Saturday, April 10, 2010

Address by Paul Levy, Hospital Medicine 2010

Paul Levy, President and CEO of Beth Israel Deaconess Medical Center in Boston, spoke yesterday on patient safety. He writes a lot about safety and transparency at BIDMC on his blog Running a Hospital. His approach, though widely applauded, is difficult of me to accept uncritically. A highly celebrated example of transparency at BIDMC a couple of years ago, for example, concerning a case of wrong side surgery, seemed oddly selective to me:

What surgical procedure was actually done? We aren’t told, but given that it was characterized as wrong side we know it involved a structure of bilateral symmetry. And, from White Coat Notes (linked from Levy’s post) we learn that it was not an organ removal and did not result in permanent harm. Was it a biopsy, an arthroscopic procedure or carpal tunnel release?

Whatever it was the hospital is apparently not threatened with huge financial loss. Levy’s candor, laudable as it is, must be viewed in that context. After the OR staff disclosed the error to the patient Levy emailed the entire hospital staff, the Boston Globe and other media about the incident! But what if the patient had renal cell carcinoma and had the wrong kidney removed, sentencing him/her to long term hemodialysis? Would Levy have responded in the same way? I doubt it. If he shared such an incident with the media Beth Israel’s attorneys would have concerns and the malpractice carrier would arguably be within its rights to refuse coverage.

What’s equally disappointing is that Levy seems to buy into the popular but implausible notion of never events. In his talk he acknowledged that the idea isn’t scientific and that motivational thinking, the real mark of a leader, may have to trump scientific objectivity. To me, as regular readers know, it’s a goofy idea and one that has consequences.

So how is Beth Israel doing? Despite rigorous adherence to multiple evidence based measures (their hand hygiene rates are second to none) their central line infection rates, though low, are not trending toward zero. In fact they’ve hardly budged in almost two years.

That criticism aside their safety processes are praiseworthy. They do a root cause analysis on every event in designated categories and are relentless in their efforts to reduce harm. Levy wrote about his visit to Hospital Medicine 2010 here.

1 comment:

Michael Kirsch, M.D. said...

I am very hostile to the never events concept. In short order, the list will grow to include legitimate complications and adverse reactions. The public already does not often distinguish the difference between negligence and and adverse event. This is one cause of pursuing groundless litigation against physicians.