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• Today’s Big ACGME and Joint Commission Announcements: The Courage To – and Not To – Change

  One of the mantras of performance improvement is that caregivers and provider organizations should learn from their experiences. That’s all well and good, but how about policy-setting organizations?A few moments ago in the on-line version of the New England Read More... Posted Wed, Jun 23 2010 7:18 PM by Bob Wachter | 9 Comments Filed under: Quality Improvement, Hospital Care, Pay-for-performance, Transparency and Reporting, Quality Measurement, Medical Education/Academia, Hospitalists/Hospital Medicine, Patient Safety/Medical Errors, Health Policy

• My Interview on The Health Care Blog

  If for some reason you haven't gotten enough of me on Wachter's World, I just did a long, fun interview with Matthew Holt on the always-interesting THCB. We cover patient safety, the future of IT, the demise of primary care, Death Panels, and more. I Read More... Posted Wed, Aug 19 2009 3:48 PM by Bob Wachter | 2 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Efficiency, Medical Education/Academia, Hospitalists/Hospital Medicine, Information Technology, Ambulatory/Primary Care, Patient Safety/Medical Errors, Health Policy

• “Mr. Obama, Tear Down These (Hospital) Walls”: Readmissions in Context

  I like readmissions. Well, that didn’t come out quite right, did it? What I mean is that I like focusing on readmissions as a potentially actionable quality measure. I believe that it’s possible to prevent many readmissions, thereby improving quality Read More... Posted Sat, Apr 04 2009 12:36 AM by Bob Wachter | 10 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Efficiency, Hospitalists/Hospital Medicine, Information Technology, Ambulatory/Primary Care, Patient Safety/Medical Errors, Health Policy

• Will Academic Medical Centers Show the Love to Their Faculty Quality Improvers?

  When we launched our hospitalist program in 1995, I dreamed that many of our faculty would become leaders in quality and patient safety. That dream has come true, but we now must leap over two hurdles: getting these superb physicians paid and promoted. Read More... Posted Sat, Feb 28 2009 9:52 AM by Bob Wachter | 1 Comments Filed under: Quality Improvement, Hospital Care, Quality Measurement, Hospitalists/Hospital Medicine, Patient Safety/Medical Errors

• Checklists (The Sequel), 5 Million Lives, and the Magic of Measurable Results

  Last month’s New England Journal included another astounding checklist study, an international extravaganza that found nearly 50% reductions in mortality and complications after implementation of pre- and post-op surgical safety checklists. Wow. Coincidentally, Read More... Posted Fri, Feb 13 2009 8:22 AM by Bob Wachter | 4 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Hospitalists/Hospital Medicine, Patient Safety/Medical Errors, Health Policy

• My Patients Are Dying… And I’ve Never Been Prouder

  I’m on clinical service now and my patients are dying left and right. And I’ve never been prouder of my own care, and that delivered by my colleagues and hospital.When I was in training, a patient’s death was invariably considered a medical failure, and Read More... Posted Thu, Nov 27 2008 8:16 PM by Bob Wachter | 7 Comments Filed under: Hospital Care, Transparency and Reporting, Quality Measurement, Medical Education/Academia, Hospitalists/Hospital Medicine, Health Policy, Medical Ethics

• The Best and Worst of Times For “Infection Preventionists”

  As I mentioned in my last post, these should be the best of times for "Infection Preventionists" (formerly known as Infection Control Officers). After years of trying to get someone – anyone – to pay attention to their work, their day in the sun has finally Read More... Posted Mon, Jun 23 2008 5:51 AM by Bob Wachter | 1 Comments Filed under: Quality Improvement, Hospital Care, Quality Measurement, Hospitalists/Hospital Medicine, Information Technology, Patient Safety/Medical Errors, Health Policy

• Could Intensivists Be Harmful to ICU Patients’ Health?

  Of all the structural (how care is organized) “evidence-based markers of high quality care,” perhaps the most ironclad has been the involvement of critical care physicians in the care of ICU patients. That is, until now. In a sophisticated study in today’s Read More... Posted Wed, Jun 04 2008 7:34 AM by Bob Wachter | 8 Comments Filed under: Quality Improvement, Hospital Care, Quality Measurement, Hospitalists/Hospital Medicine, Patient Safety/Medical Errors, Health Policy

• Should Patient Satisfaction Scores Be Adjusted for Where Patients Shop?

  Last week, Medicare added patient satisfaction data to its hospital reporting website. This is progress, but it raises an interesting question: should patient satisfaction scores be case-mix adjusted? The motivation to include patient satisfaction data Read More... Posted Sun, Apr 13 2008 4:03 AM by Bob Wachter | 1 Comments Filed under: Hospital Care, Pay-for-performance, Transparency and Reporting, Quality Measurement, Hospitalists/Hospital Medicine, Information Technology, Health Policy, Media/Press Coverage

• 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? Read More... Posted Wed, Mar 26 2008 7:05 AM by Bob Wachter | 15 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Efficiency, Hospitalists/Hospital Medicine

• Is Medicare’s “No Pay for Errors” Plan a Good Idea?

  In this month’s issue of the Joint Commission Journal of Quality and Patient Safety, I (with UCSF’s Adams Dudley and the American Hospital Association's Nancy Foster) tackle this provocative question. The answer may surprise you: yes (probably). The devil Read More... Posted Mon, Feb 11 2008 7:34 AM by Bob Wachter | 2 Comments Filed under: Quality Improvement, Hospital Care, Pay-for-performance, Quality Measurement, Medical Education/Academia, Hospitalists/Hospital Medicine, Patient Safety/Medical Errors, Nurses/Nursing, Media/Press Coverage

• 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 Read More... Posted Thu, Dec 20 2007 9:05 AM by Bob Wachter | 2 Comments Filed under: Hospital Care, Quality Measurement, Efficiency, Medical Education/Academia, Hospitalists/Hospital Medicine, Ambulatory/Primary Care, Health Policy

• The Weekly Roundup…

  Stuff this week that caught my eye: Does medical tourism harm the natives? Are all those CT scans destroying more than our budgets? Are nocturnalists at risk for more than decubs? Will Medicare need to cut hospital payments to fuel P4P? Answers: yes, Read More... Posted Fri, Nov 30 2007 9:45 PM by Bob Wachter | 0 Comments Filed under: Hospital Care, Pay-for-performance, Transparency and Reporting, Quality Measurement, Hospitalists/Hospital Medicine, Diagnosis/Clinical Reasoning, Information Technology, Ambulatory/Primary Care, Nurses/Nursing, Health Policy, Outsourcing/Medical Tourism

• Rapid Response Teams: Ready for Prime Time?

  Last year, I (with Peter Pronovost) wrote the toughest paper of my life – one that critiqued the Institute for Healthcare Improvement’s 100,000 Lives Campaign. This is the healthcare equivalent of criticizing both Mother Teresa and your local food bank Read More... Posted Tue, Nov 27 2007 9:31 AM by Bob Wachter | 5 Comments Filed under: Quality Improvement, Hospital Care, Quality Measurement, Hospitalists/Hospital Medicine, Patient Safety/Medical Errors, Nurses/Nursing, Health Policy

• Rating Doctors Like Restaurants

  So Zagat will now be rating doctors, using the methods it perfected helping you find the best sushi in Brooklyn Heights. What’s next, Consumer Reports rating grad schools? Fodor rating auto mechanics? Whatever you think of Zagat’s cross-dressing, it again Read More... Posted Sun, Oct 28 2007 5:57 AM by Bob Wachter | 4 Comments Filed under: Hospital Care, Transparency and Reporting, Quality Measurement, Medical Education/Academia, Hospitalists/Hospital Medicine, Information Technology, Ambulatory/Primary Care