Since the start of any year paves the way for reflection, I thought I'd revisit some of the most-read columns in this space over the last year.
Topics ran the gamut, literally from A, for architectural design of one innovative California hospital to Z, for the efforts of providers to reduce hospital-acquired infections to zero.
A is for Architecture
This column described the bold design concepts launched with the August opening of Palomar Medical Center's 288-bed hospital in Escondido, about 20 miles north of San Diego, and was the most popular quality column of 2013. Automatic faucets turn on to prompt hand-washing.
B is for Berwick
One year after he left his post as administrator of the Centers for Medicare & Medicaid Services, Don Berwick, MD, let loose on what he thinks is wrong in healthcare. This former pediatrician, who co-founded the Institute for Healthcare Improvement, thinks hospitals and doctors should do more to keep people from needing their services.
Berwick talked non-stop for more than an hour in a December conversation and was so engrossing, the interview needed to be divided into two parts.
C is for Canada
Why healthcare costs in America are trillions higher than they are in Canada was the topic of a piece in the Archives of Internal Medicine, and prompted an interview with one of the two authors, Steffie Woolhandler, MD, an unrepentant single payer advocate.
This column provoked numerous comments. One writer wrote the article was "false, misleading, and a joke." While another wrote: "Similar and even more detailed comparisons have been done by WHO (the World Health Organization) years ago. Embarrassing [sic] enough the results were similar."
D is for Disaster
We learn from our mistakes, right? When Frankenstorm Sandy took out 705-bed NYU Langone Medical Center, staff scrambled to evacuate hundreds of fragile patients and move them to other hospitals. Politicians were upset. Talk show hosts got on their high horses.
How could this major hospital, which sits right next to the East River, put its backup generators in the basement? This column notes that the hospital had previously decided to spend its money elsewhere, on new CT, MRI, and PET imaging technologies, rather than on upgrading this essential piece of infrastructure.
F is for Flunk
When The Leapfrog Group in June began grading each hospital's safety, many hospital officials were enraged. They blasted the organization's methodology, fairness, and even accused its leaders of trying to make money by selling the right to market those achievements.
H is for Harm
I was somewhat surprised at the strongly positive response from many hospital quality chiefs to this column, which described the launch of a Facebook page devoted to patient harm. I saw many hospital leaders, some of whom I would not have expected, join the site to observe, and perhaps to contribute.
The Facebook page idea is monitored by ProPublica, a Pulitzer Prize-winning non-profit journalism group looking for actual stories about harm. The group also hopes to help illuminate problem areas to prevent such errors from happening to others.
I is for Serial Infector
This column describes what must be every hospital's absolute nightmare. In May and June, this tiny Exeter Hospital, a 100-bed facility in New Hampshire, discovered that a tech in its cath lab was suspected (and later charged) with stealing the drug fentanyl, injecting the drug in himself, and then replacing the injectables for use on dozens of patients awaiting catheterization.
David Kwiatkowski had worked in dozens of other hospitals, and documents say he had even been caught "diverting drugs" before. But because he worked for a registry, and because he traveled from state to state, he eluded subsequent employers. In November, the New Hampshire U.S. Attorney indicted Kwiatkowski, and said that the investigation into who at Exeter knew what, and when, is still very much underway.
Perhaps just as disturbing is the idea that because these patients didn't get the full dosage of fentanyl, they may have endured suffering during their procedures, but were unable to convey it to their anesthesiologists.
P is for Patient Information
We blame patients for not following instructions, not doing their healthcare homework, and relying on an ads or corner gossip to choose providers and procedures. But this novel idea, which would result in patients taking classes recommended by primary care doctors before undergoing invasive procedures—before even seeing a surgeon—prompted numerous comments and criticism.
I didn't think surgeons, or even primary care doctors, would like the idea described in this column. But will it work to reduce unnecessary procedures or at least improve outcomes by educating patients about their expectations?
R is for Readmissions
In this column, a top Harvard healthcare policy physician-researcher, Ashish Jha, MD, questioned federal thinking in assigning higher penalties for higher 30-day readmissions than for 30-day mortality in its formula to incentivize higher quality care.
For example, in the first year that both of these penalties are in effect under two separate provisions of the Affordable Care Act, hospitals with higher 30-day readmission rates are penalized up to 2% of their Medicare base DRG payments. But hospitals with higher 30-day mortality rates see that driving down or affecting only 25% of a 1.25% value based purchasing incentive payment.
It seems that readmissions carry a weight that is just under six times heavier than mortality.
S is for Surgical Site Infection
This column describes what happens when what you write about all the time becomes a real horror to someone you know. A friend and former editor, John Muncie and his wife Jody Jaffe, sought a resolution to his intolerable back pain. What could go wrong? They liked their doctor and the hospital, in a small Virginia town, was spanking brand new.
What came next was a near death experience, and many lessons learned. Thank goodness, John and his wife just posted happy New Year's photos, and I know he's going to be okay.
U is for Unaccountable
Johns Hopkins cancer surgeon Marty Makary's new book "Unaccountable," released this fall, is causing quite a stir. This column describes his first hand accounts of such physician operators as "the Raptor," and Dr. Hodad (a surgeon, nicknamed because he uses "hands of death and destruction" and turns simple surgical instruments into "wrecking balls."
Makary published the book, which sounds like a "tell all," to get patients to be more skeptical and inquisitive about the track records of their prospective healthcare providers.
Z is for Zero
Perhaps there's no better effort to get some hospitals trying harder to get their central line-associated bloodstream infections down to zero than publishing hospital scores on HospitalCompare, which it did in early February.
After all, it's a worthy goal, since federal documents estimate CLABSIs killed 10,000 or more of 41,000 patients who acquired them in U.S. hospitals during 2009, and adding $700 million to the U.S. healthcare bill.
The good news is that the numbers are going down dramatically. Here's hoping that they will continue to do so in 2013.
Happy New Year.