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• Resident Duty Hours and Patient Safety: Did The IOM Get It Right?

  The Institute of Medicine just released its long-awaited report on trainee duty hours. It is well researched and balanced, and its recommendations appropriately reflect what we know vs. what we believe. Now the fun begins.Let’s start with a little background, Read More... Posted Sat, Dec 06 2008 5:23 PM by Bob Wachter | 10 Comments Filed under: Hospital Care, Medical Education/Academia, Hospitalists/Hospital Medicine, Patient Safety/Medical Errors, Health Policy, Media/Press Coverage

• How the Newly Vigorous Patient Safety Regulatory Environment May Be Harming the Cause of Safety

  In responding to dysfunctional systems, America instinctively turns to “more regulation” (Exhibit A: today’s Wall Street). But regulation can, and often does, go too far, and – in patient safety – I believe that it now has.Note that this comes from someone Read More... Posted Sun, Oct 19 2008 8:34 PM by Bob Wachter | 6 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Patient Safety/Medical Errors, Health Policy

• The Color-Coded Wristband Saga

  Last week’s New York Times front-page piece on colored wristbands highlighted an issue I’ve been fretting about for years. We can achieve consensus on a $700B bailout in 3 days (well, perhaps not), but can’t agree on what color a DNR wristband should Read More... Posted Tue, Sep 30 2008 12:27 AM by Bob Wachter | 6 Comments Filed under: Hospital Care, Patient Safety/Medical Errors, Health Policy

• Big Brother Arrives: Monitoring Patient Safety Compliance By Remote Video

  Today came the announcement that Suzanne Delbanco, founding director of the Leapfrog Group, has assumed the presidency of a company that tracks compliance with safety and quality practices via remote video. Big Brother, meet the Joint Commission.The report, Read More... Posted Tue, Sep 23 2008 8:18 AM by Bob Wachter | 10 Comments Filed under: Hospital Care, Transparency and Reporting, Quality Measurement, Information Technology, Patient Safety/Medical Errors, Industry/Pharma

• Is it “Macaca” Time in Healthcare?

  August 11th was the 2nd anniversary of the epic implosion of George Allen's presidential campaign, the first defeat at the hands of YouTube. Two recent videos of unattended patients dying in ER waiting rooms leave me wondering whether healthcare has also Read More... Posted Tue, Aug 19 2008 8:00 AM by Bob Wachter | 1 Comments Filed under: Hospital Care, Transparency and Reporting, Information Technology, Patient Safety/Medical Errors, Media/Press Coverage

• 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

• Another Case of Wrong Site Surgery: Are We Averting Our Eyes From Some of the Root Causes?

  Yet another case of wrong-side surgery, this one at Boston’s Beth-Israel Deaconess Hospital. Though CEO Paul Levy does a nice job discussing the case on his blog, I’ll focus on two aspects Paul neglects: the role of production pressures in errors, and Read More... Posted Wed, Jul 09 2008 7:52 AM by Bob Wachter | 12 Comments Filed under: Hospital Care, Patient Safety/Medical Errors, 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 | 8 Comments Filed under: Quality Improvement, Hospital Care, Quality Measurement, Hospitalists/Hospital Medicine, Patient Safety/Medical Errors, Health Policy

• Should Hospitals Install Bar Coding or CPOE First? Why I’ve Changed My Tune

  This is one of the most commonly asked questions in IT World, and my answer has always been “CPOE first” – largely because that has always been David Bates’s (the world’s leading IT/safety researcher) answer. But I’ve changed my mind. Here’s why. Before Read More... Posted Fri, May 02 2008 9:00 PM by Bob Wachter | 9 Comments Filed under: Hospital Care, Information Technology, Patient Safety/Medical Errors, Industry/Pharma, Nurses/Nursing, 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 | 7 Comments Filed under: Hospital Care, Transparency and Reporting, Quality Measurement, Patient Safety/Medical Errors, Health Policy

• Snooping At Britney’s Chart: Why Should Docs and Nurses Have Different Rules?

  Should doctors and nurses be subject to different penalties for precisely the same infraction? Of course not. Are they? Sure. Just ask Britney Spears. Britney was hospitalized at UCLA at least twice in the past few years – once when she gave birth to Read More... Posted Sun, Apr 20 2008 8:53 PM by Bob Wachter | 2 Comments Filed under: Hospital Care, Information Technology, Patient Safety/Medical Errors, Nurses/Nursing, Media/Press Coverage, Medical Ethics