Aggravated DocSurg explains the importance of hospital culture as he dissects data from the ACS Surgery News. When you expect little, you get little in return. I have full faith in the abilities of most folks at Happy's hospital that come in contact with patients in one way or another. That which I am not trained to handle, I leave for others more educated than I. As an internist trained hospitalist, the volume of disease I am capable of handling is immense. My limits are well known to me. And when they are met, I act accordingly.
Physicians also play an important role in following protocols designed for patient safety. If you have infection control policies in place that require full shield protection while placing central lines, the policies do no good if the physicians do not follow them. If you have good policies in place to prevent venous thromboembolism (VTE), they do no good if the physicians are not active participants. Physicians must be willing participants, along with everyone else, in a culture of excellence.
Some physicians don't seem to want to do the right thing for patient care. Eventually, those physicians will be found out. If they don't want to prevent VTE in their patients, their numbers will eventually prove their failure. If they don't want to barrier protect their patients from infection, their numbers will eventually prove their failure.
On a personal note, I am happy to report that my data is exceptional. If you were taken care of by me, you were 50% less likely to die than your severity of illness adjusted expected mortality would have suggested. Every year I get a report indicating my actual mortality % vs expected mortality %. Some of this can be manipulated by how well I document, compared to the rest of the physician universe. I understand the documentation rules very well. That may, to some degree, skew my data when compared with the physician universe. But so what. It's accurate data. And it's accurate when comparing me against my own data. If my patient is sick, I document exactly how sick they are.
So how do my numbers look? Well, in 2008, 355 cases were evaluated. The severity of illness adjusted expected mortality for my patients was 5.7%. This compared with the national database numbers of 5.1%. But how often did my patients die? 5%? 4%? 3%? None of the above.
My patients died only 2.8% of the time. Less than half my patients who were expected to die, did. How did I compare with the rest of Happy's hospitalist group? Despite having a higher severity of illness (which may be due to better documentation), I beat them out too with an actual mortality of 2.8% vs 4.5% for Happy's entire hospitalist group. So not only are my patients dying 50% less often than would be expected, patients in my entire hospitalist group are dying 12% less often than would be expected when compared with national statistics.
Hospitals with strong safety initiatives and a culture of compliance with those initiatives from all players, including physicians, separate good hospitals from great ones. And physicians that practice sound clinical medicine can expect more of their patients to survive their acute illness, despite all the barriers to their survival. Quality will come from within, not from the government. How many bad mothers do you know out there on welfare? How many bad mothers do you know not on welfare? What makes a good mother is the mother, not the government.
So what does it all mean? If you should ever find yourself as a patient on my service, you can sleep well at night knowing that your chance of dying is 50% less than if the average physician in this country cared for you. And should you ever find yourself admitted to Happy's hospitalist service , you can sleep well at night knowing that if you don't get me as your physician, at the least, you have a 12% less chance of dying during your stay than the average patient in the average hospital being taken care of by the average physician in this soon to be average country.