tag:blogger.com,1999:blog-32053362.post8472505043806160600..comments2024-03-29T06:37:18.029-04:00Comments on Not Running a Hospital: Cullen and friends helped show the wayPaul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-32053362.post-48343366754369912642012-02-08T18:13:44.554-05:002012-02-08T18:13:44.554-05:00Excellent comment; Dr. Cullen. As I keep reading t...Excellent comment; Dr. Cullen. As I keep reading these things, I become more and more convinced that the reason there is not a larger public outcry is that we only kill people one at a time, rather than in large numbers such as a plane crash (including the pilot!), or in scary fashion as in a nuclear plant accident. The public doesn't think through that these one-by-ones add up to very large numbers.<br /><br />As for the general physician community, they almost uniformly contest the validity of the IOM report, even questioning the ethics of its authors. THAT boggles my mind.<br /><br />nonlocal MDAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-59438536415215259092012-02-08T15:25:34.274-05:002012-02-08T15:25:34.274-05:00Allow me to add a few thoughts to add to your comm...Allow me to add a few thoughts to add to your comments. First, as to how these reports were received by the profession, within a few months it was clear that the medical profession as well as the media were very taken with the fact that we even did the study and that the MGH and the BWH were willing to report these errors in the public arena. This led fairly quickly to the first of many Patient Safety conferences involving a coalition of many concerned groups like JCAHO, consumer advocates, AMA, malpractice insurers etc. Subsequently, this led to the formation of The National Patient Safety Foundation modeled after the Anesthesia Patient Safety Foundation under the great leadership of Ellison “Jeep” Pierce and Jeff Cooper. <br /><br />Because we had a natural experiment with the adoption of CPOE at the Brigham but not at the MGH, we were able to do a second series of studies comparing the effect of introducing CPOE hospitalwide at the Brigham with no CPOE at the MGH. At the same time, we were able to compare adverse drug event rates at 2 medical intensive care units at the MGH, the intervention in this case being the introduction of an extensive and deliberate role of clinical pharmacists in one ICU but not the other. The clinical pharmacy intervention at the MGH was as dramatic in reducing the adverse drug event rate as the introduction of CPOE at the Brigham. Since the Brigham was going to introduce CPOE with or without our study, I can't say that our first set of studies led to adoption of CPOE. After showing that the intervention worked in dramatic fashion, they probably did accelerate adoption of CPOE in other hospitals. I'm not sure that there was an increased role for clinical pharmacists at hospitals around the country although there certainly should have been.<br /><br />These were the first studies of adverse drug events with denominator data and served as a paradigm for human error studies in general, building on the Harvard Adverse Event Study led by Howard Hiatt and published mainly in the New England Journal of Medicine a few years earlier. We are convinced that these two groups of studies served as the scientific database foundation for the Institute of Medicine's human error report in 1999 and made studies of human error in healthcare "socially acceptable". Unfortunately, as you point out time and again, hospital leadership has too often been passive in dealing with the problem of systems failures leading to errors in healthcare, injury and death.David Cullennoreply@blogger.com