Thursday, November 04, 2004

A Glimmer of Progress

The October 28, 2004 issue of The Boston Globe carried an article about medical errors that had been committed by house staff at Brigham and Women’s Hospital and attributed to fatigue following long hours of continuous duty. The article was a report of a study conducted by Brigham and Women’s researchers and published in the prestigious New England Journal of Medicine.

The numbers were not trivial. One chart showed a total of about 100 medication errors per 1000 patient days. A little simple math will tell you that his means that if you had been an inpatient in that hospital, the chances of your being subject to a medication error during the period of the study were about one in three.

Not so long ago, a study of this kind would have been impossible. Supervising house staff was a province of clinical departments that no one would have dared to invade. And if information of the sort was somehow developed, the public report would have taken the form of an exposé. The hospital would have reacted defensively, saying that the information was being misrepresented, its significance was being exaggerated, corrective action had already been taken, etc. etc.

But those days seem to be on the way out, and happily so. What happened in this case is that Brigham and Women’s suspected it had a patient safety problem, confirmed its suspicions with a formal study, and made the results public. It also reported the steps it was taking in response to the information it had uncovered.

Having had something to do with the creation of that institution some 30 years ago, I can perhaps be excused for taking some pride in the leadership it is showing.

One such incident does not create a redesigned health care system. But successful redesign can only take place if old and outdated attitudes are abandoned in favor of new and progressive ones such as those that have taken root at Brigham and Women’s.

Given the prestige that Brigham and Women’s enjoys in the field of health care, it is an encouraging sign.

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