Archive for April 2011

Discharge processes and readmission rates

In this single institution case-control study, researchers found that none of the discharge processes studied had any effect on 30 day readmission rates, including discharge summary completion / content, discharge instruction completion / content, medication reconciliation, presence of caretaker for discharge instructions, and arranged follow up. Although disappointing that this failed to discern which components of the discharge process are most likely to yield a reduction in 30 day readmission rates, it is ongoing testimony to the difficulty and complexity of the discharge process, the multi-factorial nature of readmissions, and lack of correlation between what care teams document and what they actually do (abstract)

Early goal directed therapy in ED sepsis patients is cost effective

In this analysis of several hundred patients at one institution before and after the initiation of early goal directed therapy for sepsis patients in the ED, although the overall costs were higher after initiation, it was found to be cost-effective with a mean increase in 1.3 QALYs (for a cost of about $5,400 per QALY, far below the typical US standard of $50,000). (abstract)

Can Berwick Be Saved? Here’s One Possible Scenario

We’ve all had the experience of hearing someone we know well say or write something totally out of character, and wondering, “what was that about?” Don Berwick said such a thing last week, all-but-contradicting President Obama’s support for a strengthened, independent Medicare payment board. After a little head scratching, I began to wonder whether this might have been a harbinger of some good news regarding his tenure as Medicare czar. This is one complicated political dance, so let me explain. Berwick, as you know, received a recess appointment to lead the Centers for Medicare & Medicaid Services (CMS) last July, after his nomination had become hopelessly entangled in a web of partisan politics. I applauded President Obama for the appointment, and predicted that Don would do a great job in this crucial role, perhaps even wooing some of the Republican legislators who hijacked his nomination process to re-litigate the fracas…


"Clinical microsystems are the small,  functional frontline units that provide most health care to most people. They are the essential building blocks of larger organizations and of the health system. They are the place where patients,  families, and careteams meet. The quality and value of care produced by a large health system can be no better than the services generated by the small systems of which it is composed. A seamless, patient centered, high-quality, safe and efficient health system cannot be realized without the transformation of the essential building blocks that combine to form the care continuum." Quality By Design-A Clinical Microsystems Approach, E. Nelson et al (ed). I submit to you that this is our task:  To create, manage and refine the hospital microsystems in which we and our colleagues care for patients--to lead the team. (more…)

What Did You Wear To Work Today?

Recently, because of some injuries and need to purge a few items of clothing from my usual code of adornment, I was tieless and shoeless (sneakers instead) for several weeks.  No decorum faux pas here, as my generation of practitioners seem to have adapted to this style of dress, say, on holidays or weekends—right or wrong. (more…)