3 ms·
These kinds of metrics are almost not interpretable, for two main reasons : (1) as logicallee has mentioned, we're getting better at treating patients and prev
by paviva 10y ago
These kinds of metrics are almost not interpretable, for two main reasons :
(1) as logicallee has mentioned, we're getting better at treating patients and preventing death due to disease. The better we get, the more different treatments patients get, the higher is the risk of a medical error happening.
(2) it is very difficult to know exactly what proportion of "medical errors" are preventable. For instance, the seemingly "simple" case of healthcare-associated infection is far from simple, and except for a few cases (infection associated with elective surgery, and so on), there are NO known intervention to reduce risk further. I will give you an example: a patient needs a central catheter in order to survive. If we don't put it in, and he dies, he'll be classified as a "death due to primary disease X". If we do put a central line, and he acquires an infection (and a certain baseline rate of infection IS inevitable, because the catheter is indwelling and gets colonized by the patient's own flora), and dies 2 months later due to sepsis, it will be codified as "medical error". Adverse drug reactions are also codified as medical errors, even if the drug was administered in a life-or-death situation, when even the patient's ID was not known, even less his full list of medications (and thus, the error could not be prevented in any way). I could go on and on.
That being said, I also see stupid preventable errors like quietly giving the drugs to the wrong patient going unreported. Hospital stay is certainly dangerous.
- Retric 10y agoNot accepting any failure as 'unpreventable' has long term benefits. Medical errors need not be any specific persons fault, the root cause may be poor understating of what's going on. EX: It's generally accepted that people get sick going to the doctors office and being around sick people. Reducing this by installing UV lights is viable even if such illnesses where not any specific persons fault.
- paviva 10y agoOf course, but those kind of reports do not make the difference between at least theoretically preventable events and those are related either to basic physiology or to dying people for whom the choice is between dying a little bit faster due to their disease, or lingering as long as they can, and dying due to a "medical error" all while taking 50 different medications concurrently. I am especially irked by the constant airplane analogies. Healthcare is not comparable to an assembly line nor modern aviation. The checklists/verifications/pathways only work when you take pretty healthy people and you submit them to a standardized, elective, safe procedure. In those cases, errors are obvious, and the efficacy of any quality improvement method is easy to assess. Unfortunately, in most cases, healthcare works like a completely chaotic, black box kind of system, in which the output can hardly be predicted with any kind of certainty. It is easy to get excited by "quality initiatives" which may improve the one tiny and unimportant outcome that we measure, all while not realizing the severe side effects it causes on other outcomes.
- nradov 10y agoActually research shows that many central line catheter infections are preventable. The AHRQ and CDC have published best practices and checklists, yet many hospitals still don't adhere to those. http://www.cdc.gov/hai/bsi/bsi.html http://www.cdc.gov/hai/bsi/bsi.html http://www.ahrq.gov/professionals/education/curriculum-tools/clabsitools/index.html http://www.ahrq.gov/professionals/education/curriculum-tools...
- paviva 10y ago> many central line catheter infections are preventable Again, of course some of them are preventable, and nobody's saying its OK to install central lines without putting gloves on, and so on. However, there is a baseline rate of infection which is not preventable, and will continue to happen. Check the Figures S1 and S3 in this recent study : http://www.nejm.org/doi/suppl/10.1056/NEJMoa1500964/suppl_file/nejmoa1500964_appendix.pdf http://www.nejm.org/doi/suppl/10.1056/NEJMoa1500964/suppl_fi... > many hospitals still don't adhere to those. What is the source ? As far as I'm aware, around ~ 90% facilities do have checklists -- I do not follow this literature closely, though.