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• Post-Vacation Potpourri: Items Interesting, International, and Ineffably Sad

  Just returning from a work-acation, including a talk in Buenos Aires. Today I’ll briefly cover a few items: Medicare’s final “no pay” list; patient safety in Argentina; a great post on hospital finances; and one of the saddest things I’ve ever experienced. Read More... Posted Thu, Aug 14 2008 3:07 AM by Bob Wachter | 0 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Patient Safety/Medical Errors, Health Policy, Media/Press Coverage

• Door to Antibiotics Time in Pneumonia: Lessons from a Flawed Quality Measure

  In today’s Annals of Internal Medicine, my colleagues and I describe the saga of the four-hour measure of door-to-antibiotics time for pneumonia – the first truly dangerous measure in the era of public quality reporting. It is an important cautionary Read More... Posted Wed, Jul 02 2008 8:09 AM by Bob Wachter | 4 Comments Filed under: Hospital Care, Pay-for-performance, Transparency and Reporting, Quality Measurement, Patient Safety/Medical Errors, Health Policy

• The New (CMO) Math: Passion + Power = Progress

  In his five years on the job, Dr. Ernie Ring taught me why the Chief Medical Officer role is crucial, and how to do it right. Since Ernie is retiring at week’s end, it seems like an opportune time to share what I’ve learned.A bit of background. UCSF Medical Read More... Posted Wed, Jun 25 2008 8:36 AM by Bob Wachter | 3 Comments Filed under: Quality Improvement, Hospital Care, Quality Measurement, Medical Education/Academia, Patient Safety/Medical Errors, Health Policy

• The Best and Worst of Times For “Infection Preventionists”

  As I mentioned in my last post, these should be the best of times for "Infection Preventionists" (formerly known as Infection Control Officers). After years of trying to get someone – anyone – to pay attention to their work, their day in the sun has finally Read More... Posted Mon, Jun 23 2008 5:51 AM by Bob Wachter | 1 Comments Filed under: Quality Improvement, Hospital Care, Quality Measurement, Hospitalists/Hospital Medicine, Information Technology, Patient Safety/Medical Errors, Health Policy

• How Infection Prevention Came to Dominate the Patient Safety Movement

  The Joint Commission just released its 2009 National Patient Safety Goals, and – no surprise – they focus on infection prevention. While this seems natural today, it wasn’t always so. In fact, the conflation of infection control and patient safety is Read More... Posted Sun, Jun 22 2008 1:10 AM by Bob Wachter | 2 Comments Filed under: Hospital Care, Transparency and Reporting, Quality Measurement, Patient Safety/Medical Errors, Nurses/Nursing, Health Policy

• Could Intensivists Be Harmful to ICU Patients’ Health?

  Of all the structural (how care is organized) “evidence-based markers of high quality care,” perhaps the most ironclad has been the involvement of critical care physicians in the care of ICU patients. That is, until now. In a sophisticated study in today’s Read More... Posted Wed, Jun 04 2008 7:34 AM by Bob Wachter | 7 Comments Filed under: Quality Improvement, Hospital Care, Quality Measurement, Hospitalists/Hospital Medicine, Patient Safety/Medical Errors, Health Policy

• Why Diagnostic Errors Don’t Get Any Respect… And What Can Be Done About It

  I gave a keynote yesterday to the first-ever meeting on “Diagnostic Error in Medicine.” I hope the confab helps put diagnostic errors on the safety map. But, as Ricky Ricardo would say, the experts and advocates in the audience have some ‘splainin’ to Read More... Posted Mon, Jun 02 2008 4:20 AM by Bob Wachter | 4 Comments Filed under: Quality Measurement, Medical Education/Academia, Diagnosis/Clinical Reasoning, Information Technology, Patient Safety/Medical Errors, Industry/Pharma, Health Policy, Media/Press Coverage

• Oprah, Obama, Putin, Springsteen… and Pronovost

  Last week, Time Magazine named the 100 most influential people in the world. Among the luminaries was Dr. Peter Pronovost of Johns Hopkins. I thought it was an inspired choice. The modern patient safety field has been blessed with a number of important Read More... Posted Sun, May 11 2008 7:28 AM by Bob Wachter | 2 Comments Filed under: Quality Measurement, Patient Safety/Medical Errors, Health Policy, Media/Press Coverage

• Message to Medicare: Whoa, Nellie!

  Last week, Medicare proposed nine additional “do not pay” conditions, several months before implementing the first eight. I like the concept of not paying for preventable adverse events, but this new list is a case of too far, too fast. In my previous Read More... Posted Mon, Apr 28 2008 7:37 AM by Bob Wachter | 5 Comments Filed under: Hospital Care, Transparency and Reporting, Quality Measurement, Patient Safety/Medical Errors, Health Policy

• Should Patient Satisfaction Scores Be Adjusted for Where Patients Shop?

  Last week, Medicare added patient satisfaction data to its hospital reporting website. This is progress, but it raises an interesting question: should patient satisfaction scores be case-mix adjusted? The motivation to include patient satisfaction data Read More... Posted Sun, Apr 13 2008 4:03 AM by Bob Wachter | 1 Comments Filed under: Hospital Care, Pay-for-performance, Transparency and Reporting, Quality Measurement, Hospitalists/Hospital Medicine, Information Technology, Health Policy, Media/Press Coverage

• Average Time of Discharge: Why a Hospital is Not a Hilton

  Do you get as annoyed as I do about being pressured on your “Time of Discharge?” I just received my monthly report, and we’re in The Doghouse again: our average TOD – 3:28 pm – is hours after “check-out time.” But when did we turn into the Holiday Inn? Read More... Posted Wed, Mar 26 2008 7:05 AM by Bob Wachter | 13 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Efficiency, Hospitalists/Hospital Medicine

• The Great Quality Debate: Berwick’s Plea for Action vs. Evidence-Based Medicine

  In this week’s JAMA, Dr. Don Berwick, CEO of the Institute for Healthcare Improvement, argues that evidence-based standards should be relaxed for quality improvement practices. Ironically, a few pages away, a Swiss study finds than an IHI-endorsed MRSA Read More... Posted Mon, Mar 17 2008 11:59 PM by Bob Wachter | 4 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Medical Education/Academia, Patient Safety/Medical Errors, Health Policy

• And Speaking of the Unintended Consequences of Quality Measurement...

  I must have "you can't manage what you don't measure" on the brain – here's a piece I wrote this week for AHRQ's Guidelines/Quality Measures Clearinghouses called "Is the Measurement Mandate Diverting the Patient Safety Revolution?" Well, of course it Read More... Posted Tue, Mar 04 2008 4:06 PM by Bob Wachter | 1 Comments Filed under: Quality Improvement, Transparency and Reporting, Quality Measurement, Patient Safety/Medical Errors

• Quality Measurement and the Risk of Yin Without Yang

  "You can’t manage what you don’t measure." This well-worn business axiom has been embraced by the healthcare quality movement, a trend this is healthy and long past due. But it comes with a risk: Yin without Yang. What do I mean? With the (still scanty) Read More... Posted Sat, Mar 01 2008 10:20 PM by Bob Wachter | 2 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Patient Safety/Medical Errors

• The Checklist Saga: Victory!

  I must admit, I didn’t hold out high hopes that a ragtag band of committed clinicians and other quality improvers could change federal policy. But we’ve done just that. If the Feds are capable of rectifying this mistake, who knows what might be next! Read More... Posted Sat, Feb 16 2008 7:24 PM by Bob Wachter | 5 Comments Filed under: Quality Improvement, Hospital Care, Quality Measurement, Medical Education/Academia, Patient Safety/Medical Errors, Health Policy