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The Need for Quality Control (part2)

The fractured nature of patient care has increased dramatically. A cancer patient may well have over four specialists who rarely meet to discuss the individual. Computerized patient entry would assure that each physician has access to the complete patient file.

Drug toxicity is the single most common threat, hitting 6.5% of hospitalized patients. Information technology can help prevent errors and catch drug interactions before they do much damage. OSF Healthcare in Peoria, IL, has reduced drug-related injuries by almost 75% since 2001 using available technology.

There are many more examples - wrong site surgery, provision of evidence-based care, the benefits of setting up rapid response teams, to name a few. Adding to the problem:

  • The CT Department of Public Health has ranked 40th in the elimination of bad doctors. Their investigations have gone on for years and often ended with an inappropriate slap on the wrist. An anesthesiologist who turned off monitors resulting in the death of a healthy three year old was fine $5,000. A pill-pushing physician in New Haven faced criminal charges and was convicted before the Medical Examining Board dealt with the problem.
  • The National Practitioner Data Bank is available to only healthcare professionals and because it is under funded it is out of date and full of inaccuracies. An anesthesiologist, who was fired from St. Raphael Hospital, went to Massachusetts and practiced there. After a few years, he returned and worked at Norwalk Hospital. Today, two women are in a permanent vegetative state due to his injuries. Even after the first incident, the hospital took no action nor did the Medical Examining Board. His record, as well as that of others who have injured, maimed or killed their patients, should be readily available to the public and healthcare institutions.

A Casualty Count

  • 3% or more of hospital patients are hurt by medical error
  • 1 in 300 patients die from such mistakes
  • 24% of people say they or a family member have been harmed by medical error
  • 90,000 people die of hospital-acquired infections annually. More than half of these may be preventable. Healthgrades puts the number of preventable deaths at 200,000 annually.
  • 55% of recommended care actually gets administered.
  • $2,000 Annual cost to employers per insured worker due to poor-quality care
  • 61% of doctors wash their hands before examining a patient if they know someone is watching. Only 44% wash their hands if they think no one is watching.

Sources: Lucian Leaper; New England Journal of Medicine; Forbes Magazine; The Institute of Medicine; Quality and safety in Health Care; Rand.

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Links to Explore

Routine Surgery, Fatal Error 7 Oct 2007 Hartford Courant ... more

Kickback to Surgeons Lead to Fines 28 Sept 07 CBS News... more

Most Science Studies Sloppy 14 Sept 07 Wall Street Journal ... more

Is Your Surgeon Scamming You? Men's Health ... more

Cost Isn't Proof of High Quality 14 Jun 07 NY Times ... more

Hospital Mistakes Increase 2 Apr 07 KC Star ... more

What if Medical Care Came with a 90-day Warranty? 17 May 07 NY Times ... more

Mistakes That Kill - 4th Annual HealthGrades Study ... more

Hospitals paying administrators generously 9 Apr 07 The Hartford Courant ... more

Hospital Errors Continue to Rise 2 Apr 07 The Washington Post ... more

Wanted: More Information on Health Care 2 April 07 The Boston Globe ... more

CJ&D Chart: Malpractice Small Percent of Total Health Costs ... more

Medication Errors Affect Children Most March 7 McClatchy Newspapers ... more

Medication Errors Are Studied March 3 NY Times ... more

Philadelphia Evening Bulletin March 3 The Way to Fix Medicine is Obvious ... more

The Medical Malpractice Hoax: Data Show Liability System Produces Rational Outcomes Jan 2007 Public Citizen... more

Nurse faces charges she gave painkiller illegally Dec 2 06 Hartford Courant ... more

USA Today's Patient Safety Page ... more

Before You Pop That Pill Aug 11, 2006 Time ... more

2 Maryland Hospitals to Test for Bacteria July 22, 2006 The Baltimore Sun ... more

The Medical Malpractice Myth July 11, 2006 Slate Magazine ... more

Saga of Curtis, almost electrocuted and severely burned ... more

Couple Suing Doctors July 19, 2006 The Hartford Courant ... more

Medical Error: PBS reporter visits a hospital ... more

Cutting Errors Saves Lives June 15, 2006 The Wall Street Journal ... more

Landro: The Informed Patient
(The Wall Street Journal )
5/23 Hospitals Seek to Collect Better Data View

Patient-Safety Incidents Edge Up
April 4, 2006 Modern Health Care.com View

Harvard Alters Doctors' Training
March 20, 2006 The Boston Globe View

Hartford Hospital Fined for Violations
January 5, 2006 The Hartford Courant View

Bad Medicine
November 14, 2005 The New Yorker View

Reducing Medical Errors: Background Brief
The Kaiser Family Foundation's overview of the problem of medical error and what has been done since the IOM's To Err is Human report. View

To Err is Human
From the Institute of Medicine, this 1999 report lays out a comprehensive strategy by which government, health care providers, industry, and consumers can reduce preventable medical errors. View

Taking the Pulse
A new international survey supported by The Commonwealth Fund finds that one-third of U.S. patients with health problems reported experiencing medical mistakes, medication errors, or inaccurate or delayed lab results - the highest rate of any of the six nations surveyed. View

Anesthesia Awareness
"Anesthesia Awareness is perhaps the most helpless and terrifying feeling in the world. It occurs when one is supposed to be completely asleep under full general anesthesia, but the brain is not asleep ..." View PDF