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We discussed the use of checklists in the medical industry in a previous blog entry. Yesterday, CNN’s Sanjay Gupta interviewed Dr. Peter Provonost, a medical researcher at Johns Hopkins University. He was selected in 2008 as Time Magazine’s Top 100 Most Influential People. He had a great discussion on the use of checklists in medical industry, specifically hospitals. He mentioned a statistic that there are over 30,000 preventable deaths each year in the US due to inadvertent infections that could be mitigated by the use of simple checklists. He said that consistent use of checklists in the medical industry would save more lives than any other single medical therapy currently being developed. Quite a statement! Something as cheap and as inexpensive as implementing simple checklists could save more lives than many of the more expensive therapies now under development.
What do you think? With so much research indicating the benefits of checklists, why have they not yet come into widespread use?
Category: Current Events, Medical/Healthcare, Performance Improvement, Quality
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For those outside the medical industry … Have you ever had any problems with procedure usage? (Enforcement NI?)?
Mark
Comment by Mark Paradies — March 22, 2010 @ 2:37 pm
On February 3rd, my 80 year old father in law had his appendix removed at XXXXX XXXXXX Hospital in XXXXXXX. On February 15th, his stitches burst. His small intestine perforated and his abdomen was flooded with bacteria. The hospital removed a 2″ section of his small intestine, flushed his abdomen with antibiotics and stitched him back up. They did a good job because he did not run a fever initially. But after a month in the XXXXX XXXXX ICU, he contracted VRE, MRSA and several other hospital acquired infections. His tempearture and white blood cell count spiked. His kidneys stopped functioning. He got pneumonia. On March 16th, we removed him from life supports and he passed away.
We will probably never know whether there was an incident in the initial surgery that caused the problems. But the fact that he died from hospital acquired infections is totally unacceptable.
His death is a terrible loss to his family and friends. His mind was still strong. Prior to the surgery, he was still very active. He had just returned two days previously from a 10-day cruise with 16 close friends. XXXXX XXXXX has signs all over the hospital claiming to be one of the top rated hospitals in the country. It didn’t do us any good. They essentially killed him.
Comment by Rick Thompson — March 30, 2010 @ 10:51 am
That is heartbreaking about your father, Rick. I am sorry to hear it. “30,000 preventable deaths” … so many patients and families of the patients needlessly affected.
Comment by Barb Phillips — March 30, 2010 @ 1:47 pm
Hi, Rick.
I’m terribly sorry for your loss. Sometimes our discussions seem so impersonal, until something like this brings us back to reality.
I have the good fortune of not requiring much personal experience in hospitals (either me or my family). Do you know how this tragedy is being investigated? Is it written off to “expected hospital environment”, or is there a more in-depth investigation planned? Are you privy to the results, or is it a totally in-house occurrence? These are my personal questions, and I understand if you do not wish to discuss on a public board.
Comment by Ken Reed — March 30, 2010 @ 8:56 pm
Mark Paradies;
The paperwork burden for nurses and frontline staff is crushing. My son recently completed a 2 year battle with cancer, he won. But throughout this journey I was always amazed at the volume and complexity of the paperwork that had to be completed.
PS . I work in the Nuclear industry in manufacturing, so I am used to tremendous paperwork.
Additional checklists , which simply add to the burden, will be hard to get implemented. A more thorough review, and a reduction to “medically necessary” from ” liability limitation” and “administrative costing” functions will work.
Comment by Richard Lucas — April 1, 2010 @ 8:02 am
Thank you for your comments, Barb and Ken. I have not been back to this site for the last three weeks so didn’t see them until today.
To answer your question, Ken, I don’t know whether the hospital is investigating this case or not. We have just started receiving hospital bills, which we will not pay until we have had a discussion with the hospital about what happened. Their attitude was that “hospitals are dangerous places” and if you are there long enough you will eventually get one of these killer bacteria. With that attitude, they are certainly correct.
I would like them to learn from this experience. I know we sure have. If we had it to over again, we would have hired a private nurse advocate to sit with my father in-law and make sure proper sterile technique (and perhaps checklists) were followed.
Comment by Rick Thompson — April 21, 2010 @ 2:23 pm
Find out about Medicare “never events.”
I think these are suppose to receive NO compensation for one of these and an aquired infection is one of the “never events” if I’m not mistake.
(Any hospital billing experts reading this who can chime in?)
Mark
Comment by Mark Paradies — April 21, 2010 @ 6:16 pm
Here’s some information on those “never events”: http://patients.about.com/od/patientempowermentissues/a/medicare08never.htm. They mention that although this is a Medicare policy, many insurance companies are following suit.
Comment by Ken Reed — April 22, 2010 @ 6:55 am
Thank you, Mark and Ken for the replies. We were aware that Medicare won’t pay for hospital acquired infections, but that doesn’t necessarily mean we won’t be billed for the cost. We’ll see what happens. The total bill is around $600,000, but we haven’t seen anywhere near that much to date.
Comment by Rick Thompson — April 27, 2010 @ 10:07 am
Just to let others know … we are following up with Rick about the “Never Events” policy.
Here is one piece of info we passed along:
“There is a provision that says the cost may not be passed onto the patient.
Unfortunately, we can worry that billers may find a way around that.
From CMS – ‘Medicare prohibits the hospital from billing the beneficiary for the difference between the lower and higher payment rates.’
Read more here:
http://www2.cms.gov/apps/media/press/factsheet.asp?Counter=3227&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date
If Rick let’s us know what eventually happens, we will pass along the info here.
Mark
Comment by Mark Paradies — April 28, 2010 @ 4:52 pm