Bureaucracy is apparently not pro-life

[brynndragon]

First, learn how an incredibly simple piece of organizational tech (so simple I hesitate to use the word "tech") means ICU staff spend less money to save more lives: The Checklist

Then, learn how the government decided we certainly can't let something this useful continue: A Lifesaving Checklist

Look, I'm a huge fan of ethics in research. I wish examining ethical issues with scientific research was a requirement for all science undergrads. But holding this research to the exact same standards as experimental drugs is a terrible mistake. We do need to be hella careful when dealing with the sickest of the sick, but you can take it too far and it looks like OHRP has. How many people will die of preventable infections before they figure out the standards this sort of research will require to satisfy Confucius' bastard child, bureaucracy?

Comments

[glenmarshall.livejournal.com]

See http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1863

Also see http://www.leapfroggroup.org/for_hospitals/leapfrog_hospital_quality_and_safety_survey_copy/never_events

HHS and insurers are starting to not pay for the added cost of things that simply should never happen in hospital stays. The checklist article is bizzare. I know of many cases where deliberate steps are being taken to reduce the incidence of infections and other preventable complications, and the statistics are collected and used to prove those steps are effective.

I think the article is an abberation in what I'm seeing happen all over the place, in the US and elsewhere.

[benndragon.livejournal.com]

Honestly, I don't find it surprising that insurance companies would insist on better means to prevent the preventable, but as soon as someone tries to actually research what such means would be a government bureaucrat puts a stop to it because they need to piss on it first so it smells right. I find it sad and deplorable, but not surprising.

[glenmarshall.livejournal.com]

I'm friends with the person in AHRQ (a department in HHS) that funds such studies, as I am with his counterparts in CDC that fund and oversee such studies. One of my co-workers is one a couple of national government-sponsored committees that work on such matters. And I am a co-chair of the national standards committee that defines the patient privacy aspects.

In other words, I have a real professional knowledge of the topic and those who are involved in it.

The op-ed piece you linked-to is simply mind-boggling. It differs strongly from what I have specific knowledge about from multiple sources. This bears some looking-into. So I'm going to forward the article to some of my contacts and find out more about it.

[benndragon.livejournal.com]

Oh! My apologies, I failed to understand what you were getting at. That would be awesome and I would really appreciate you getting back to me with what you find out.

[glenmarshall.livejournal.com]

Here's the response I got from my co-worker...

"The article's take on the ... consent requirement for the IHI sponsored program is bizarre. The techniques recommended are common practice (or should be, but are sometimes skipped). The issue seems to be the checklist. While the checklist is an obtrusive, time consuming way to have a nurse document common practice, it certainly shouldn't require consent from the patient.

"It is interesting this article just came out addressing the checklist. Last week, I provided comments for the Society of Healthcare Epidemiology of America to respond to the IHI about the program. My comments were that, although the practices (gown, gloves, mask and proper care of the insertion site) were laudable, the requirement of a checklist was not productive. My concern was not that of consent. However, there is no evidence that a checklist will improve practice; it will only increase the amount of documentation a nurse has to do and, perhaps, limit the nurse's ability to actually care for a patient. I recommended that IHI seek to encourage measurement for routinely captured care delivery processes that are proven or to focus more on outcomes rather than increasing the burden of process documentation.

"In short, the checklist is a cumbersome and not likely to be helpful. Can you imagine a nurse actually documenting anything but successful technique on a checklist?"

[benndragon.livejournal.com]

But, that completely contradicts everything in the first article about the utility of checklists, including the statistics! Now I'm terribly confused.

(I'm also rather offended by the implication that nurses would outright lie on the checklist as a matter of course - apparently the doctor-nurse wars are far from over.)

[glenmarshall.livejournal.com]

My colleague is directly involved in the issue, as you can see from his comments.

The basic idea is to eliminate sources of bias in data collection to improve the value of the data. There may be better/simpler ways to get the data, such as measuring actual patient outcomes following an emphasis on basic cleanliness techniques.

re: I have a real professional knowledge of the topic and those who are involved in it.

[etherial.livejournal.com]

As do I, and I agree with your assessment.