A campaign to reduce lethal errors and unnecessary deaths in the nation's hospitals has saved an estimated 122,300 lives in the last 18 months, the campaign's leader said Wednesday. "I think this campaign signals no less than a new standard of health care in America," said Donald Berwick, a Harvard professor who organized the campaign.
About 3,100 hospitals participated in the project, sharing mortality data and carrying out study-tested procedures that prevent infections and mistakes. Experts say the cooperative effort was unusual for a competitive industry that does not like to focus publicly on patient deaths. "We in health care have never seen or experienced anything like this," said Dr. Dennis O'Leary, president of the Joint Commission on Accreditation of Healthcare Organizations.
Dr. Berwick of the Harvard School of Public Health announced the campaign's results Wednesday at a hospital conference in Atlanta. Dr. O'Leary was one of hundreds of industry dignitaries and representatives in attendance.
Medical mistakes were the focus of a 1999 report that said 44,000 to 98,000 Americans die each year as a result of errors and low-quality care. The changes Dr. Berwick sought included the deployment of rapid response teams for emergency care of patients whose vital signs suddenly deteriorated. Another change urged checks and rechecks of patient medications to protect against drug errors.
Source
A Skeptical note from a reader:
Perhaps my hospital did not participate in this study. I serve on the Quality Management committee, which investigates "medical" errors of any severity. I certainly would be aware of any deaths due to "medical errors". Based on The numbers reported (100, 000 deaths), our city should have several hundred such deaths. This is simply not true.
Dr Berwick must have taken a number from somewhere, but not from real world data. Some analysis has suggested that these alleged numbers consider those who have died where "medical errors" have been reported. This does not prove causation.
For example, it is easy to accumulate such numbers. If someone misses a dose of medication, or gets the wrong medication, this is counted as a "medical error". This type of error seldom leads to death. It is sloppy medicine, and is improved by constant attention. In truth, this procedure has long been on-going. Hospital committees keep track of these errors, and counsel people to do a better job of tracking this stuff. Many such people later go on to die, but counting a "medical error" by itself in no way indicates causation.
Dr. Berwick claims to have saved 122,300 lives out of 44,000 to 98,000 lives. Appears somwehat contrived to me - saving more lives than are allegedly lost.
Perhaps we were ahead of the rest of the country. "Rapid response teams" (code teams) have been around long before the 1999 report. And "checks and rechecks of patient medications" have been standard practice for a long time before 1999.
No doubt Dr Berwick and others have spent a lot of grant money studying this "problem". So self congratulation and declaring success is of course expected, and essential so they can have their grants renewed and continue their academic careers.
No doubt President Bush will hear of this. No doubt he will be convinced that more of "the poor" die due to "medical errors". To prove he is "sensitive" to "the poor", he will sign a bill requiring billions of dollars in computers and even more government auditors to protect medical workers from themselves, and to "save lives'. No doubt Dell and IBM and others are already counting their money.
One concern I and others have about this issue is the lowering of standards for nursing schools. The product is just not as good as it was. And more motivated nurses are going to school to get advanced degrees so they can push paper and not take care of patients. So what is left is the less competent and less experienced.
There are times when an inexperienced doctor in training orders the wrong dose of drug; an experienced nurse will usually pick up such an error in a heartbeat. Today, we are losing these experienced nurses. Some believe automated systems will bridge this gap. I am not convinced. With medicine ever more complicated, we need both better nurses and better machines. In fact, it takes a certain amount of smarts to run the machines. The fantasy from administrators of saving money by hiring lower paid, lower skilled workers is just that - a fantasy.
THE NEGLIGIBLE ETHICS OF THE AMA
Excerpt from Mystery Pollster
We have had some new developments over the last few days regarding the online Spring Break study conducted earlier this year by the American Medical Association (AMA). The story, as long time readers will recall, involved an AMA release that initially misrepresented the study, calling it a "random sample" complete with a margin of error and implying in some instances that results from a small subgroup of women that had actually gone on Spring Break trips represented the views of all the women in the survey. While my posts on the subject received a fair amount of attention in the blogosphere, the mainstream media -- including outlets that had reported the misleading survey -- largely ignored the controversy. This week that changed.
Here are details and links:
Although I had missed it, the New York Times did make a formal correction of a Week in Review story that cited results of the poll soon after American Association for Public Opinion Research (AAPOR) President Cliff Zukin wrote the Times to complain. Their correction now appears at the end of versions of the story available on the Web or through a Nexis search:
For the Record
A chart on March 19 about the history of spring break referred incompletely to an American Medical Association survey of female college students and graduates on vacation behavior. It was conducted online and involved respondents who volunteered to participate; they were not chosen at random.
Earlier this week, the Washington Post's Howard Kurtz devoted his Media Notes column to the story. Kurtz reviewed some of the most colorful headlines and quotations from the initial media coverage. "At the risk of spoiling the fun," he concluded, "it must be noted that this poll had zero scientific validity."
Kurtz also quotes Richard Yoast, the director of the AMA's Department of Alcohol, Tobacco and Other Drug Abuse as saying,
[H]is organization posted a correction on its Web site to note that this was not a nationwide random sample and should not have included a margin of error, as in standard polls. "In the future, we're going to be more careful," he says.
While they are at it, the AMA might want to be a bit more careful about the way they post corrections. As noted in my original post on this subject, the AMA did correct the methodology blurb in their online release, but the corrected version includes neither a trace of the original misrepresentation nor any statement that the current version corrects the original. Also, as Kurtz points out, the corrected AMA release continues to highlight statistics based on "only the 27 percent of the 644 respondents who said they had actually been on spring break," yet still "make[s] no distinction between those who have taken such trips and those who haven't" (see this post for details).
The appearance of the Kurtz item may have been the reason that the Associated Press issued this correction just yesterday:
Correction: Spring Break Risks story
Eds: Members who used BC-Spring Break Risks, sent March 7 under a Chicago dateline, are asked to use the following story.
05-31-2006 15:23
CHICAGO (AP) _ In a March 7 story about an American Medical Association survey on spring break drinking and debauchery among college women and graduates, The Associated Press, using information provided by the AMA, erroneously reported how the results were obtained. The AMA now says participants were members of an online panel, not a random sample
Finally, today's Numbers Guy column by the Wall Street Journal's Carl Bialik takes a close look at the story and the new communications initiative that AAPOR will undertake to try to react to stories like this more quickly:
Sixty years after its founding, a key association of professional pollsters is dismayed with all the bad survey numbers in the press. In an overdue response, the group is seeking new ways to curtail coverage of faulty research...
"Our ability to conduct good public opinion and survey research is under attack from many sides," the group's long-range planning committee wrote in a May report. As part of its response, Aapor, as the group is known, plans to hire a staffer to spot and quickly respond to faulty polls.
If Aapor does come down hard, and quickly, on bad research, it could drive pollsters to do better work and disclose their methods more fully, and perhaps even introduce higher standards to what is today an unruly industry. However, a solitary staffer will be hard-pressed to improve the treatment of polls by a numbers-hungry print and electronic press. [link added]
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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