ideas for quality improvement that could be done at a community hospital

1. The return of the Morbidity and Mortality conference, but with a twist--When I was in medical school and residency, if any hospital admission went spectacularly wrong, we had an M and M conference. The major players had to research the medical record, draw a timeline of what happened, and discuss their reasoning and actions with regard to the case. Everyone came. It was like a gladiator show. There was blood. There were tears. And everybody at the conference thought about what they would have done differently to make the whole thing come out better. There is nothing wrong with a traditional M and M conference, other than the fact that should there be a malpractice case it would potentially lead to embarrassment or successful prosecution. What I would propose would be C and Q conference which would explore the cost and quality of any spectacularly complex case. The bill would be projected on the wall, and the various actions would be evaluated and discussed in terms of their adherence to known effective practice, and their eventual contribution to the health or disease of the patient. We would all get to see exactly how much all of the things we ordered and did cost.

2. Suggestion boxes, possibly online, with rewards: This was effective in reducing costs in airlines, and might be helpful in hospitals. Airlines got rid of mandatory bags of peanuts and various other silliness that I don't remember. The scale of these companies made peanuts a big deal. Still. Community hospitals don't have the scale issue, but an individual aliquot of money in medicine is usually huge. Perhaps just the activity of thinking about cost savings would help focus us appropriately.

Comments

How to make your own ultrasound gel (which is also sterile and edible and environmentally friendly) UPDATED--NEW RECIPE

I have been doing lots of bedside ultrasound lately and realized how useful it would be in areas far off the beaten track like Haiti, for instance. With a bedside ultrasound (mine fits in my pocket) I could diagnose heart disease, kidney and gallbladder problems, various cancers as well as lung and intestinal diseases. Then I realized that I would have to take a whole bunch of ultrasound gel with me which would mean that I would have to check luggage, which is a real pain when traveling light to a place where luggage disappears. I heard that you can use water, or spit, in a pinch, or even lotion, though oil based coupling media apparently break down the surface of the transducer. Or, of course, you can just use ultrasound gel. Ultrasound requires an aqueous interface between the transducer and the skin or else all you see is black. Ultrasound gel is a clear goo, looks like hair gel or aloe vera, and is made by several companies out of various combinations of propylene glycol, glyce...

Ivermectin for Covid--Does it work? We don't know.

Lately there has been quite a heated controversy about whether to use ivermectin for Covid-19. The FDA , a US federal agency responsible for providing unbiased information to protect people from harmful drugs, foods, even tobacco products, has said that there is not good evidence of ivermectin's safety and effectiveness in treating Covid 19, and that just about sums up what we truly know about ivermectin in the context of Covid. The CDC, Centers for Disease Control, a branch of the department of Health and Human Services, tasked with preventing and treating disease and injury, also recently warned people not to use ivermectin to treat Covid outside of actual clinical trials. Certain highly qualified physicians, including ones who practice critical care medicine and manage many patients with severe Covid infections in the intensive care unit vocally support the use of ivermectin to treat Covid and have published dosing schedules and reviews of the literature supporting...

Actinic Keratoses and Carac (fluorouracil) cream: why is this so expensive?

First, a disclaimer: I don't know why Carac (0.5% flourouracil cream) is so expensive. I will speculate, though, at the very end of this blog. Sun and the skin: what happens If a person reaches a certain age, has very little pigment in her skin, and has spent lots of time in the sun, bad stuff happens. The ultraviolet radiation of the sun does all kinds of great things: it makes us happy, causes us to synthesize vitamin D which strengthens our bones and it gives us this healthy glow until we get old and wrinkled and leathery. And even that can be charming. The skin cells put up with this remarkably well for a long time, partly aided by melanin pigment which absorbs the radiation, which is why we tan and freckle, if we are fair skinned. Eventually, though, we absorb enough radiation that it injures the skin and produces cells which multiply oddly. It also damages the skin's elasticity which creates wrinkles. The cells which reproduce in odd ways peel, creating dry skin or...

Why is American health care so expensive?

Search This Blog