The recurring narrative among health reformers is that hospitals that provide more care raise health costs, but don’t necessarily improve quality. This has lead to a backlash against so-called “aggressive” hospitals and doctors, with upcoming financial penalties to match. But the situation, as always, appears to be more nuanced than that.
In her column in the New York Times, Dr. Pauline Chen looks at one subset of patients who actually may benefit from aggressive care: Those who suffer surgical complications. The study,
found no difference in the rate of complications for aggressive and nonaggressive hospitals. But when they looked at all the patients who had complications and examined their outcomes, the researchers found that regardless of the urgency of their operations, those patients who were cared for at more aggressive hospitals were significantly more likely to survive their complications than those who had their operations at less aggressive hospitals.
In addition, the investigators found that characteristics associated with intensity of care treated surgical complications better:
… a hospital’s failure or success in treating surgical complications correlated consistently with factors that also characterized intensity of care — general expenditures, intensive care unit use and the total days of hospitalization — they found that benefits of this more aggressive care extended well beyond the time of the operation.
I constantly remind readers of this blog that more medicine isn’t necessarily better. The counter-intuitive findings from the Dartmouth Atlas study have been instructive in convincing patients that they are, in many cases, overtreated. Read more »
*This blog post was originally published at KevinMD.com*
Although I’ve been a proponent for the prevention of medical errors for years and wrote a book to address those issues, I think my obstetrician-gynecologist (OB/GYN) colleagues are finally catching on.
Dr. Patrick Duff of the University of Florida’s OB/GYN department wrote an article in the December issue of the journal Obstetrics & Gynecology that caught my attention. In his article, “A Simple Checklist for Preventing Major Complications Associated with Cesarean Delivery,” Duff outlines steps that OB/GYNs should take in order to reduce complications during and after a cesarean section. Duff patterns his list after Dr. Atul Gawande’s book, “The Checklist Manifesto: How to Get it Right,” which has set the standard regarding reducing complications after surgery. According to Duff, the following steps should be taken in order to reduce complications after a cesarean section:
1. Clip hair at the surgical site just before making the incision to reduce wound infections. Duff states that there is a greater chance of promoting infections when the hair is shaved the night before the procedure. He also recommends clipping hair as opposed to shaving which reduces the rate of would infections.
2. Cleanse skin with chlorhexidine solution rather than iodine because medical studies have demonstrated a reduction in infections using chlorhexidine solution.
3. Give broad spectrum antibiotics before the surgical incision as opposed to after the newborn’s umbilical cord is clamped. Read more »
*This blog post was originally published at Dr. Linda Burke-Galloway*