Top Gun Hospital Program Brings New Meaning to the Phrase "Frequent Flyer"

Provena Health hospitals are learning 'top flight' maneuvers from LifeWings Partners LLC, headed by former TopGun instructor Stephen Harden.

Click here to read coverage by Leslie Mann for the Chicago Tribune.

The 3 year old company is building an impressive roster - they've already worked with 75 H/HC facilities.

Provena service line administrator Joan Cappelletti says the LifeWings method is useful "when her department has shift changes or when a patient is moved from one area to another, such as from an operating to a recovery room."

LifeWings' website claims use of the system can help hospitals realize a host of benefits:

• Total elimination of wrong surgeries

• Statistically significant improvement in attitudes of care givers toward using teamwork and communication to provide better care¹

• 75% improvement in pre-procedure antibiotic administration

• 50% improvement in observed to expected mortality ratios

• 40% decrease in Class 1 surgical infections

• 57% improvement in observed to expected mortality with patients with risk of mortality of less than 10%

• Improvement in employee satisfaction

• 50.1% reduction in surgical counts errors²

• 51% improvement in OR turnaround times

• Reduction in nurse turnover to less than 2%

• Reduction in nurse-physician occurrence reports

• Improvement in patient satisfaction survey results

• Improvement in adherence to diabetes treatment protocols and clinically significant improvements in patient outcomes³

• Decrease of patient visit time by 10 minutes³

• Reduction in time-to-train for new hire employees³

• Approximately 50% decrease in open claims files for potentially compensable events

Here's some more info on reducing wrong-site surgeries.

The given figures for reducing nursing staff turnover are even more incredible - ICU turnovers reduced by 23 and 35 percent?

Where can I see these guys in action?!

"Peeling Back the Veil of Ignorance" - Health 2.0 Featured Today in VentureBeat

Very interesting coverage by David Hamilton (2.11.08), who voices good criticisms re: enthusiastic estimates of Health 2.0's change capabilities. (Health 2.0 bubble anyone?)

Click here to head over the VentureBeat and read the full text.

Hamilton makes a great point: Health 2.0's unintended side benefits, including revealing corporate & geographically influenced cost differentials for the same exact course of treatment, may be the most change-worthy byproducts of a slew of recent startups.

By attempting to increase the transparency of the US healthcare system for the individual consumer, patient-empowered sites also increase transparency for the general population.

And of course, for policy makers, if they bother to follow along.

Hamilton quotes a small, localized change:healthcare study where researchers called 6 chain pharmacies in 4 different areas of Nashville to get prices for 6 prescriptions, including Lyrica, Lipitor, Ambien, and Singulair.

Findings? Kroger charged 2x more for Singulair in a different part of town. RiteAid charged 2x more for a Lyrica fill than Walgreens.

Another study gathered pricing data for a strep test.

Shocker: estimated costs ranged from $50 to $295. Five of the thirteen providers change:healthcare called, listed by a major insurance co., were either listed incorrectly or couldn't/wouldn't provide pricing data.

Read the article, and then take a look at change:healthcare.

Next, ask yourself if having this type of information readily available wouldn't change the way you personally make healthcare purchasing decisions.

Medical Records Make Wired Magazine's "Why Things Suck" List

Not exactly something to be proud of...

Click here to read the summary.

Unfortunately prescriptions, infertility treatments, and "knees and backs" also make the list.

Are American Hospitals Suffering From Technolust?

In Alexandria, VA, TC Williams High School administrators thought they'd increase staff satisfaction by installing all the latest gadgets, including mobile pointers that allow them to change computer views without wandering back by the desk to click a mouse.

No such luck.

Teachers are concerned a "technolust" and DTA (desire to acquire) philosophy is overshadowing the larger mission of the school. Some are concerned machines are dehumanizing the 'craft' of teaching.

Patrick Welsh, a TC Williams teacher (for 30 years) and author of the Washington Post piece, defines technolust as:

"a disorder affecting publicity-obsessed school administrators nationwide that manifests itself in an insatiable need to acquire the latest, fastest, most exotic computer gadgets, whether teachers and students need them or want them."

Sound familiar?

Are American hospitals suffering from technolust?

Are we purchasing the latest 45689 slice scanners whether doctors and consumers need them or want them? Are we too adopting technology just for the sake of technology?

Welsh says "Principals and other administrators may live off headlines, but teachers live off whether their students learn."

Hospitals live off whether patients recover, not headlines.

It's great when hospital administrators implement improvements and initiatives that help patients recover, but for god's sake - give us the quantitative data already.

Hospitals have gotten very, very good at sharing qualitative patient profiles (personal success stories) as proof that the latest tech initiative was worth the investment - for at least one person.

But what's the institutional ROI? Why is that tech investment important for me as a prospective patient? If you purchase, for instance, 50 Nintendo Wii's for the rehabilitation medicine department, I want to see how "Wiihab" is improving outcomes for stroke, ortho and trauma patients.

As hospitals begin to publish pricing and quality data, this type of material should be included.

After all, if I'm comparing prices on a TKR and your price is significantly higher, I want to see if corresponding tech purchases may be worth the investment on my part.

Of course, this type of extended transparency surrounding tech purchases may provide disincentives for hospitals to offer care outside 'centers of excellence.'

If an administration is pouring money into treatment tech for cancers but I need a state of the art burn center, information about tech purchases and how they affect the bottom line may eventually factor into my decision to select your facility for care - or not.

Bottom line: If you buy the hottest machine, that's not news. If you buy the hottest machine and it immediately improves treatment outcomes for 20% of patients with a specific diagnosis, that's news. Especially if I have the same diagnosis.

Tech for the sake of tech in hospitals shouldn't make headlines. Tech for the sake of healing should.

UK Hospitals Have a "Management Problem"

According to McKinsey, whose analysts have determined that all the NHS needs is some outside HR talent. Oh, and stronger leadership by doctors.

Premise of this study:

"For health care, we...decided to test a hypothesis: that the direct involvement of doctors in the management of a hospital helps to improve its performance."

You don't say?

The article did include interesting comments on the efficiency of hospital performance tracking initiatives...

• "Hospitals that track performance particularly well...continually monitor key performance measures and communicate information about them, both formally and informally; include the whole staff in these communications; and use a range of visual-management tools, such as electronic display boards, progress charts, and performance scorecards."

• "Hospitals that track their performance poorly might monitor only a limited range of externally imposed performance metrics, measure the results sporadically, and communicate them solely to hospital executives."

And here's a shocker - apparently managers with clinical backgrounds are better at running hospitals...

• "Hospitals whose general managers have a clinical background had overall management scores higher than other hospitals did (Exhibit 3). Clinical skills apparently help managers to understand hospital operations and to manage clinicians more successfully."

But they still need to adopt management best practices via cross-vertical pollination:


"The NHS...should look to other sectors, including industry and private-sector hospitals, for examples of good practice in talent management... "

If this research is groundbreaking, perhaps it's no surprise staying in an NHS hospital is as dangerous as bungee jumping and rock climbing...

Tough Love - A New ED Pain Management Model

Valentine's Day is Thursday.

The US emergency room has become infirmary, dispensary, primary care clinic, birth control provider, prison health office, pediatrician, counselor, pharmacy, meal ticket, and yes, there is a life-threatening emergent condition or trauma every so often just to spice things up.

Emergency care professionals in the blogosphere tell us it's becoming near impossible to show patients the TLC they want - issues of legitimate need and, alternately, misuse abound. Crowding in the ED is crowding out timely quality care.

The prescription? Time for some tough love in emergency rooms.

I'm not going to rehash multiple episodes of drug-seeking behavior or abuse of the system's resources in EDs detailed by medbloggers, such as the good docs over at M.D.O.D.

If you want tragically interesting examples of misuse, read entries by EMTs like Emergency Em (calling 911 and then asking the ambulance crew to take you to the ER for a flu shot? seriously?)

We're all spending a lot of time writing about the unbelievable excess use & abuse of the US emergency care system.

One could even argue we've become "frequent flyers" in the blogosphere - reporting anonymously on repeat patients, are we too becoming addicted to getting our chronic cathartic fix without seeking appropriate preventative care, i.e. trying to mend the broken model?

I'd like to propose a new method for ED pain management care and in-house referrals. Code name: tough love.

Here's how it could work:

• Each and every time ER staff rules out other complications, emergent conditions, etc., and is able to isolate pain management as a primary issue, the ER doc transfers the patient to the pain management or "chronic pain" section of the ED (similar to a Fast Track or Urgent Care setup, with dedicated staff and physical space concurrent to the ED - don't be tempted to put this team in the basement to deter prospective patients).

• There, the patient is seen by a specialist, a pain management doc/NP who begins treatment by gathering a comprehensive H&P and interview.
  

• If (and only if) the pain mgmt ED team determines that narcotics are appropriate, they will be administered onsite or prescribed according to the team's best-practice treatment and goals. Let the pain specialists make the decisions for these patients. Let them see the repeat patients who present with chronic pain and/or pain management issues.
  

• In the pain management docs black bag is a list of treatment centers, including dental clinics, county/municipal health departments, etc. Prescriptions for treatment may be doled out in place of narcotics as the team determines necessary. Patients in noncompliance with a previous treatment program referral may find they will not receive narcotic refills via this ED until they are in compliance with a program the pain management team recommends.

Here's what you need:

• First, you must have a pain management doc on staff. All the time.

• Second, your ED physicians must be willing to appropriately and efficiently hand off patients with pain management issues as primary complaints. You have to track systemic bottlenecks that block flow, including those to the new department.
  

• Third, your administration will have to have, ahem, certain anatomical parts of steel. They have to be able to sell this idea to the Board, the medical team, the support staff, the community, the 'consumer', the media, and bare-everything medbloggers.
  

• Fourth, the pain management ED team will quite often see people with 'legitimate' chronic pain issues (migraines, cancer care, etc). The pain management skills of the team must be surmounted only by their high level of empathy. In other words, hire caregivers with people skills.
  

• Oh, and the lawyers will have to go over the program design with a fine-toothed comb. I'm sure the Joint Commission will want a look-see as well.

• And of course if a pain mgmt. patient develops an emergent issue during treatment, they can be quickly transferred to an ER bed (based on triage) for appropriate care.
  

Who knows if this tough-love program could actually work? The answer is simple: we won't know unless someone tries it.

Maybe it's time we stop blogging about caregivers showing more compassion and customers who take advantage. To some extent, that will happen no matter what we do to address the issue at a systemic level.

Let's show patients a little love by connecting prospective need and a service line that has the opportunity to help those living with chronic pain.

Let's design a system that allows ED personnel to get back to doing what they do best: assessing and treating emergent injuries and illnesses.

And let's build a safeguard into the system so those who abuse the 'open door' ED with drug-seeking behaviors are referred to appropriate care - including treatment and rehab centers.

In other words, let's do something about the situation, one ED at a time.

Of course, this is only a stopgap solution - we still have to fix primary care.

Roll up your sleeves, folks.

When it Rains it Pours

Three grandparents in the family have cancer. One diagnosis is older and involved reconstruction of an orbit. The other two loved ones have been diagnosed in the past month.

Please, prayers for the Health Mgmt Rx. Family.