Hospital-Induced Fatalities Gets Public Airing
Today the House Committee on Oversight and Government Reform investigated the 6th leading cause of death in the U.S.: infections from hospital errors. Last year alone, a startling 100,000 people died from hospital-associated infections and almost 2 million suffered non-fatal health problems.
Democratic and Republican Committee members and witnesses shared their astonishment at the volume of deaths. Henry A. Waxman, (D-Calif.), committee chairman, noted that thousands of deaths can be prevented by elementary procedures like hospital personnel washing their hands and using clippers instead of a razor to remove hair before surgery. "You seem to be of one mind," Waxman said to the witnesses representing government and the medical profession. "Unlike other causes of death, this is one we know how to reduce."
Less clear is how much government can do to reduce them. Cynthia Bascatta, Director of Health Care Issues at the Government Accountability Office, said one way to alleviate the problem is to improve information-sharing between the Centers for Disease Control and other agencies under the Department of Health and Human Services. In fact, four different agencies are compiling their own data on hospital associated infections. As Arthur Allen reported for The Independent, former CDC scientists believe the agency's hospital infection program is increasingly dysfunctional.
Questions of competence aside, witnesses argued that government health agencies need to go back to basics. "The federal government spends a dollar on medical research for every penny on safety and the health-care industry," said Peter Pronovost, medical director at the Center for Innovation in Quality Patient Care at The John Hopkins University.
The most controversial solution to the hospital infection problem was returned to time and again by Rep. Tom Davis, the committee's ranking Republican. Davis wants to end reimbursements to hospitals that treat medicare patients who contracted hospital-associated infections. Hospital infections cost $5 billion a year, which Davis said creates a "perverse incentive," where the government pays the hospital to treat a problem the hospital caused.
Can any of these solutions be quickly implemented to curtail the hospital death epidemic? Hospital associated infections are a distressingly simple problem. But revisions in the government health care system during a lame duck Bush administration could be a bridge too far.
Comments:
Posted 04/16/2008 04:33pm with
What is missing yet again is any mention and attention to the role and affect of professional nursing on infection rates (morbidity) and preventable death rates (mortality).
Professional nurses – those who are licensed to practice as a registered nurse, number just under 3 million in the US. Research by Aiken sponsored by the IOM demonstrates significant increases in morbidity and mortality rates when patients are not cared for by registered nurses who were educated at the baccalaureate level or above. Only about 1/3 of nurses are educated at this level.
Nurses have untenable work conditions, 70% or more have been bullied (including incidents which are defined as criminal attacks) at their places of work. The top two categories of people who bullied nurses are #1 physicians, and #2 fellow nurses, followed by patients, visitors and other healthcare workers.
Nurses often take care of too many patients, work with continual interruptions, have no proportional representation of their professional issues and interests as employees, and 90% do not enjoy collective bargaining or representation.
Yet nurses provide about 95% of all reimbursed professional health care services, largely attributable to the continuous around the clock nature of patient care and nursing care as opposed to the episodic, appointment-based nature of physician and therapy services.
Nurses are not adequately represented in the boardrooms, the policy table or in government. They get almost zero reportage across all forms of media (including the progressive blogosphere. Nursing research is almost never cites, yet the National Institute for Nursing Research is a full fledged NIH Institute with a robust research agenda which is providing new knowledge leading to improved patient care and advancing nursing theory and practice.
No presidential candidate has addressed the needs or issues of professional nurses, and patient advocacy is critically compromised when nurses – the key patient safety protectors and advocates – do not enjoy self-governance and the autonomy, authority and legitimacy needed to affect practices which protect patients.
When nurses have the authority and autonomy to practice nursing without suffering the external insults of employers, third party payers and non-nurse administrators, physicians and other stakeholders, patients and nurses will benefit.