“Improvements in Patient Experience”–Really?

December 15, 2010

Hospitals improve their communication with patients when  patient survey results are publicly reported, say researchers with the RAND Corporation and the federal Centers for Medicare and Medicaid Services (CMS).

Writing in Health Affairs, the researchers report that hospitals participating in the first two rounds of annual reporting improved overall in eight of nine survey measures.  The measures comprised communication with nurses and doctors, staff responsiveness, communication about medicines, pain management, and discharge information.  The surveys took place in 2008 and 2009.

Hand-lettered sign reading, "Stop complaining"The problem is that none of the average improvements exceed one percent. And, physician communication didn’t improve at all–although, interestingly, it scored first or second both years, with four in five patients reporting positive experiences.

Surveying patients is now de rigueur (I took French but, alas, had to look up how to spell this phrase–I hope my use of it impresses you).  The federal survey program is widespread–the vast majority of hospitals now participate–allowing comparisons to be drawn across hospitals and over time.  Hospitals survey patients for marketing purposes and because CMS penalizes hospitals that fail to participate in the program.

CMS pushes the program to improve quality of care, which, in the view of many advocates of quality (this blogger being one), includes patient satisfaction.

Author Marc N. Elliott and colleagues say the result is “encouraging.”  This is because hospitals that take part in the program are improving.  The title of their article is probably an over-reach: “Hospital Survey Shows Improvements in Patient Experience.”  Elliott is a statistician and sounds a bit more interested in the use of statistical measures than in quality of care.

My problems with the results are: Read the rest of this entry »


Young Couple Challenges Surgeon at Bedside

December 13, 2010
young, friendly, confident-looking woman before a backdrop with Eleanor Roosevelt's name

"The Courage to Lead"

A young married couple whom we’ll call “Ted” and “Alice”–real-life friends of ours, with a 1 1/2-year old child–had questions for the attending physician, a surgeon, on Ted’s day of discharge from the hospital yesterday, six days after he underwent emergency abdominal surgery.

The hospital is more than 1,000 miles from home, so there would be little opportunity for normal followup.  Yet the surgeon was not much interested in answering questions.  “You have to trust me,” he said, finally.  “I’ve done this a thousand times.”

“But we haven’t!” said Alice.  “This is our first time.  And I’m the one who will have to care for him.”

Their main questions were the following:

  1. What should we do to manage pain?  Ted’s been on strong pain relievers all week, and now we don’t have a prescription for a pain drug.
  2. What about diet?  Today’s the first day Ted’s eaten any solid food, and we don’t know what he should eat or not eat.
  3. What kinds of complications should we be on the lookout for?  What should we do if they occur?
  4. We want to see our primary care physician back home as soon as possible, but how do we provide that doctor with a record of what went on here in the hospital?

Read the rest of this entry »

No One Wants To Be an “Adverse Event”

December 8, 2010

We cling to hope.  We assume our interaction with the health care system will work to our benefit and we can safely rely on the competence and good will of physicians, nurses, and other health professionals.  The problem is, we can’t.

Lots of evidence points to the stubborn pervasiveness of so-called “systemic” problems in quality of care.  A recent federal study, for example, found that 15,000 people on Medicare died in one month due to an adverse event–a medical error or other mistake, improper execution, or unintended consequence–suffered in a hospital.

photo of a man in a hospital bed with padding at his nose

Sinus Surgery

Another 119,000 hospitalized Medicare beneficiaries sustained a serious adverse event during the month, but survived it.  All told, one in seven hospital patients on Medicare suffered a serious adverse event–and an additional one in seven experienced an adverse event that caused only temporary harm.

The adverse events generated about $325 million in Medicare costs.  On an annual basis, this extrapolates (according to the study authors) to $4.4 billion in extra costs for the bankruptcy-skirting Medicare program.

There is no reason to believe that adverse events happen only to people on Medicare–if anything, Medicare is especially committed to improving quality and safety–or only to people in hospitals.

What this means is:  You are not immune from being linked to this grisly chain. You have to be on your guard.

Poor communication causes many, perhaps most, adverse events.  Most notably, medication errors result from misunderstandings about dosage, frequency, allergies, changes in orders, when to take the drug, how to administer it, and whether the patient is due for another dose.  Lapses in informing patients and staff about what they need to know also can cause dietary problems, infections, treatment complications, and all manners of bad things.

What can you do to keep from being a quality-of-care statistic (and not in a good way)?  If nothing else, take these three steps if you or a family member is in a hospital or other health facility:

  1. Ask questions about anything you don’t understand or that seems funny to you–a drug, test, or procedure that appears to differ from what a doctor or nurse had described, a change in routine that doesn’t make sense to you, or an intervention that appears to repeat something you just had.  Mention any contradictions between what different people tell you. Read the rest of this entry »