Health Care Checklists - Part II
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Last month, I posted a blog on work being done by researchers at Johns Hopkins University that had demonstrated tremendous success using checklists in ICUs to reduce C-line infection rates. I referenced an article by Brigham and Women’s Surgeon Atul Gawande in The New Yorker as the source of my information. Imagine my disappointment when I read an op-ed in the New York Times two weeks ago by Dr. Gawande that indicated that the federal government has shut down this research project. His op-ed pretty much speaks for itself.
This decision by the federal government, and the lack of screaming outrage from the medical community that has followed it — pretty much says it all. To reiterate the Hopkins researcher’s previous comments — ‘The fundamental problem with the quality of American medicine is that we’ve failed to view delivery of health care as a science. The tasks of medical science fall into three buckets. One is understanding disease biology. One is finding effective therapies. And one is insuring those therapies are delivered effectively. That third bucket has been almost totally ignored by research funders, government and academia.”
Every year, we all watch the tug of war — the fight — the brawl — that goes on in Washington over NIH funding for basic research. Simply put, this is the fight over funding parts 1 and 2 of the aforementioned quote. Part 3 — the part that has to do with the effective application of what we know — never gets the same level of advocacy from the medical and academic communities as parts 1 and 2. We fight for and fund the pursuit of knowledge with every last breath and dollar we can find — but we put almost no effort into the study of how applying what we already know might improve performance. And we wonder why health care is so expensive.
At the risk of over-selling Dr. Gawande’s second book — “Better…” — which I’ve quoted and written about before, there’s a story in there on the medical care provided to US soldiers in Iraq that makes for fascinating reading on this subject. Dr. Gawande writes about the fact that deaths from injuries in Iraq among US soldiers have dropped from 25 percent of all injuries — a figure that remained constant from the Korean War through the first Gulf War, despite all kinds of advances in clinical technology and techniques — to 10 percent — with virtually no major technology breakthroughs since the Gulf War.
The improvements in performance have come from changing some of the fundamentals about how care is delivered to wounded soldiers, how performance is tracked and monitored, and how clinical teams work with one another to save wounded soldiers. Gawande himself points out that some of these interventions would be extremely hard to translate into traditional medicine back in the States, but his over-arching observation is compelling — that being smarter about what we already know is an enormous — and often missed — opportunity for improvement.
Right now, the discussion and disappointment concerning the federal government’s decision to can the Hopkins project is taking place among a few interested citizens on the op-ed pages and in the blogosphere. Let’s hope the AMA or the AHA — or some of the other Washington-based advocacy organizations that work so hard to chase NIH funds — can find their way into this discussion. Without them, it’s just another opportunity lost.
I think it’s right on target to be questioning why the AMA, and other patient advocacy groups, are not railing against the Federal Government’s decision to halt this program – or at least why they are not doing so more vocally. There is no mention of this issue on the AMA’s website, but there is a link to a bill that the AMA “led the passage” of: S. 544, the Patient Safety and Quality Improvement Act of 2005.
This bill is designed to both improve patient care, and to streamline the process by which such improvements are implemented through evidence-based performance measures. These processes and measures include:
“(A) Efforts to improve patient safety and the quality of health care delivery. (B) The collection and analysis of patient safety work product. (C) The development and dissemination of information with respect to improving patient safety, such as recommendations, protocols, or information regarding best practices. (D) The utilization of patient safety work product for the purposes of encouraging a culture of safety and of providing feedback and assistance to effectively minimize patient risk.”
The bill also establishes the legal definition and precedent for “Patient Safety Work Products,” which are defined as “any data, reports, records, memoranda, analyses (such as root cause analyses), or written or oral statements…” which “…are developed by a patient safety organization for the conduct of patient safety activities; and which could result in improved patient safety, health care quality, or health care outcomes…” Now, it’s not entirely clear whether a checklist would fit into the strictest confines of this definition, but at first look, it would appear so.
In introducing the bill on their website, the AMA vows to “ensure the law’s implementation.” Here’s their chance.
The Op-Ed states: “A checklist is an alteration in medical care no less than an experimental drug is. Studying an experimental drug in people without federal monitoring and explicit written permission from each patient is unethical and illegal. Therefore it is no less unethical and illegal to do the same with a checklist. Indeed, a checklist may require even more stringent oversight, the administration ruled, because the data gathered in testing it could put not only the patients but also the doctors at risk — by exposing how poorly some of them follow basic infection-prevention procedures.”
That’s just insane. This is why the government should be LESS involved, not MORE involved in healthcare.
Firstly, I want to congratulate Harvard Pilgrim in being #1 for several years now.
Secondly, I would like to say, for all the monies in the world, all the statisticians in the USA, all the politicians in the world CANNOT make any changes unless the consumers understand the very basics of their treatment in their healthcare plan. What I am trying to say, that none of these professionals have open up medicaid, medicare, managed care or self pay programs. How can any of you understand this without being at this basic level. All you do is put in numbers to see what works or not. As an administrator in behaioral health systems such as: hospitals, partial hospitalizations, intensive out-patient programs and home health programs, I have seen too many patients fall thru the cracks. I have seen too many patients discharged from programs including doctor’s offices, who cannot even read their prescription, let alone understand what it says. As a behavioral health consultant, who has developed the tools necessary to promote empowerment in the patient. I really would like to challenge the powers that make decisions. Do managed care companies use cost-management techniques when they describe administrative decisions that deny, prevent, interrupt, or terminate health care.
What is a healthcare checklist worth, if the basic premise of education is not inserted. You can respond to: http://medicationmanagement.blogspot.com/ or altairhealthsystems@gmail.com