I was recently speaking to the clinical leaders of a mid-sized hospital, and a senior administrator posed the question, “should we require our doctors and nurses to get flu shots?” The answer, I said, is yes, and it isn’t just to prevent the flu. It’s to get into the habit of making our folks do [...]
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Nurse Staffing, Patient Mortality, And A “Lady” Named Louise
How many nurses does it take to care for a hospitalized patient? No, that’s not a bad version of a light bulb joke; it’s a serious question, with thousands of lives and billions of dollars resting on the answer. Several studies (such as here and here) published over the last decade have shown that having [...]
Are Academic Medical Centers Toast in a Post-Healthcare Reform World?
My hospital, UCSF Medical Center, is thriving. Our profits this year will be nearly $200 million. We’re building a sparkling clinical complex – a combined women’s, children’s, and cancer hospital – adjacent to our new downtown biomedical research campus. We are installing a state-of-the-art computer system. US News & World Report calls us the 7th [...]
Tugging on Superman’s Cape
Several years ago, I spoke at Baylor College of Medicine in Houston, where Michael DeBakey, the legendary heart surgeon, was master of the universe for nearly half a century. I heard lots of DeBakey stories during my visit, but one in particular really stuck with me. “A few years back,” someone told me in a [...]
What’s Behind Today’s Primary Care Crisis: You Don’t Know the Half of It
If you’ve ever been on a diet, you know that it really helps to keep a food log. Seeing your consumption chronicled in one place is illuminating – and often explains why those love handles aren’t melting away despite two hours on the treadmill each week. In today’s issue of the New England Journal of [...]
ICU Glycemic Control: Another Can’t Miss Quality Measure Bites the Dust
A disconcerting pattern has emerged: a blockbuster study finds that a certain practice leads to improved outcomes. Large national organizations codify the practice into a quality measure, forcing widespread adoption. Later studies prove the practice to be unhelpful, perhaps even dangerous. Oops. Think about it – we’ve now seen quality measures that prompted the use [...]
Why the Medical Record Needs to Become More Like Facebook
The explosive growth of Facebook and MySpace illustrates the market for electronic tools to enhance communication and collaboration. Could there possibly be another workplace more in need of social networking tools than the modern hospital? If you are not familiar with Facebook, find yourself a teenager and take a look over his shoulder while he [...]
How Infection Prevention Came to Dominate the Patient Safety Movement
The Joint Commission just released its 2009 National Patient Safety Goals, and – no surprise – they focus on infection prevention. While this seems natural today, it wasn’t always so. In fact, the conflation of infection control and patient safety is one of the most surprising twists of the patient safety revolution. The inclusion – [...]
Should Hospitals Install Bar Coding or CPOE First? Why I’ve Changed My Tune
This is one of the most commonly asked questions in IT World, and my answer has always been “CPOE first” – largely because that has always been David Bates’s (the world’s leading IT/safety researcher) answer. But I’ve changed my mind. Here’s why. Before I start, I promised that I’d let you know if I ever [...]
Snooping At Britney’s Chart: Why Should Docs and Nurses Have Different Rules?
Should doctors and nurses be subject to different penalties for precisely the same infraction? Of course not. Are they? Sure. Just ask Britney Spears. Britney was hospitalized at UCLA at least twice in the past few years – once when she gave birth to her first son in 2005, and again in early 2008 for [...]
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