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How Hospitals Treat Women
Tweet Share on Facebook June 24, 2008 Comment (3)Today HealthGrades.com, which rates individual hospitals on an assortment of relatively routine procedures such as heart bypass surgery and C-sections, issued its fifth annual report on how well hospitals treat women when they give birth and when they have heart disease. As in previous years, it shows a gap between top-performing hospitals and those at the bottom in complications following vaginal and C-section births and in deaths following cardiovascular procedures such as bypass surgery and stent insertion.
I thought I'd take a look, partly out of curiosity—I hadn't spent much time with the previous reports—and partly because of the proliferation of Web-based report cards on hospitals. If hospitals were patients, they'd be spending much of their time being poked and questioned and examined. The Agency for Healthcare Research and Quality, a federal body, currently tabulates 68 online report cards (including the U.S. News Americas Best Hospital's rankings) that use different combinations of clinical data, patient surveys, and other information (on patient safety, for example) to put hospitals—nationally, regionally, by state—through the mill.
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What Medicine Can Learn From Business
Tweet Share on Facebook June 17, 2008 Comment (1)It has been 14 years since Betsy Lehman, then the Boston Globe's chief medical columnist, died of a massive chemotherapy overdose at Dana-Farber Cancer Institute. Her case seized headlines, but oft-cited statistics from the Institute of Medicine suggest that from 44,000 to 98,000 hospital patients die every year the way she did, because of safety lapses and incompetent care, meaning a toll since the publication of the IOM report in 1999 of perhaps 400,000 to 900,000 people—or from roughly the population of Oakland, Calif., to that of Detroit. The IOM estimate is highly questionable, representing assorted leaps of faith from selected studies, but if the actual count were 300,000 or 100,000, how much less horrifying would that be?
Attention has been paid. The Best Practice—How the New Quality Movement Is Transforming Medicine, to be published next month, is in part an account of the shock wave the 1999 IOM report sent through hospital boardrooms and clinics and in part a recitation of remedies that enlightened healthcare organizations are putting in place. The book, by journalist Charles Kenney, isn't nearly as wonkish as its title suggests. It's a great read, as exemplified by a passage describing a visit to Japan a few years ago by top administrators at Virginia Mason Medical Center in Seattle, to see if Toyota's vaunted management and production techniques could work at the hospital.
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Pediatric Hospitals Make Errors, Too
Tweet Share on Facebook June 11, 2008 Comment (1)Having just shepherded the 2008 "America's Best Children's Hospitals" rankings to completion, I've still got young patients on my mind, and a study in the latest issue of Pediatrics caught my attention. It is a poignant reminder that while adults comprise the vast majority of inpatients and consequently suffer from a greater number of mistakes and instances of shoddy care, young patients, too, are accidentally punctured, develop infections, have surgical sponges left in their bodies, and are otherwise victimized by mishaps that are almost always preventable.
The study identified more than 6,600 such significant slipups at 38 stand-alone children's hospitals during 2006 out of a total of about 430,000 children treated. It is not too much of an oversimplification to conclude that 1 child out of every 65 admitted to these hospitals—arguably the crème de la crème source of pediatric care—had something go seriously wrong.
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Are Hospitals Overdosing on Intensive Care?
Tweet Share on Facebook June 2, 2008 Comment (3)If you are very, very sick—so sick you have to be admitted to an intensive care unit, draped with tubes and IVs and catheters and sensors, fluids going in and coming out—what kind of physician should be at your side? An intensivist, of course. Many studies, including an exhaustive 2002 analysis in the Journal of the American Medical Association of the value of these specialists (pulmonologists, internists, and other physicians with specific training in critical-care medicine) concluded that the greater their role in the ICU, the lower the risk of death. This makes sense. Intensivists are experts in managing such fragile patients.
Then how to explain an unsettling study, out Tuesday in the Annals of Internal Medicine, that reaches exactly the opposite conclusion? The paper, which analyzed the care of more than 100,000 patients in 123 ICUs at U.S. hospitals, found that the chance of death was higher for ICU patients whose care was handled by critical-care specialists than for patients overseen by the admitting surgeon or other physicians lacking specialized training. Researchers adjusted for age, sex, severity of illness, length of stay prior to the ICU, and other factors. They call their results "surprising and completely contrary to previously published findings." No kidding.
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.
