Entries for November 2007

Nursing homes that want Medicare or Medicaid funds must submit to state inspections to see whether residents covered by those programs are receiving decent, safe care. The federal Centers for Medicare and Medicaid Services posts the results of the inspections online as part of its Nursing Home Compare tool, and the results, unsurprisingly, show that such care is by no means universal. But a handful of homes out of the roughly 16,000 operating in this country do badly over and over in these inspections; CMS calls them special-focus facilities, and they are inspected more frequently and watched more closely. As of last month there were 128 such nursing homes.

Today CMS released a list of the 54 worst offenders, facilities seemingly unable to improve after many months—some of them after several years. Perhaps shining a light on them, CMS reasoned, might push these homes to change.

A thank-you to hospitalist Rob Wachter and his informative and readable new medical blog, Wachter's World, for tackling a question that might have occurred to some last week. When news broke that actor Dennis Quaid's newborn twins and another baby at Cedars-Sinai Medical Center in Los Angeles (it's on the Honor Roll of "America's Best Hospitals") had accidentally received a dose of the blood thinner heparin that was 1,000 times the normal concentration, it would have been reasonably logical to think, "How could this have happened? Don't celebrities get special care?" (The hospital says the kids are fine.)

I took a metaphorical stroll the other day through a funhouse of mirrors, or maybe a better analogy would be watching while Alice grew and shrank as she sampled different "Drink Me" bottles. It had to do, first, with attempts to put a number on surgical mix-ups—operating on the wrong patient, wrong side of the patient, or wrong part of the patient, not to mention performing the wrong procedure—and second, whether the number even matters.

Sometimes the work of the patient and professional groups to raise standards of hospital quality and safety reminds me of tugboats hauling and pushing gigantic ocean liners—their ponderous bulk resists changing course, but eventually they come around. On gloomier days, what comes to mind is border collies racing around to move a flock of sheep from one pasture to another, snapping at their heels while the woolly ones scatter this way and that, wondering in their dumb way why they can't be left alone to graze as they would in a world without annoying border collies. Yesterday I thought of both.

An E-mail popped into my inbox a few minutes ago with an interesting announcement that I can't resist passing on:

And the headline of the accompanying press release (from the journal Chest) reads:

And the first sentence of the release reads:

"New research reveals that the families of patients who died in the intensive care unit (ICU) had higher satisfaction of care ratings than families of patients who survived their time in the ICU."

The actual study is interesting and worthwhile. The publicity for it is truly a candidate for my press Leave-Out-the-Context Hall of Fame.

Last week, on a dazzling fall afternoon at West Point, a beribboned Marine gunnery sergeant held a roomful of military medical officers captive. They didn't object; they were locked in on the story he had to tell. I was there, too, invited to give a talk about our hospital rankings and medical quality and safety that evening for military physicians and nurses and civilian consultants at a conference with the theme "Taking Care of Our Warriors." Ken Barnes's message was disturbing, a tale of marines wounded in Iraq or Afghanistan, treated at stateside military hospitals, and cast adrift to fend for themselves. After I'd chewed over his account and talked with him, I found myself thinking: How different, really, is civilian care? Roll your eyes—I understand—but stay with me.