Thursday, December 27, 2007

Top ten issues in hospital medicine for 2007, issue 5: therapeutic hypothermia and early goal directed therapy

Hospitals, scrambling for good public report cards, have implemented various core “quality measures” promulgated by Joint Commission, CMS and others. Unfortunately these measures have suffered from lack of evidence, ill conceived implementation and unintended consequences. Among the unintended consequences is distraction from other measures which may be better supported by evidence and which really matter.

Early goal directed therapy for sepsis and the application of hypothermia to promote neurologic recovery after cardiac arrest are examples of evidence based therapies that matter, but which are currently being ignored by the core measure police. In addition the detailed planning, organizational requirements and expense involved in the implementation of these therapies constitute institutional barriers.

This year I found and posted links to several papers which addressed practical aspects of implementation. Articles on therapeutic hypothermia are linked here and here. Implementation issues for early goal directed therapy are discussed here and here.

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