated from a patient’s medical information.

But in an intriguing new study just published — on a very small cohort — researchers found that where hospitals allowed any properly authorized medical staffer to access the patient’s psychiatric information in the electronic health record (EHR), hospital readmissions went down.

Perhaps it’s time to re-evaluate whether opening up the sharing of such information among all doctors on a patient’s treatment team might actually be a good thing.

To get the data, the researchers surveyed 18 hospitals on the 2007 U.S. News and World Report list of the “Best Hospitals in the United States.”

“Of that group, eight hospitals (44 percent) kept most or all of their inpatient psychiatric records electronically, and five (28 percent) let non-psychiatrist physicians see mental health records, including psychiatric admission notes, discharge summaries, notes from the emergency department, and consultation notes.”

Just four hospitals did both. Among this latter group, however, readmission rates for psychiatric patients were substantially lower than at the others on the list. Here’s what they found:

Top teaching hospitals that provided non-psychiatrists with electronic access to inpatient psychiatric records had up to 39% lower rates of readmissions within 7, 14, and 30 days of initial discharge than comparable institutions that did not include inpatient psychiatric notes in their EHRs. Full access also cut 7-day readmission rates by as much as to 27% when compared to hospitals that did not let primary care and emergency physicians see psychiatric records in the EHR

I only have one concern — that non-psychiatrist physicians treat the psychiatric information with the same care they would as if it were their own information. Sometimes doctors are a little too loose with a patient’s medical information when talking to other docs — especially in public places where many others may hear (like an elevator).

I’m also concerned that stigma, discrimination, prejudice and misunderstanding are still fairly rampant among some physicians — especially in certain specialties. Without proper education and training, I worry that some doctors may misuse or inappropriately share information gleaned from a patient’s psychiatric record. Proper education and training could readily solve this concern, however.

Patients, too, ultimately benefit from such increased sharing, as this study — if confirmed by others — demonstrates. If patients are afraid of this development, I usually find information is the best remedy — showing patients exactly what is and isn’t in their medical and psychiatric charts. Patients, of course, have a right to view their medical and psychiatric records in their entirety. In most instances, once a patient sees how little is actually in their psychiatric or mental treatment progress notes (if it’s being properly maintained), they’re usually satisfied.

I’m a big believer in the benefits of transparency and open communication. If giving doctors access to all relevant data of a patient — including their psychiatric history — can help patients receive better care, why not do it?

 

Read the full article: Sharing Psychiatry EHR Data Cuts Readmission Rates

The Strange & Surprising Science of Sleep

The Strange & Surprising Science of SleepIn his book Dreamland: Adventures in the Strange Science of Sleep, author David K. Randall calls sleep “one of the dirty little secrets of science.” That’s because despite spending almost a third of our lives sleeping, we don’t really know much about the process of sleep.

In fact, Randall, a senior reporter at Reuters, notes that sleep is one of the youngest fields in science. Until the 1950s, researchers believed that our brains remained quiet during slumber.

But the discovery of the stages of sleep shattered this perspective. For instance, our brains are just as active in REM sleep — aptly named rapid eye movement because our eyes shift rapidly against our lids — as they are when we’re awake.

In Dreamland, Randall shares a slew of these fascinating, surprising and eye-opening facts, anecdotes and research studies. These are a few curious tidbits from his book.

Our Normal Sleep Isn’t So Normal

Today, we think that sleeping through the night is a sign of normal and healthy slumber. In fact, people who wake up around the same time every night think their sleep is fractured — and that something is wrong, Randall writes. And when they complain about this concern to their doctors, they probably walk away with a sleeping pill, he says.

But segmented sleep has actually been the norm for thousands of years — that is, until the advent of artificial lighting. In the 1980s and ‘90s, history professor Roger Ekirch began seeing interesting patterns in his book collection, which included tales and medical texts: references to “first sleep” and “second sleep.”

Psychiatrist Thomas Wehr also began seeing strange results in his sleep experiment: After participants, who were deprived of artificial light for up to 14 hours, caught up on their sleep and felt more rested, they’d wake up around midnight and lie awake for about an hour, and then fall asleep.

In another study, Wehr found that during that hour awake the brains of participants were churning out higher levels of prolactin. This hormone reduces stress and relaxes the body after orgasm, according to Randall.

Before Thomas Edison invented the light bulb, people would fall asleep after sunset. Then they’d naturally wake up around midnight for about an hour. During that time individuals might do anything from praying to reading to having sex. Then they’d naturally fall back asleep until morning.

Randall notes that other studies have confirmed that people naturally experience segmented sleep. And in areas with no artificial light, people still experience first and second sleep.

Naps Get a Bad Rap

In our society, naps are viewed as luxurious activities only reserved for the privileged or the lazy. That’s a shame, because research continues to show the benefits of naps and discredit these beliefs.

One study found that astronauts who slept for just 15 minutes had better cognitive performance, even when there was no boost in their alertness or ability to pay attention.

Another study found that participants who napped and experienced the deeper stages of sleep had more flexible thinking. They were able to apply information they memorized to a new task much better than participants who watched a movie instead of napping.

Randall also notes that participants who take naps outperform their counterparts who aren’t allowed to doze off on other various tasks. For instance, research has found that they’re able to finish mazes faster and remember longer lists of words.

Big companies have even made naps part of their workday. According to Randall, Google and Nike are just some of the companies that have created specific spaces for their workers to sleep. “The idea is that naps may allow engineers and designers to arrive at creative solutions more quickly than they would by staying awake all day,” he writes.

In Dreamland Randall explores many more peculiar issues surrounding sleep, from the purpose of dreams to the bizarre world of sleepwalking and “sleep crime.”

While sleep research is in its infancy, one fact is undeniable: Sleep is vital for everything from our survival to our success.

When functioning optimally, sleep can sharpen our thinking and help us problem solve (like golfer Jack Nicklaus did when he figured out how to tweak his swing in his sleep). When gone wrong – as in cases of sleepwalking and sleep deprivation – it can distort our cognitive skills, sink our mood and even make us dangerous.

As Randall notes, “Sleep isn’t a break from our lives. It’s the missing third of the puzzle of what it means to be living.”

 

Woman sleeping photo available from Shutterstock