When one considers the great breakthroughs in surgery that gain most public attention, the usual candidates are heart transplants, joint replacements or robotic surgery. There can be little doubt these headline operations have saved lives or helped relieve many patients’ suffering.
However, as our resources continue to be stretched to near breaking point, it may be time to focus on the relatively inexpensive but highly significant improvements that can be introduced today with far greater effect than any foreseeable new surgery or drugs. Unfortunately, few of these initiatives are likely to capture the public imagination or politicians’ attention, yet if aggressively supported and resourced will have major health gains, save lives and decrease costs.
At last, deep venous thrombosis (DVT) has been fully appreciated as a killer of patients admitted to hospital. Patients undergoing surgery are particularly at risk, yet this can be largely eliminated or at least reduced by simple measures at the time of surgery and injections of an anticoagulant until recovery has occurred.
Even cheaper is careful attention to hand washing before healthcare staff touch patients. Recent work continues to suggest that less than 50% of the time hand washing precedes patient interventions. If we can remember to put on a seat belt, flush a toilet or collect the mail, why can’t doctors and others get into the routine of washing hands before and after patients are examined? In centres with meticulous hand washing and appropriate attention to sterility, infections transmitted by hospitalisation have all but been eliminated. The savings in costs for the Australian healthcare system would be enormous and provide greatly improved outcome for all patients within the health system.
Just as straightforward would be the introduction of a surgical checklist at the time of surgery. Every year in Australia a significant number of patients undergo incorrect procedures because they were not carefully checked off before the intervention. Further refinement of simple checklists also helps ensure appropriate equipment is always present and special post-operative care is flagged. Surgical checklists cost almost nothing yet have been shown to almost halve mortality and mortality in hospitals in which they are used.
If all Australian hospitals followed DVT protocols, ensured hand washing occurred and demanded serious attention to simple, relevant checklists we could save lives and save money and set a world standard for health care.
anyone interested in reading further on the issue of checklists should check out the excellent book by Atul Gawande – The Checklist Manifesto
Bravo professor, I couldn’t agree more. I spent 3 months in an ICU of a large public hospital and was amazed at the carefree attitude with regard to hygiene. Whilst hand washing on entering was mandatory, the staff regularly moved from patient to patient without washing their hands. Also, the bin next to the basin that took the paper towels used for drying was left to the point of overflowing with old dressings spilling out onto the floor. A case of meningococcal arose as well as golden staph requiring the whole ward to be stripped and sterilised at considerable cost . It seems to me that this issue is more about the culture that exists in each facilit.y The fact that staff are overworked, underpaid and routinely undervalued promotes a culture of bullying and general laxity where nobody wants to do anything that could be deemed someone else’s job. Action was taken to avoid the development of DVT.
Its interesting that surgeons and tradespeople working on much less complex systems have similar attitudes….
They believe that they know what they’re doing because they’ve had the training & experience to be where they are now.
In a blue collar workplace this attitude gets people badly injured or killed. Same in hospitals it seems.
Its also interesting to note the debate about publicising investigations in hospitals. If mining or construction kept investigations and statistics hidden it would be a different world. How many patients get information about a hospital’s ‘incident’ rate – mistakes in surgery etc. In construction, customers demand information of safety stats and incident outcomes.
Seems like health has some other 1970s concepts apart from the closed shop going on.
Scott, the reason they are kept secret is that trust and faith in the healthcare practitioner is paramount, otherwise the placebo doesn’t work.
Scott I agree with you. Hospitals are very dangerous places which should be avoided unless absolutely necessary. People can and do die from seemingly simple mistakes. In my view all health practitioners should be required to publish their stats including both successful outcomes and unsuccessful ones as a matter of course. In this digital age it would be relatively easy to do and would give consumers the information they need to make an informed choice not only about who to seek advice from, but also which discipline offers the most acceptable outcome. You could be sure the AMA would fight tooth and nail to stop such a proposal going through though.