checking on health care

Checking On Health Care

As a people we like solutions that are BIG, BOLD, and JAZZY!!! Alas,

all to often they are mundane, simple, and require a little effort on

our part. (My favorite Thomas Edison quote: "Opportunity is missed by

most people because it is dressed in overalls and looks like work.")

Case in point, Gov. Ed Rendell's Prescription for Pennsylvania (81

page pdf). One of his initiatives is to reduce hospital acquired

infections. Here is an excerpt from the state's website:

The second initiative focuses on improving patient safety and

containing costs by eliminating hospital- and

health-facility-acquired infections. The Governor noted that most

hospital-acquired infections are avoidable. In Pennsylvania,

however, the number of hospital infections reported last year was

19,154, which led to nearly 2,500 deaths and more than $3.5 billion

in hospital charges.

One example of a hospital- and health-facility-acquired infection

specifically addressed in the Prescription for Pennsylvania is

MRSA, a type of drug-resistant bacteria that is commonly carried

inactive on the skin but can be deadly if it is introduced into the

bloodstream. In 2004, there were 13,722 hospitalizations in

Pennsylvania in which the patient had an MRSA infection - a rate of

7.4 per every 1,000 inpatient hospitalizations. Data shows that 8.9

percent of those patients, or 1,221 people, died as a result of

contracting MRSA.

MRSA can be virtually eliminated from health centers through simple

patient-safety procedures. Groundbreaking work by Pennsylvania's

veteran's administration hospitals has resulted in the near

elimination of MRSA infections in those facilities.

The legislation introduced that pertains to this effort is SB 968. A

simple explanation is offered, in addition to the full text of the

bill. It was signed by the governor on July 20, 2007.

There are, however, even simpler ways of controlling hospital acquired

infections. This past December 10's issue of the New Yorker included

an article, "The Checklist," by Atul Gawande, that discussed the

amazing success of having emergency room medical staff use checklists

when treating patients. Yes, a piece of paper, a clipboard, and a

pencil. Pilots use checklists, why can't doctors and nurses? (Top

item: wash hands).

Here was the result of a pilot project that used checklist for putting

lines in patients:

The results were so dramatic that they weren't sure whether to

believe them: the ten-day line-infection rate went from eleven per

cent to zero. So they followed patients for fifteen more months.

Only two line infections occurred during the entire period. They

calculated that, in this one hospital, the checklist had prevented

forty-three infections and eight deaths, and saved two million

dollars in costs.

In another study:

In December, 2006, the Keystone Initiative published its findings

in a landmark article in The New England Journal of Medicine.

Within the first three months of the project, the infection rate in

Michigan's I.C.U.s decreased by sixty-six per cent. The typical

I.C.U.--including the ones at Sinai-Grace Hospital--cut its

quarterly infection rate to zero. Michigan's infection rates fell

so low that its average I.C.U. outperformed ninety per cent of

I.C.U.s nationwide. In the Keystone Initiative's first eighteen

months, the hospitals saved an estimated hundred and seventy-five

million dollars in costs and more than fifteen hundred lives. The

successes have been sustained for almost four years--all because of

a stupid little checklist.

And the cost?

I asked him how much it would cost for him to do for the whole

country what he did for Michigan. About two million dollars, he

said, maybe three, mostly for the technical work of signing up

hospitals to participate state by state and co�rdinating a database

to track the results. He's already devised a plan to do it in all

of Spain for less.

Unfortunately, in the time-honored fashion of bureaucracies

everywhere, the program has been shut down because it is impossible to

get the informed consent of all patients and doctors participating.

Gawande outlines the problem in a Dec. 30th New York Times op-ed, "A

Lifesaving Checklist," and suggests Congress step in.

This is the sort of thing that, if widely implemented, say in a state

or commonwealth, could make a huge difference for a small amount of

money.

I hope the informed consent issues can be worked out (let it be known

that I formally grant my consent for a nurse to make sure a doctor has

clean hands before treating me) and that the gov's folks take note of

the possibilities inherent in mandatory medical checklists.