Archive | March, 2008

Average Time of Discharge: Why a Hospital is Not a Hilton

Do you get as annoyed as I do about being pressured on your “Time of Discharge?” I just received my monthly report, and we’re in The Doghouse again: our average TOD – 3:28 pm – is hours after “check-out time.” But when did we turn into the Holiday Inn? Let’s start by appreciating where this […]

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The Great Quality Debate: Berwick’s Plea for Action vs. Evidence-Based Medicine

In this week’s JAMA, Dr. Don Berwick, CEO of the Institute for Healthcare Improvement, argues that evidence-based standards should be relaxed for quality improvement practices. Ironically, a few pages away, a Swiss study finds than an IHI-endorsed MRSA prevention strategy doesn’t work.What’s a person or hospital to do?A little background on both issues, beginning with […]

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NPR’s Morning Edition Story on Physician Blogging and Patient Privacy

Here’s the link, featuring, among others, celebrity blogger Kevin, M.D., as well as yours truly, batting clean-up. Although the privacy concerns raised by the story are real, personally I thought the psychiatrist went a bit overboard when she said, “If you are unhappy with the people that you’re supposed to be serving and taking care […]

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Absurd: Resuscitating 90-year-olds with Dementia or Metastatic Cancer

Last month on the wards, I unilaterally told two patients’ families that we were not going to resuscitate their loved ones. My residents were horrified – this violated the DNR playbook – but the alternative seemed both immoral and absurd. What do you think? In deference to HIPAA, I’ve altered a few clinically irrelevant factoids, […]

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And Speaking of the Unintended Consequences of Quality Measurement…

I must have “you can’t manage what you don’t measure” on the brain – here’s a piece I wrote this week for AHRQ’s Guidelines/Quality Measures Clearinghouses called “Is the Measurement Mandate Diverting the Patient Safety Revolution?” Well, of course it is. In it, I make the point that our hunger for measurable targets – generally […]

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Quality Measurement and the Risk of Yin Without Yang

“You can’t manage what you don’t measure.” This well-worn business axiom has been embraced by the healthcare quality movement, a trend this is healthy and long past due. But it comes with a risk:   Yin without Yang. What do I mean? With the (still scanty) evidence that tight glucose control improves the outcomes of […]

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