Archive for December 2007

Fixing Fumbled Handoffs

I recently participated in a meeting whose aim was to develop safety measures for hospital units (ie, med-surg, ED, L&D). As various measures were being ticked off, I muttered that we should also try to capture errors that occur as patients move between units. One of my colleagues, quite sensibly, asked, “but who will be accountable for that?”  “Exactly!” I said. “You’ve put your finger on why we stink at handoffs. If transitional glitches were measured, and if botching them carried consequences, every hospital in the country would identify an accountable person in a nanosecond.”Get ready to clear out the corner office of the C-Suite for the Chief Transitions Officer.Although we’re not very good at washing our hands, we are terrific at washing our hands of patients who leave our medical radar screens. Just consider these scary facts:Half of all medical patients experience at least one error in the post-discharge…

Today’s New England Journal Hospitalist Study

Today my pals Peter Lindenauer and Andy Auerbach (and colleagues) published the largest hospitalist outcomes study to date, in the New England Journal of Medicine. It is a rigorous, important piece of work. Let me try to add a bit of context.First, the What’s What. Using the massive database of the Premier system (which Peter has mined to tremendous advantage, such as in this study and this one), they compared the hospitalizations of nearly 80,000 adult inpatients with 7 disorders at 45 hospitals. They chose these disorders (things like pneumonia, CHF, and COPD) because they are common and are cared for by hospitalists, general internists, and family physicians. They found that hospitalists had a length of stay 0.4 days below that of non-hospitalists, a 12 percent reduction that was highly significant. Patients cared for by hospitalists also had lower hospital costs ($268 lower than internists, $125 lower than FPs); this…

The UCSF-Kessler Saga and the Press

I've not been posting regularly on this story (as you might imagine, it's a bit tricky for me to do so), but for those following it from near and far (I've received emails from friends in Europe and Asia) there have been a number of interesting articles, including pieces in the LA Times, Washington Post, and SF Chronicle [some may require subscriptions]. The latter generated about 70 comments, from every corner of the ideological map.What is striking to this observer – who still lacks any inside information about what really happened (damn!) – is the asymmetrical warfare being waged in the media. Former Dean Kessler, who is an attorney as well as a physician, knows everybody in the press from his FDA years, loves taking on big institutions (ask Big Tobacco if you doubt this), and has a – how do I say this charitably – rather unusual personal style,…

The Termination of UCSF Dean David Kessler

Well, today the great Mecca of medical care and innovation that is UCSF all but ground to a halt. Our Dean was just let go under very odd circumstances, and everyone’s flocking to water coolers and Starbucks around the city to find out who knows what.I won’t be giving away any trade secrets here, since I have none. Lucky for me, I operate at an altitude in the University just below that of the muckety-mucks, which allows me to do my work distracted by a manageable volume of palace intrigue. On most days, that’s a good thing. But on days like this, I’m as hungry for the inside dish as anyone else.Here’s the story: two hours ago, our Chancellor, Nobel Prize winner Michael Bishop, sent an email to the University community that read, in part:I write to inform you that Professor David Kessler has left office as Dean of the…

More on Quality Reports: Lessons From SAT Scores

My older son is gearing up to apply to college (:-\ and so I bought him one of the Bibles, the Fiske Guide. The book is cleverly written – enough academic factoids to get parents to spring for it, leavened with enough social scene skinny to get kids to read it. The Guide dutifully lists ranges of SAT scores for accepted applicants at 300 schools, but then adds this shocking caveat:In their zeal to make themselves look good in a competitive market, some colleges and universities have been known to be less than honest in the numbers they release. They inflate their scores by not counting certain categories of students at the low end of the scale, such as athletes, certain types of transfer students, or students admitted under affirmative action programs. Some colleges have gone to such extremes as reporting the relatively high math scores of foreign students, but…
12