Wonder if THIS kind of crap will get worse under Healthcare 'reform'

Gatekeeper

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Nov 11, 2009
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But then again, this kind of crap has been occurring for generations.
I cannot imagine the pain and anger that this person is going to deal with
forever.

How can 'super educated' staff members in any medical institution be so damn stupid is beyond me. Are they hiring mental midgets or have the limits for intelligence been lowered to accommodate political correctness and 'fairness' in hiring? :eek:
 
It's been a decade now since the Institute of Medicine (one of the United States National Academies) released To Err Is Human which was a landmark report on patient safety and the surprising prevalence of medical errors in our system. Two of the many authors of that report (one of whom is Don Berwick, now head of CMS) did sort of a five-year check-in in a piece published in JAMA in 2005 and found that things weren't progressing particularly quickly on the patient safety front, though some improvement had been made.

Several months ago, at the 10-year anniversary of the report, there were lots more retrospectives that seemed to agree that things are a little better now but not much. For example:

Since the landmark report, health providers have been chagrined by the revelation that they were killing "a jumbo jet" full of passengers every day, about 98,000 preventable deaths a year. And many of them reacted to the allegation by launching a broad spectrum of efforts to reduce medical mistakes.

But are we really better today at preventing mistakes and safeguarding our systems from causing harm than we were 10 years ago?

"We're safer in many more places, and more of the time," says James Conway, senior vice president of the Institute for Healthcare Improvement in Cambridge, MA.

"We're seeing very courageous people in many organizations doing exceptional work. We're seeing sobering discussions about the circumstances in which patients died unnecessarily, confronting the reality of the patient who was harmed with graphic detail, using the name of the patient, and their age."

There is in many places, Conway says, more accountability and more responsibility. There is more acknowledgment that mistakes are preventable, and not just part of the background noise that says it's OK because bad things happen in medicine sometimes.

But on a national level, he's not so sure. He's concerned that in many regions, facilities have not become "expert at looking for trouble. We're just learning to identify what harm is," he says.

First the good news.

  • Many states now require reporting of adverse events and some require public reporting of hospital-acquired infections, patient falls or pressure ulcers. In some states, health officials hold press conferences to publicize hospital errors that caused, or had the potential to cause serious patient harm or death. At least one state, California, imposes hospital fines and publishes the incident report in all its excruciating detail on the Web.
  • Medical residents' hours are now restricted to prevent errors caused by fatigue.
  • Providers in many hospitals that normally compete have joined hands to unify how they label high-risk intravenous medications, to avoid a new doctor or nurse from misusing a potentially lethal drug because the facility's coding or storage system was not the same as their previous hospital.
  • The Institute for Healthcare Improvement launched a number of safety strategies, including its "100,000 Lives Campaign." Following that campaign, the IHI launched its "5 Million Lives Campaign" to understand and address those medical mistakes, an estimated 40,000 per day, that injure patients and take a toll on their quality of life.

    Providers are setting goals for their communities. Hospitals are starting to use the IHI "global trigger tool" to more accurately measure areas of care that might be causing avoidable harm, including the 28 adverse events now required to be reported.
  • Facilities were urged to adopt a "no-blame" system to encourage providers to report their own missteps, in the chance the practice or situation might be easily repeated by a colleague. Disclosure of those mistakes and transparency has become acceptable at many facilities as well.
  • Central Line Associated Bloodstream Infections have been reduced.
  • Many facilities are using "checklists" before beginning surgery or a complex procedure.
  • The Centers for Medicare and Medicaid Services will no longer reimburse health facilities for the cost of caring for a patient with a preventable hospital-acquired infection.
  • More attention is being paid to physicians' diagnostic errors, and the importance of being candid with patients and patients' families when preventable errors occur.

But many significant challenges remain.

Let me also throw out there that Thomson Reuters estimated that medical mistakes are costing us $75-$100 billion every year.

Does health care reform (i.e. the ACA) make some strides toward improving patient safety? Some, there's a lot more quality reporting that will be happening, new national standards, money for incorporating patient safety training in clinical education programs, programs within the public payers to link payment to quality and reduce preventable hospital re-admissions. And one of the key concepts behind one of the big enchiladas in the law--the new and innovative care delivery models being rolled out--is patient safety and patient-centeredness.

But I would suggest that the really big potential to reduce medical errors doesn't come from ACA but from another law that passed early in 2009, the HITECH Act. I've talked about HITECH before: essentially it's spurring states to start building the infrastructure to exchange health information and it's offering incentives to Medicare and Medicaid providers (doctors and hospitals) to adopt electronic health records and "meaningfully use" them. The definition of what it means to meaningfully use an electronic health record is rolling out in three parts (that thread I linked to is about the first stage of the definition, which has been released) but we do know that by the third and final part, which will go into effect in 2015, improving patient safety and reducing medical errors is going to be a huge part of it.

Electronic health records have a huge potential to cut down on those kinds of mistakes at a practice-to-practice level. So if in a decade most or all physicians and hospitals were not only using EHRs but using them to their full potential in compliance with national standards, I think that would go a long way toward severely reducing these kinds of medical errors.
 

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