More Consequences of IT: The Disappearance of Radiology Rounds

When I was a med student, the Beating Heart of the Hospital of the University of Pennsylvania (HUP) was not the CEO’s suite, the neurosurgeon’s OR, or the Dean’s lair. It was the seat of one Wallace Miller, Sr., in the decidedly unglamorous Chest Reading Room. Do you even know where the chest reading room […]

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How Clinical IT is Transforming Hospital Care – For Better and Worse

My friend Mark Smith, who runs the California HealthCare Foundation, once wryly observed, “Have you ever noticed that the doctors who talk about how much fun primary care is only practice it one afternoon a week?” I may have become the hospitalist version of Mark’s Ivory Tower internists, but I’ll take my chances. I just […]

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Did I Violate Federal Regulations Today? (I Hope So)

The patient safety and quality movements are precious and fragile. Just as IOM reports I and II spawned these modern, life-saving revolutions, the Federal shutdown of the Hopkins/Michigan checklist program may help extinguish them. After all, Tipping Points can tip both ways. I laid out the issues in this prior post. Those of you who […]

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Bureaucracy Run Amok: Can Checklists Kill?

As you may know, I’ve argued that that the quality and safety of healthcare have traditionally been underregulated. But regulators are like patients with Parkinson’s: it’s hard to get them unglued, but once they’re moving, it’s hard to stop them. Welcome to Exhibit A. Last month, I described Atul Gawande’s thrilling New Yorker article recounting […]

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A Nordstrom To-Do List: Tie, Slacks, a Little V. Tach?

Great quote by USC cardiologist Leslie Saxon (a reporter reached her on her cell phone as Leslie was shopping) on this week’s NEJM study on delayed defibrillation: “You’re better off having your arrest [here] at Nordstrom [than in a hospital]… because there are 15 people around me.” You’ve probably seen the study, a detailed analysis […]

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Fixing Fumbled Handoffs

I recently participated in a meeting whose aim was to develop safety measures for hospital units (ie, med-surg, ED, L&D). As various measures were being ticked off, I muttered that we should also try to capture errors that occur as patients move between units. One of my colleagues, quite sensibly, asked, “but who will be […]

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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 What’s What. Using the massive database of the Premier system (which […]

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The UCSF-Kessler Saga and the Press

I’ve not been posting regularly on this story (as you might imagine, it’s a bit tricky for me to do so), but for those following it from near and far (I’ve received emails from friends in Europe and Asia) there have been a number of interesting articles, including pieces in the LA Times, Washington Post, […]

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The Termination of UCSF Dean David Kessler

Well, today the great Mecca of medical care and innovation that is UCSF all but ground to a halt. Our Dean was just let go under very odd circumstances, and everyone’s flocking to water coolers and Starbucks around the city to find out who knows what. I won’t be giving away any trade secrets here, […]

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More on Quality Reports: Lessons From SAT Scores

My older son is gearing up to apply to college (:-\ and so I bought him one of the Bibles, the Fiske Guide. The book is cleverly written – enough academic factoids to get parents to spring for it, leavened with enough social scene skinny to get kids to read it. The Guide dutifully lists […]

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