Tag: Quality

Big administrator is watching you

Sep 29, 2008• 4

Robert_wachter By Bob Wachter

Last week, came the announcement that Suzanne Delbanco, founding director of the Leapfrog Group, has assumed the presidency of a company that tracks compliance with safety and quality practices via remote video. Big Brother, meet the Joint Commission.

The report, in Modern Healthcare, describes the process this way:

Video auditing refers to a system in which cameras are mounted in targeted locations to continuously capture specific clinical processes, such as observing handwashing and hand-sanitizing stations. [Using video] fed through a Web-based link, independent, third-party observers audit the recordings and provider reports on safety incidents.

Did you ever doubt this was coming? Virtually every other industry with compliance standards has long used video to monitor compliance and to goose workers into following the rules. If video surveillance is good enough for Vegas croupiers and Kansas meat packers, why wouldn’t it be good enough for neonatal nurses and ER docs?

Mixed reception for hospital ID bracelets

Sep 26, 2008• 2

By Sarah Arnquist

Color-coded hospital bracelets intending to identify categories of patients and prevent errors by ensuring they receive proper care have received a mixed reception, the New York Times reports.

Red bracelets indicate allergies, amber says the patient has a falling risk and purple tells hospital staff that the patient has a not resuscitate order. The DNR bracelets seem to be attracting the most criticism.

Apparently, the Joint Commission warns that the purple bracelets may "brand" patients by their end-of-life choice, and may upset family members unfamiliar with the patient’s wishes.

Are those really legitimate reasons for blocking greater uptake of this seemingly simple and pragmatic strategy to improve patient care and ultimately deliver the care the patient wants?

A Genius Shines…And, Where the Light Doesn’t, Hospitals Don’t

Sep 25, 2008

By Michael L. Millenson

It doesn’t take a genius to figure out that hospitals could dramatically reduce the hundreds of thousands of deaths and injuries they unintentionally cause patients ever year, but it may take a genius to coax change out of ossified organizations. As for getting hospitals to publicly disclose injuries and deaths the law says they must? That’s another story entirely.

On the good news front, The MacArthur Foundation has just honored Johns Hopkins’ Dr. Peter Pronovost with a “genius award,” the informal moniker for the go-and-do-smart-stuff prize given to MacArthur Fellows.

Pronovost, you may recall, is the critical care physician who came up with the idea of culling lengthy guidelines on error prevention in the ICU into a simple checklist of five precautionary steps. When tested in ICUs throughout Michigan, the result was to “change the culture of [the] institutions in the interest of reducing the risk of medical errors and hospital-acquired infections,” the foundation noted. “Pronovost’s checklist intervention yielded a significant and sizeable decrease in rates of infection and is currently being replicated by hospitals across the U.S. and Europe.”

Evidence of a Need for Change

Sep 24, 2008• 4

By THCB Staff

The Health Care Blog regular Michael Millenson wrote a great piece recently in Miller-McCune Magazine on the necessity of practicing more evidenced-based medicine, and why it’s not happening.

Here is a powerful snippet but it’s definitely worth checking out in its entirety.

Experts believe that a stunning 20 to 40 percent of the $2.4 trillion America spends on health care in 2008 will be wasted on misuse (including harmful and fatal errors), overuse (care that’s unnecessary) or underuse ( effective care that’s not provided). If you take a midrange figure — let’s say 30 percent — you end up with $720 billion in savings. That’s enough in health care savings to pay the cumulative costs of the Iraq war (about $560 billion by mid-September 2008) and still have enough cash left over to pay for universal health care and the entire federal education budget. If you simply sent out a rebate check, it would come to some $2,100 for every man, woman and child in the country.And that’s just one year of savings.The failure to follow best practice carries a price tag in human lives, too, and it is equally enormous. Providing appropriate, effective and safe care where we know how to do it — no “medical mysteries” included — could annually prevent the deaths of hundreds of thousands of Americans in and out of the hospital and millions of injuries.

Wonder if your doctor is laughing at you?

Sep 12, 2008• 3

By Sarah Arnquist

That CNN headline grabbed my attention and got me to read a column that basically chastises the 17 percent of internal medicine residents who reported they had laughed at patient in a survey published in JAMA.

The author then goes on to express great relief that 94 percent of those who find humor in their patients considered it unprofessional behavior.

Lighten up! Of course, no doctor — or any professional for that matter — should laugh in a patient or client’s face or use humor maliciously. That’s basic human decency.

But humor is a release, and in a work environment as stressful as a
hospital, people need a release. Maybe that release should occur
outside the hospital walls, but funny things occur in stressful
environments and people do strange things that often merit a chuckle or
two.

A long way to go in price and quality transparency

Sep 2, 2008• 4

By Jane Sarasohn-Kahn

Providing price and quality information is viewed as a Holy Grail among health plans and providers, who see transparency as the key for igniting health care consumerism. However, that Grail remains elusive, as issues of tool usefulness and consumer trust cloud the market."A Health Plan Work in Progress: Hospital-Physician Price and Quality Transparency," a report from those indefatigable folks at the Center for Studying Health System Change (CSHSC), explains that health plans are ramping up transparency efforts in what is still an early phase of market development and adoption.

Medicare hospital quality reporting steps up in sophistication

Sep 2, 2008• 2

By Bob Wachter

Robert_wachter
Medicare is now reporting actual risk-adjusted mortality rates for pneumonia, MI, and heart failure. The topic must be important because NPR’s "Talk of the Nation" spent 30 minutes interviewing Don Berwick and me about it — on the day of Hillary’s speech nonetheless!

To listen to the show, click here. Also, here’s an article from USA Today that got the ball rolling, as well as Avery Comarow’s thoughtful blog on these new reports.

Here are a few observations about the new Centers for Medicare & Medicaid Services initiative, some of which I made on the NPR broadcast:

Health care in the YouTube era

Aug 19, 2008• 5

By Bob Wachter Robert_wachter

August 11th was the 2nd anniversary of the epic implosion of George Allen’s presidential campaign, the first defeat at the hands of YouTube. Two recent videos of unattended patients dying in ER waiting rooms leave me wondering whether health care has also entered the YouTube era.

Remember the George Allen fiasco? A 20-year-old Indian-American named S.R. Sidarth, working for Allen’s opponent Jim Webb, was filming an Allen campaign stop in Breaks, Virginia. Twice, Allen pointed to him and called him “Macaca,” a racial slur meaning “monkey.” Once the video hit YouTube, it went completely viral (this clip, one of many, has been viewed 350,000 times) and Allen’s promising political career was toast.

What does this have to do with health care? In the past 18 months, two powerful, highly troubling videos have surfaced of patients being left to die in ER waiting rooms. The first, in May 2007, involved a woman named Edith Rodriguez. Rodriguez began vomiting blood while waiting outside the King-Drew ER, and soon collapsed. Rodriguez’s husband called Los Angeles’s 911 system, but got nowhere. Then someone else in the waiting room called:

Prescribing a dose of healthy skepticism

Aug 15, 2008

By Sarah Arnquist Healthyskeptic

Headlines declare wine is good for your health. So is a small bit of dark chocolate. Then, they say it’s not. One day coffee is bad for you and the next it’s good.

We’re bombarded with health messages daily from companies selling things, advocacy groups promoting their agendas and journalists trying to sift through it all.

Who are you to believe? Unless you have a degree in epidemiology, it’s very difficult to discern the valuable information from all the garbage.

In his new book, “The Healthy Skeptic,” journalist Robert Davis gives readers some quick tips to become better consumers of health care information.

“A healthy skeptic carefully and critically evaluates each piece of advice taking into account not only its source but the science behind it,” Davis writes.

NICE job. Cost-effectiveness in the UK

Aug 5, 2008• 18

By Matthew Holt

Yesterday I went to a high powered lunch put on by HealthTech, with a high powered crowd attending (including the head of the California Dept of Managed Health Care, lots of Kaiser Permanente people, Arnie Milstein from Mercer, et al).

The speaker was Andrew Dillon, the head of the National Institute for Clinical Excellence (NICE), the UK’s technology assessment agency. But unlike the late and somewhat lamented Congressional OTA that the Republicans killed in 1995, NICE has teeth. NICE is only well known in the US as being the agency that stops new wonderful treatments getting to blighted Brits who are instead left to die in the streets.

The way this works, as Dillon explained to the somewhat incredulous head of the California Dept of Managed Healthcare (and I paraphrase) was that if NICE says something’s off limits (such as a new drug) a doctor won’t prescribe it. And if they did, the pharmacy wouldn’t fill it. And if they tried to, well they wouldn’t find it because the hospital wouldn’t have bought it. Such power! And I’m sure the envy of the many regulators and payers in the room.

However, Dillon explained that contrary to popular belief there isn’t a straight cut off point for approving new technologies.