Fire!

Earlier this month, Modern Healthcare published a story about the slow movement by hospitals to prevent operating room fires. An excerpt:

Despite a slew of news accounts about patients being set on fire in operating rooms across the country, adoption of precautionary measures has been slow, often implemented only after a hospital experiences an accident. Advocates say it's not clear how many hospitals have instituted the available protocols, and no national safety authority tracks the frequency of surgical fires, which are thought to injure patients in one of every three incidents. About 240 surgical fires occur every year, according to rough estimates by the ECRI Institute, a not-for-profit organization that conducts research on patient-safety issues. But fires may be underreported because of fear of litigation or bad publicity. 

“Virtually all surgical fires are preventable,” said Mark Bruley, vice president of accident and forensic investigation for ECRI, which has been tracking operating-room fires for 30 years. He blames the persistence of the problem on the slow migration of best practices across the hospital industry.  

Most surgical fires involve the ignition of concentrated oxygen by electrosurgical tools used in upper-body procedures, where patients receive the highly flammable gas through face masks and nasal devices. But a growing number are linked to the ignition of alcohol-based antiseptics.

Solid numbers on the incidence of operating-room fires do not exist. ECRI's latest estimate of 240 operating-room fires each year between 2004 to 2011 was revised down from earlier estimates of 650 fires a year between 2004 to 2007. 

While that suggests there has been improvement, studies of anesthesia malpractice claims suggest there's been a rise in incidents. “There is an inherent problem in preventing relatively rare events,” said Dr. John Clarke, clinical director of the Pennsylvania Patient Safety Authority. People think “it is not likely to happen to you in particular,” he said.

I was surprised and contacted a patient safety expert who replied, "No one believes it can happen to them, so they cut corners."

That seems to be the case in lots of places.  From the article:

Many of the best fire-safety practices developed in recent years stem from the work at Christiana Care Health System, Newark, Del., after two patients caught fire in operating rooms within eight months in 2003.

They pioneered their own process, which involves discussing the risk of fire during the scheduled time-out before surgery. The hospital hasn't burned a patient since.

Protocols like Christiana's have been widely disseminated. Yet, Christiana says it still get calls several times a month from hospitals that are just starting to implement a system. “It's a bit of an uphill slog,” said Dr. Kenneth Silverstein, chairman of Christiana's department of anesthesiology. “The bottom line is, in order to have a culture of safety in your institution, you have to get people behind it.” 

Sounds familiar.  We saw (and still see) hospitals go through the same slow process with central line infections, ventilator associated pneumonia, and other infection-related problems.  Maybe now it's time to yell, "Fire!"

2008 graphic from hpnonline.com

Debunking the debunking

I really don't want to write more about surgical robots, but you folks out there keep sending good material.  Here's an article by a surgeon on ThirdAge.com "debunking the myths about robotic surgery."

Let's look some assertions:

The robotics technology is expensive and the whole surgical team has to be trained, which can add to the cost. But there’s also a tremendous savings compared with traditional surgery because the patient is out of the hospital more quickly and there are fewer complications.

Many times, the robotics-assisted procedures can be done much more quickly, so there’s less risk simply because the duration of the procedure is shorter. You also have the smaller incisions, and less bleeding, factors that reduce the risks.

This kind of fast and loose talk is a discredit to the profession. I wish there were an agreement that we would rely solely on sound research studies instead of this anecdotal tripe.

Will you be in Panama City in August?

This is a must-see exhibit by the Smithsonian Tropical Research Institute.  A good chance to meet Matt Larsen, STRI’s new director, too.

Keeping up with the Joneses

Just by casual observation, I have asserted that a hospital was more likely to acquire a surgical robot if a nearby competitor hospital had already done so.  But this was an untested conclusion, based on viewing websites and highway signs, particularly from community hospitals, like above.  So I was intrigued to see this great article by Huilin Li (Department of Population Health, New York University) and others in Healthcare.  From the abstract:

Background

The surgical robot has been widely adopted in the United States in spite of its high cost and controversy surrounding its benefit. Some have suggested that a “medical arms race” influences technology adoption. We wanted to determine whether a hospital would acquire a surgical robot if its nearest neighboring hospital already owned one.

Methods

We identified 554 hospitals performing radical prostatectomy from the Healthcare Cost and Utilization Project Statewide Inpatient Databases for seven states. We used publicly available data from the website of the surgical robot's sole manufacturer (Intuitive Surgical, Sunnyvale, CA) combined with data collected from the hospitals to ascertain the timing of robot acquisition during year 2001 to 2008. One hundred thirty four hospitals (24%) had acquired a surgical robot by the end of 2008. We geocoded the address of each hospital and determined a hospital's likelihood to acquire a surgical robot based on whether its nearest neighbor owned a surgical robot. We developed a Markov chain method to model the acquisition process spatially and temporally and quantified the “neighborhood effect” on the acquisition of the surgical robot while adjusting simultaneously for known confounders.

Results

After adjusting for hospital teaching status, surgical volume, urban status and number of hospital beds, the Markov chain analysis demonstrated that a hospital whose nearest neighbor had acquired a surgical robot had a higher likelihood itself acquiring a surgical robot (OR=1.71, 95% CI: 1.07–2.72, p=0.02).

Conclusion

There is a significant spatial and temporal association for hospitals acquiring surgical robots during the study period. Hospitals were more likely to acquire a surgical robot during the robot's early adoption phase if their nearest neighbor had already done so.