Monday, September 22, 2008

To Err is Buckner..To Forgive is Costly

Ten years ago, if you needed your hip joint “tapped”, you could go to your local hospital about thirty minutes before the procedure, sign some consent forms, have the X-ray-guided aspiration and be out of there – barring unforeseen delays – in an hour….hour-and-a-half.

Today, thanks to the IOM’s (Institute of Medicine) staggering unchallenged assertion that 98,000 people are killed yearly by “medical errors” you better make plans to stay the day. Oh, and get ready to be put on wallet suction. Because the assumption that “of course” we are making these medical errors has lead to the biggest change in corporate behavior since bosses stopped pinching asses.

Only this change costs a lot more.

Today, before the hospital will allow the aspiration of your hip you will need to arrive three hours early and check in to an eight bed pre-procedure “suite” that is equipped better than the original Soviet’s Mir space station.
What is in the suite?
Eight high-tech Hill-Rom hospital beds (prepared to turn you upside-down and resuscitate you if an “error” happens) that cost $8-12,000 each.

After you are changed into a gown and lying in your $10,000 bed you’ll be attached to one of eight high-end blood pressure and oxygen saturation machines which, @ $3,400.00 each makes sure that you -- a normal walking, talking outpatient -- do not suffer from a significant lack of oxygen or blood pressure.

And who hooks you up to this apparatus? An RN of course. An RN who is exclusively assigned to this “pre-procedure” suite with a salary of $70K per year.

This RN will push up to you in an ergonomically appropriate Herman Miller Aeron work chair ($1,300.00 each) while she asks you almost identical questions (“are you allergic to peanuts; do you have headaches when you orgasm; do you tend to react violently in adverse situations…”) which she will type into a Dell laptop ($800.00) before she shuffles off to call the PA.

The PA is another nurse, the “physicians assistant” ($80K/ year) who is permanently assigned to the department and who roves in place of an M.D. in case there are complexities that might bridge the gap between RN and MD in a situation that used to need nothing more than a secretary…

Then they will ask you more questions.

And after the basic, simple, minimally invasive, without-risk procedure, you will be monitored like a baby mouse in a hawk’s nest for any little indication that you might “win the lottery” and suffer some infinitesimally statistically small complication of this essentially safe procedure; and... God help you if you do.

If your heart beat should accelerate or your blood pressure rise (even at the sight of a pretty girl) you will be immediately assaulted by a playbook of scenarios memorized by the RN and PA and meant to replace all simulacra of judgments so that nothing is left to chance.

And, four hours later your test will be done. The system will be $10,000 poorer; and, no man in his right mind will be able to accuse the system of a medical error.

Will it have been worth it?

Well, I guess if 98,000 people a year were actually really dying from medical errors, then any change – no matter how expensive—will have been worth it. However, nothing has changed. As two of the IOM researchers reported six years after the egregious “landmark” IOM report To Err is Human:

Despite finding small improvements at the margins—fewer patients dying from
accidental injection of potassium chloride, reduced infections in hospitals due
to tightened infection control procedures—it is harder to see the overall,
national impact…the groundwork for improving safety has been laid in these past
five years but progress is frustratingly slow...

Why is that? Why haven't the monitors and the questions about peanut allergies and the inclusion of thousands of paraprofessionals and doctor-substitutes and myriad technological advances improved the “error” rate?

Because it was bogus to begin with.
That next in BS in Healthcare.

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