Thursday, August 14, 2008

Plastic Surgery 101 suggests look before you leap (in logic) on hospital infections

There's an op-ed piece in today's Wall Street Journal by one Betsy McCaughey which has my blood pressure up. The article titled, "Hospital Infections: Preventable and Unacceptable" implies that any hospital acquired infection was preventable and should be remedied with class action lawsuits.

For someone who's bright like Ms. McCaughey, she shows little insight and understanding apparently into what drives and perpetuates many different types of infections. Nobody disagrees that common sense steps like hand washing and protocols for invasive intravenous (IV) access maintenance are important in limiting infections, it is both a dangerous and disingenuous idea to suggest that a goal of ZERO is attainable. It is impossible to achieve a failure rate of 0% for system or process, particularly one with infinite numbers of variables (as with a human population of patients). Unlike a Toyota, no two models of the human assembly line are exactly alike (even identical twins gradual accumulate differences due to environmental exposure).

Patients with more comorbities are going to have higher infection rates PERIOD. An overweight, diabetic, smoker (a frequent demographic for vascular disease patients in my neck of the woods) who has open heart surgery has more problems then others and an increased infection rate is more attributable to the patient's behavior rather then the hospital. Obese patients and smokers have higher rates of problems after elective plastic surgery (like breast reconstruction or reduction for instance)as well for that matter. You can be sure at some point, hospitals (and doctors) will be looking at patient demographic data to exclude higher risk patients from treatment at their facility whatsoever.

In referring to a list of "never events" recently laid out by Medicare for which they will not cover the cost of complications she blithely writes
"No wonder Medicare calls these infections "never events" Why should jurors reach a different conclusion in a lawsuit."

This coming from a bureaucrat and politician is hard to take. While we should always strive to be perfect, it's important to realize that there are processes which we can all agree on to attain low and reproducible rates of infection.

For a related writing here on Plastic Surgery 101 see the post "Medicare announces they won't pay for complications - How the F*** is this going to work?" that I wrote last year.



Jeffrey Frentzen said...

Ms. McCaughrey, a former Lt. Governor of New York State, is at the helm of RID (the Committee to Reduce Infection Deaths), an advocacy group that certainly sounds like a worthwhile medical organization.

A few medical blogs, though, have picked up on the "zero percent" rule espoused by McCaughrey and the so-called "Never Events" policy espoused by Medicare/Medicaid. Dr. Oliver is not alone here -- this topic can make physicians froth at the mouth on cue.

McCaughrey, who is referred to as "Dr." in some online sources, is not articulating all sides of this important issue -- and possibly ignoring basic facts about the why/how of hospital infections and related phenomena that other doctors can articulate very clearly.

So... who exactly is McCaughrey? A clue can be found at Tapped:

"...[Is] this Betsy McCaughey the "Elizabeth McCaughey" who as a fellow at the Manhattan Institute wrote the legendary article, "No Exit," in The New Republic in 1993, in which she claimed to have read the entire Clinton health care plan and adduced all sorts of nightmare scenarios? Is this Betsy McCaughey the "Betsy McCaughey Ross" who, solely on the credential of having discredited the Clinton health care plan, was chosen as the Republican nominee for Lieutenant Governor of New York in 1995, becoming probably the first person ever to make news from that position by, for reasons never explained, standing up for the entirety of Governor Pataki's 1997 State of the State address? The same Betsy McCaughey who then became a Democrat, ran for governor, and divorced and sued her husband, Wilbur Ross, when he refused to bankroll her campaign?

"Yes, all the same person. And her new gig, the "Committe to Reduce Infection Deaths"? A good cause, to be sure: make sure doctors wash their hands. But the actual activities are vague and the "committee" itself consists of folks like Erica Jong, Tina Brown, Sir Harold Evans, the architect Richard Meier, and various other New York socialites."

Burrus Boys said...

Rob -- I stumbled across your blog today and have not been able to stop reading. I hear similar stories every day -- only with a urologic spin. But it was interesting to see how the same issues filter across specialties.

Mostly I want to thank you for raising my pop culture cool points considerably with the video postings. My oldest son, Jack, was crazy about the Bat for Lashes video, too. Since you're a Gaiman fan, I strongly recommend Terry Pratchet's "Discworld" series -- particularly the ones involving "The Watch". Pratchet and Gaiman have teamed up before and I'm a huge fan of both. Thanks for the diversion today! Jodi B.