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Should U.S. News Consider Hospital Openness?
Tweet Share on Facebook December 20, 2007 Comment (6)Paul Levy, head of Beth Israel Deaconess Medical Center in Boston, enjoys stirring up a fuss on his blog, Running a Hospital. He loves tossing out challenges—twisting people's heads around a little so they have to regard a question from a different angle.
Now he has proposed that U.S. News give extra credit in the "America's Best Hospitals" rankings to hospitals that let everybody see how well or badly they're doing at keeping patients safe. Compared with other hospitals, for example, what is the rate of infections related to surgery and central venous lines? Thanks a lot, Paul. I can't wait for the outraged calls and E-mails from hospitals if we take you up on it.
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Off With the White Coat, On With the Backless Gown
Tweet Share on Facebook December 10, 2007 Comment (2)I've said many times, only partly joking, that every doctor's training should include a few days in the hospital being treated exactly like any other patient. (After that, a day or two every 10 years should be a continuing education requirement.) There's no other way to taste the fear that comes from half-overheard mumbling just outside your door, the frustration from pressing a call button that might as well be disconnected, the fury from being patronized ("And how are we today?"), and the passivity that comes from being treated as a condition and not a person.
Ask and ye shall receive. Not mandatory hospital stays for budding M.D.'s—those are still on hold. But a new book by psychiatrist Robert Klitzman, When Doctors Become Patients, burrows inside the heads of physicians who have been seriously ill.
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What Doctors Believe—and What They Do
Tweet Share on Facebook December 3, 2007 CommentEven though everybody gripes about healthcare, physicians rank just behind firefighters in "most-admired" polls. A new survey of more than 3,500 doctors could chip away part of that pedestal we put them on, however. The results, to be published tomorrow in the Annals of Internal Medicine, reveal a disconnect between how much the 1,662 physicians who responded said they subscribe to generally recognized professional standards of competence and ethical behavior on the one hand and how they reported they act on the other.
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When Good Safety Intentions Go Bad
Tweet Share on Facebook December 3, 2007 CommentIt would be nice if the magic (if expensive) solution to dangerous errors in hospitals were largely a matter of bringing in technology like electronic medical records and bar-code readers. But, as an entry by a nursing consultant on a patient safety listserv run by the National Patient Safety Foundation reminded me, adding seemingly fail-safe technology is no guarantee that harried people will use it properly. Take, for example, how medications are distributed to patients.
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Nursing Homes That Flunk the Care Test
Tweet Share on Facebook November 29, 2007 Comment (7)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.
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Do Celebrities Get Better Care?
Tweet Share on Facebook November 26, 2007 CommentA 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.)
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An Incisive Close-Up of Surgery Mistakes
Tweet Share on Facebook November 16, 2007 CommentI 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.
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Of Ocean Liners, Sheep, and Hospitals
Tweet Share on Facebook November 13, 2007 CommentSometimes 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.
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Why I Love Medical Press Releases
Tweet Share on Facebook November 9, 2007 CommentAn E-mail popped into my inbox a few minutes ago with an interesting announcement that I can't resist passing on:
"ICU Satisfaction Rates Are Higher If a Loved One Dies"
And the headline of the accompanying press release (from the journal Chest) reads:
ICU Survival Determines Family's Satisfaction with Care
Families of Nonsurvivors More Satisfied with Their ICU Experience
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.
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Treat Them, Move Them Out, Forget About Them
Tweet Share on Facebook November 7, 2007 CommentLast 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.
Comarow On Quality
U.S. News's Avery Comarow has been editor of the America's Best Hospitals annual rankings since they first appeared in 1990. His reporting on clinical medicine, from the latest cholesterol guidelines to robotic surgery, has been driven by the question: What does this mean to patients? And that is the perspective he brings to his observations and commentaries on the increasing number of programs by hospitals and other healthcare providers to improve care and patient safety.
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