Sunday, September 23, 2012

Hospital and Airplane Safety: The Problem with The Death-Rate Metaphor
Medical errors kill enough people to fill four jumbo jets a week.
Marty Makary, MD, born 1976,   Johns Hopkins surgeon , in “How to Stop Hospitals from Killing Us, “ Wall Street Journal, September 22-23. Wall Street Journal
When you use metaphor, do not mix it up. That is, don’t start by calling something a swordfish and end by calling it an hourglass/
E.B. White (1899-1985), Elements of Style (1959)
September 23, 2012 -  To hear hospital safety critics tell it, the health system is out to kill us.  If only, say critics, the health industry would adopt the practices of the airplane industry, and only if patients were encouraged to report mistakes, killings would decline.
To a limited extent, I am sympathetic with these points of view, as expressed as follows.
·         Donald Berwick, MD (born 1946), administrator of CMS form Jlu 7, 2010 to December 2, 2011), when president of the Institute of Healthcare Improvement, in 2007 launched a campaign “Saving 100,000 Lives”, with these specific suggestions.

1.      Deploying rapid response teams at first sign of patient decline. 

2.      Delivering evidence-based measures to save patients with acute myocardial infarction.

3.      Preventing adverse-drug reactions.

4.      Preventing central-line infections.

5.      Preventing surgical-site infection with correct peri-operative antibiotics.

6.      Preventing ventilator-site infections.

·         Marty Makary, MD, Johns Hopkins surgeon, writes in his new book, Unaccountable; What Hospitals Won’t Tell and How Transparency Can Revolutionize Health Care (Bloomsbury Press, Press, 2012), that we could reduce hospital deaths and medical mistakes if every hospital:    

1.      Had an “information dashboard” that would include rates of infection, number of readmissions, surgical complications, number of procedures performed, and lists of patient satisfaction complaints;

2.      Published surveys of comments by doctors nurses, technicians, and other hospital employees about the safety environment of their hospitals;

3.      Installed cameras at hand-washing stations and other critical safety places and made videos available to patients about procedures they are about to have or have undergone;

4.      Made doctor notes “open,” i.e. immediately available , when patients are being interviewed or online to improve compliance with safety standards;

5.      Promoted and encouraged open dialoguew abut medical mistakes with “no more gagging” of doctors, nurses, and others to coer up mistakes.

·         The Obama administration is field-testing a new reporting system encourage patients to report medical mistakes and unsafe practices by medical providers.   As part of this system, patients reporting “mistakes” would answer these queries if a mistake is perceived to have been made.

Patients would report a caregiver did not:

1)      Communicate well with the patient or the patient’s family; 

2)      Didn‘t respect the patient’s race, language, or culture;

3)      didn’t care about the patient;

4)      was too busy;

5)      didn’t spend enough time with the patient;

6)      failed to work with other caregivers; 

7)      were not aware of care received elsewhere.

I find these questions subject, open to various interpretations, and an open invitation to make easier the work of malpractice lawyers.
My Chief Complaint
My chief complatint here is not that various approaches lack value, but tht critics overuse the hospital-death airplane crash and doctor vs. pilots metaphor.
Hospital caregivers and airline pilots are not the same breed of cat, nor are they faced with similar situations.
1.      Hospital employees are for sick, often frail patiens, suffering from often chronic or terminal illnesses, while pilots are carrying a plan laod of motly healthy younger people.

2.      Doctors and other hospital personnel are caring for one patient at a time with complicated individual problems; pilots are responsible for a plane load of 100 to 300 passengers with a simple generic goal- reaching their destination.

3.      Circumstance surrounding individual patients are broad and multifaceted  while passangers tend to have a much narrower set of problems -  luggage, meal and beverage offerings, and troublesome seatmates.

I don't  quibble or question systematic organization teamwork approaches to decreasing hospital death rate, or to making patients aware of or reporting medical mistakes. These approaches are needed, and many are overdue.
Tweet: The Metaphor comparing hospital death rates to preventing death from airline crashes and doctors to pilots is over-used and may not be analogous.
1.      Marty Makary, MD, “How to Stop Hospitals from Killing Us, “ Wall Street Journal, September 22-23, 2012

1.      Robert Pear, “A New System for Patients  to Report Medical Mistakes,’ New York Times, September 23, 2012.


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