Tuesday, May 18, 2010

Timidity in Massachusetts

Over three years ago, while posting our rate of central infections, I asked the following questions:

If I can post these rates for BIDMC, why can't people from other hospitals? ... Why can't the insurance companies? ... Why can't the state of Massachusetts? ... Real-time public disclosure of key indicators like this ... can be mutually instructive and can help provide an incentive to all of us to do better.

Well, Massachusetts is getting passed by on this front. Here is a presentation showing the rate of central line infections for all of the hospitals in Illinois for 2009. If you sort on the column "infections per 1,000 central line days" by clicking on that header, you will find 50 hospitals with zero infections, and 31 more with fewer than one per 1,000.

This kind of presentation does not require state action. The Massachusetts hospitals could together decide to do this voluntarily. We all collect the data for our own hospitals. It would impose no administrative burden to forward it for publication to a collective website. (Look here to see BIDMC's figure, posted every quarter.)

What more persuasive way to demonstrate to the public and to legislators that we collectively are serious about eliminating one important form of hospital acquired infection? That we are willing to be held individually and collectively accountable to a standard of care to reduce harm to patients? That we likewise are willing to be held to a standard of care that also saves dollars for an overburdened health care system?

Look at this related story in the Chicago Tribune. An excerpt:

Ten years ago, Dr. Bob Chase would have laughed if someone had told him common infections could be eliminated in hospitals' intensive care units.

"I would have said that's ridiculous, not possible," he said. "As a physician, I was trained to believe bad things just happen."

But Chase, vice president of quality at Norwegian American Hospital in Chicago, doesn't think that anymore. A growing body of research has convinced him that many infections can be prevented if proper procedures are rigorously followed — evidence he's using to reduce higher-than-expected infection rates at his own institution.

The research is prompting a wave of improvements in hospital ICUs, and patients are starting to benefit: At many hospitals, the rates of some common infections have been cut in half or more, saving lives and money and preventing medical complications.

Why are the health care leaders in Massachusetts so timid on this issue?


Anonymous said...

I was also brought up in the era of "bad things just happen". This quote was eerily foreshadowed by Paul in a post in 2007, well worth re-reading:


Peter Pronovost deserves a Nobel prize for working in an unglamorous area to change "these things happen" into "there is no longer any excuse for these things to happen." The value of his work, now being extended to other areas, simply cannot be underestimated.

As for not publishing these results, hospitals are rapidly running out of excuses. Paul's first of many posts on this subject was back on December 17, 2006:


Patients, their families, and blogging patient advocates are increasingly angry. Government is stirring. You already report this to the CDC. Proactive is better than reactive. When are you going to wake up?

nonlocal MD

e-Patient Dave said...

Thanks for the link to BIDMC's ongoing chart. As some people know, this is a matter of personal interest to me because I had about 30 central line days.

Hm: it appears that as good as BIDMC is, it would not be close to a leadership position in Illinois! Interesting! Clearly we/they-all can do better.

The chart's Y axis isn't labeled, and probably should be. If I recall from earlier blog posts, you track infections per 1,000 ICU days, which is different from the 1,000 central line days in the Chicago Tribune article. Since I presume central line days <= ICU days, to compare we'd need to adjust BIDMC's rate upward a bit, right?

Funny this should come to light now, because in my recent speeches I've had a slide with screen shots of your earlier posts on this subject, urging all hospitals everywhere to do this. The latest was my talk yesterday at the National Patient Safety Foundation conference in Orlando. Like you, I can't imagine any defensible reason for providers concealing this information.

And yes, I think it's "concealing."

You might want to display older data, to show the improvement that's been made. In earlier posts you shows Dec 05=2.43, Jan 06=3.07, etc. (And April 06=0!)

e-Patient Dave said...

p.s. Demanding, ain't I? :-) But the more I study healthcare, the clearer it gets that less harm (including maiming and killing) is well within our reach.

And for those who don't recall the impact of central line infections, it's potent: last I heard, 25% of them lead to DEATH. Accidental, hospital-caused death.

As in "Oh my lord no." As in funeral.