Where’s that scalpel?
Consumers get more information about the fat calories in their potato chips than about the hospitals to which they entrust their lives. Before you buy a car, you probably check out its frequency-of-repair statistics. Wouldn’t it be nice to know the frequency with which your hospital’s working parts fail, resulting in serious injury?
For the first time, California has released data about some of the most serious hospital errors. These include the horror cases that make headlines, as when the wrong drug is administered or a surgical instrument is left in a patient’s body. Of the 1,002 cases of serious medical harm reported for July 2007 through May, though, nearly half involved bedsores severe enough to expose muscle or bone.
Legislators and government officials at both the state and federal levels are working on rules to keep hospitals from charging patients’ insurers for such foul-ups. That’s fair, but ineffective. According to this naive line of thinking, the ability to bill patients for egregious errors is the main reason such mistakes are repeated. In fact, the errors simply become a cost of doing business, like malpractice insurance.
No, the true value of the new information on hospitals is the information itself. It provides consumers with the first meaningful data about individual medical centers. Hospitals are more likely to mend their ways to avoid public embarrassment than to avoid an occasional unpaid bill. They can learn from a bigger pool of data, and regulators and lawmakers can use it to set priorities for improving patient care.
Let’s say the number of objects left in patients during surgery doesn’t drop from its current 145 in 10 months, but rather increases. It might be time for the state to step in to require an operating-room checklist, much like those for airplane pilots. Clamp? Check. Scalpel? ... Uh oh. Even the threat of such a requirement would send hospital administrators scrambling to reduce errors, because if there’s one thing hospitals hate more than the Medi-Cal reimbursement rate, it’s state interference.
Rather than worrying about hospital invoices, the Legislature should pass two bills that would add to the store of knowledge. would broaden hospital reporting requirements, and would require hospitals to report their rates of resistant staph infections. The state should get these data online soon, for all to see and use. Remember how quickly many foods shed their trans fats as soon as companies had to put that information on their labels? The best guardian of consumer safety is an informed consumer.