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A Surgeon’s Five Tips for Improving Hospital Safety

October 17, 2012

A few weeks ago, The Wall Street Journal published an article on its website called “How to Stop Hospitals from Killing Us” prompted by the statistic that every week, “medical errors kill enough people to fill four jumbo jets.” The author, Marty Makary, is a surgeon; he opens by remarking that massive media coverage and federal investigations follow any plane crash and that pilots and other aviation officials learn from these, thus making air travel safer. He observes that medical errors affect far more people than plane crashes, but investigations of such mistakes do not produce anything like the wealth of information available through aviation inquiries.

He writes (and this is worth quoting at length), “As doctors, we swear to do no harm. But on the job we soon absorb another unspoken rule: to overlook the mistakes of our colleagues. The problem is vast. U.S. surgeons operate on the wrong body part 40 times a week. Roughly a quarter of all hospitalized patients will be harmed by a medical error of some kind. If medical errors were a disease, they would be the sixth leading cause of death in America–just behind accidents and ahead of Alzheimer’s…[and] medical errors cost the U.S. healthcare system tens of billions a year. Some 20 percent to 30 percent of all medications, tests and procedures are unnecessary, according to research done by medical specialists, surveying their own fields. What other industry misses the mark this often?”

Dr. Makary goes on to suggest five changes to make healthcare safer.

First, he recognizes that over half of New Yorkers questioned in a survey said they look up a restaurant’s reviews before eating there. Why not have a system like this for hospitals? This sort of open-access and “public reporting” already occurred in New York in 1989: “death rates declined by 83 percent in six years.”

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Second, he points out that hospitals with self-reported rates of good teamwork are more successful. He writes that good teamwork “correlated strongly with infection rates and patient outcomes. Good teamwork meant safer care. The public needs to have access to such information for every hospital in America.”

His third recommendation is that hospitals begin to use cameras in operating rooms to encourage doctors to perform more careful and thorough procedures. He claims that surgical notes simply cannot tell you as much as a video can. This leads to better preparation for medical students and, in one hospital, 50 percent longer surgeries and a 30 percent increase in quality scores. Cameras have even proven effective in increasing the rates of things we take for granted, like doctors and nurses washing their hands regularly.

The fourth point is his simplest: that patients should have access to their medical notes so that they can correct any mistakes they may see on it. It’s very easy for a doctor to mistake “left arm” for “right arm” or “20 milligrams, not 25 milligrams.” Makary suggests these notes be accessible via the Web.

His last suggestion is that doctors be more open and honest about mistakes and that victims of medical malpractice be allowed to speak out (“if you are the victim of a medical mistake, hospital lawyers will make never speaking publicly about your injury a condition of any settlement”). Transparency, he writes, is the answer to many problems the medical field currently faces, and informing and empowering patients is where the solution must begin.

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