546851
research-article2014
FAIXXX10.1177/1071100714546851Foot & Ankle InternationalPinzur
FootForum Foot & Ankle International® 2015, Vol. 36(1) 120 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1071100714546851 fai.sagepub.com
Quality and Patient Safety Michael S. Pinzur, MD1
Whether reading medical publications or sitting at lunch at a CME program, one of the overriding recent topics has been the burdening of physicians by regulatory bodies. There is a pervasive attitude among practicing physicians that third-party regulatory bodies are creating more and more hurdles to prevent us from caring for our patients. As we move from a private practice health care model to one where many of us are employed by a health system, we feel that our health care system is placing more and more constraints upon us. And the evil insurance companies create roadblocks to performing necessary tests and providing valuable services to our patients. Are these perceptions real or imaginary? Are the terms quality and patient safety and value-based medicine artificially created roadblocks to allow the third-party payers to avoid paying for necessary services, or are they an evolution of providing patient care? One would think that, much like fine dining, individualized patient care should be much better than the cookbook medical care provided in rigid patient care pathways. One would also argue that providing our residents computer order sets would stifle the development of their decisionmaking skills. It turns out that both of these concepts are not supported by the evidence. Patient-reported outcomes from both the results of surgery and the assessment of the interaction with the health care system suggest that hospitals that use common patient care pathways obtain better clinical results than those institutions that allow individual physicians to individualize care. It is also clear that hospitals that use common patient care algorithms have a lower rate of surgical site infections, fewer perioperative complications, a shorter hospital length of stay, and fewer hospital readmissions. Quality and patient safety is a 2-pronged target. The desired goal for a physician, a practice group, or a health care system is to achieve the best clinical results possible, as defined by some agreed upon metric, with the lowest rate of
complications. Much as in the airline industry, hospitals with standardized processes outperform those hospitals that allow individualism, while at the same time having a lower rate of complications. Well-conceived patient care pathways are simply a series of questions with limited choices. By asking the question on every case, we never forget to give prophylactic antibiotics at the appropriate time, we always remember to initiate our DVT prophylaxis protocol, and we always remember to start physical therapy at the correct time following surgery. Another myth that has been rebuked by evidence is the perception that the demanding prima donna surgeon who screams the loudest achieves the most efficiency. The evidence actually informs us that fewer errors occur in operating rooms where the participants are relaxed and the surgeon simply considers himself or herself one of the members of a team. Going forward, physicians and institutions that work together to develop structured consistent reproducible patient care pathways will provide the best care. If we, in fact, wish to make our health care system patient-centric, then we will need to give up some of our autonomy and learn to develop teamwork. We are all very dependent on the people around us. Much as in professional sports where the best teams beat the best players, it will be this teamwork that will allow us to succeed in the future. The FootForum would like your comments on this topic. Please contact us at [email protected].
1
Loyola University Health System, Maywood, IL, USA
Corresponding Author: Michael S. Pinzur, MD, Loyola University Health System, Orthopaedic Surgery, 2160 S First Ave, Maywood, IL 60153, USA. Email: [email protected]
Downloaded from fai.sagepub.com at WESTERN MICHIGAN UNIVERSITY on May 5, 2015
research-article2014
FAIXXX10.1177/1071100714546851Foot & Ankle InternationalPinzur
FootForum Foot & Ankle International® 2015, Vol. 36(1) 120 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1071100714546851 fai.sagepub.com
Quality and Patient Safety Michael S. Pinzur, MD1
Whether reading medical publications or sitting at lunch at a CME program, one of the overriding recent topics has been the burdening of physicians by regulatory bodies. There is a pervasive attitude among practicing physicians that third-party regulatory bodies are creating more and more hurdles to prevent us from caring for our patients. As we move from a private practice health care model to one where many of us are employed by a health system, we feel that our health care system is placing more and more constraints upon us. And the evil insurance companies create roadblocks to performing necessary tests and providing valuable services to our patients. Are these perceptions real or imaginary? Are the terms quality and patient safety and value-based medicine artificially created roadblocks to allow the third-party payers to avoid paying for necessary services, or are they an evolution of providing patient care? One would think that, much like fine dining, individualized patient care should be much better than the cookbook medical care provided in rigid patient care pathways. One would also argue that providing our residents computer order sets would stifle the development of their decisionmaking skills. It turns out that both of these concepts are not supported by the evidence. Patient-reported outcomes from both the results of surgery and the assessment of the interaction with the health care system suggest that hospitals that use common patient care pathways obtain better clinical results than those institutions that allow individual physicians to individualize care. It is also clear that hospitals that use common patient care algorithms have a lower rate of surgical site infections, fewer perioperative complications, a shorter hospital length of stay, and fewer hospital readmissions. Quality and patient safety is a 2-pronged target. The desired goal for a physician, a practice group, or a health care system is to achieve the best clinical results possible, as defined by some agreed upon metric, with the lowest rate of
complications. Much as in the airline industry, hospitals with standardized processes outperform those hospitals that allow individualism, while at the same time having a lower rate of complications. Well-conceived patient care pathways are simply a series of questions with limited choices. By asking the question on every case, we never forget to give prophylactic antibiotics at the appropriate time, we always remember to initiate our DVT prophylaxis protocol, and we always remember to start physical therapy at the correct time following surgery. Another myth that has been rebuked by evidence is the perception that the demanding prima donna surgeon who screams the loudest achieves the most efficiency. The evidence actually informs us that fewer errors occur in operating rooms where the participants are relaxed and the surgeon simply considers himself or herself one of the members of a team. Going forward, physicians and institutions that work together to develop structured consistent reproducible patient care pathways will provide the best care. If we, in fact, wish to make our health care system patient-centric, then we will need to give up some of our autonomy and learn to develop teamwork. We are all very dependent on the people around us. Much as in professional sports where the best teams beat the best players, it will be this teamwork that will allow us to succeed in the future. The FootForum would like your comments on this topic. Please contact us at [email protected].
1
Loyola University Health System, Maywood, IL, USA
Corresponding Author: Michael S. Pinzur, MD, Loyola University Health System, Orthopaedic Surgery, 2160 S First Ave, Maywood, IL 60153, USA. Email: [email protected]
Downloaded from fai.sagepub.com at WESTERN MICHIGAN UNIVERSITY on May 5, 2015
