complications

Heads You Win, Tails I Lose

by Jerry Meyers on September 8, 2009

Kevin Pho, M.D in his medical blog, Kevinmd.com, invites a discussion concerning whether elderly patients should choose premature death at home rather than being subjected to the complications that are associated with geriatric admissions.  He concludes that elderly patients admitted to emergency departments should be given the opportunity to choose going home rather than being admitted to a hospital.

An elderly patient should not be forced to forgo necessary treatment for a readily treatable condition and thereby face certain death in order to avoid death by “complications” faced by elderly patients who are admitted. This is certainly a choice between a rock and a hard place.

It is a mistake to assume an elderly patient cannot safely be cared for in a hospital setting. The morbidity our elders face is to a great extent avoidable by assuring that they are kept clean, hydrated fed and as active as their condition permits. Adverse changes in their condition should be promptly recognized and properly and timely treated. This is the level of care all patients deserve.

Because elders are more fragile they require more attention but tend to get less. Elders suffer more complications and more serious consequences not simply because they are fragile but more importantly because they to not receive the surveillance and attention they require.

The costs imposed on medicare are magnified because of inadequate treatment which results in needlessly prolonged geriatric admissions and readmissions and prolonged and useless rehabilitation admissions.

When these patients fail to thrive they are simply fullfilling expections. This is a self-fullfilling prophecy. The expectations need to be changed.

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The Effect Of Creating And Using A Safety Checklist In Conjunction With The Performance Of Non-Cardiac Surgery

by Jerry Meyers on March 5, 2009

In January of 2009 the New England Journal of Medicine published the results of a study conducted by the Harvard School of Public Health at the Massachusetts General Hospital in Boston reporting the effect of creating and using a safety checklist in conjunction with the performance of non-cardiac surgery. Eight hospitals in eight cities as diverse as New Deli, India and Seattle, Washington participated in this study.

All hospitals who participated in this study employed a surgical safety checklist. Remarkably, none of the items involved new technology or surgical techniques.

The checklist items were as follows:

  1. Requiring each surgical patient to verify his or her own identity, surgical site and procedure.
  2. Marking the surgical site.
  3. Using pulse oximetry.
  4. Requiring that surgical team members pause to introduce themselves by name and role and then reviewing anticipated critical events.
  5. Confirming that prophylactic antibiotics were administered greater than sixty minutes before incision.
  6. Confirming needle and sponge counts and at completion of the surgery revealing key concerns for the patient’s recovery and care.

The implementation of the checklist items with respect to the non-cardiac surgical patients greater than 16 years of age resulted in a reduction in complications associated with the surgery from 10.3% to 7.1% and at high income study sites such as Seattle, Toronto, London, etc. the death rate diminished from .9% to .6%.

When one considers that 234 million operations are performed globally each year, a universal adoption of the checklist could result in saving as many as 702,000 persons annually worldwide.

Even more important, perhaps is the near 40% reduction in postoperative complications after introduction of the checklist. The checklist represents a potential for preventing postoperative complications worldwide annually by 9,360,000.

It is perhaps not so surprising that safe surgery requires an attention to very simple details which assure that all members of the team know what they are about.

Regrettably, there is no agency or law which compels our hospitals and healthcare providers to implement a surgical checklist. Indeed, the only tool available to families of patients harmed by medical negligence generally is the medical malpractice lawyer.

In Pennsylvania and many other states lawyers have fought to maintain the right of victims of medical negligence to seek justice in our courts. No doctor or other healthcare provider, hospital or otherwise is above the law.

The civil justice system provides an important incentive to healthcare professionals. There is no other effective mechanism for holding them accountable and assuring that those victims of medical negligence obtain the compensation they deserve to help them meet the great economic and other challenges which they face.

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