In May, three academic medical systems turned up the heat on a long-simmering debate about the link between surgical volumes and quality of care. Leaders from Dartmouth-Hitchcock Medical Center, the University of Michigan Health System and the Johns Hopkins Health System declared that their surgeons would need to meet annual volume thresholds for 10 high-risk(...)
The Surgeon Scorecard and the Need for Measurement Standards
Posted by | Measurement of Safety and Quality, Preventing Patient HarmMost of us would agree that there aren't enough valid and meaningful health care quality measures to guide patients' choices of hospitals and physicians. While the federal government has steadily expanded the number of publicly available measures on its Hospital Compare website, it still falls short of what many patients, payers and providers would like.(...)
Walking in Another Caregiver’s Shoes
Posted by | Organizational and Cultural Change, Preventing Patient HarmHow many of our conflicts could be handled better or averted if we had the opportunity to spend some time in the shoes of the person on "the other side"? When we experience a situation through another's eyes, and when we understand their work and world, true empathy, understanding and trust can emerge. This is(...)
Patient Safety Perils at 36,000 Feet
Posted by | Designing Safer Systems, Preventing Patient HarmThere are more than 50 in-flight medical emergencies a day on commercial airlines — or one for every 604 flights, according to a study published in 2013. What are the odds that two emergencies would occur on the exact same flight, above the Atlantic Ocean and hours from the nearest airport? My colleague Mark, a critical(...)
Learning from the Leaders in Patient Experience
Posted by | Organizational and Cultural Change, Patient-Centered CareHospitals across the country are searching for ways to create the "always positive" patient experience. For example, we want our patients to tell us that their pain was always addressed, that clinicians were always responsive to their needs and that our communications at discharge time always helped prepare them to take care of themselves once(...)
Blood Clots Show Limits of Quality Care Penalties
Posted by | Measurement of Safety and Quality, Preventing Patient HarmIn the world of medicine, blood clots during hospitalization have become synonymous with imperfect care. As many as 600,000 patients per year experience a blood clot, and more than 100,000 die as a result, accounting for between 5 and 10 percent of hospital deaths. Regulatory agencies have taken clots as signals that safety and quality(...)
What Any Caregiver Can Do to Support a ‘Second Victim’
Posted by | Organizational and Cultural Change, Preventing Patient HarmLet's say that you're a nurse on a hospital unit, and a colleague has recently been involved in a medication error. It was a mistake that anyone might make — a tenfold overdose that occurred when she wrote down an order and accidentally moved a decimal point one space to the right. Luckily, it didn't lead(...)
Supporting ‘Second Victims’ with Emotional First Aid
Posted by | Organizational and Cultural Change, Preventing Patient HarmShe was a newly minted Johns Hopkins Hospital pediatric nurse — let's call her Mary — but she was already unsure if she had chosen the right career path. She had inserted an intravenous line into a young patient's arm, and there had been an infiltrate, a pooling of IV fluid under the child's skin that indicated(...)
Blood Clots: The Least-Appreciated Complication of Hospital Care?
Posted by | Patient-Centered Care, Preventing Patient HarmIf you were undergoing a surgical procedure, would you ever think to refuse the antibiotics your physician had ordered to prevent an infection? For most hospitalized patients, that would be unfathomable. And yet, when it comes to another common complication with a far greater death toll than surgical-site infections, both patients and health care professionals(...)
Patient Safety and Quality Champions Grow into Leaders
Posted by | Organizational and Cultural Change, Preventing Patient HarmFor years, physician assistant Stephanie Figueroa has worked with our Emergency Department and the sickle cell care team to improve the treatment of patients with this disease who arrive with acute pain crisis. When beds were unavailable in the busy adult ED, these patients might spend hours in excruciating pain before our staff were able(...)