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Strategies for Safer Hospital Medicine Also Cut Costs

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   February 13, 2014

New doctors are turning the tables on seasoned physician leaders by introducing strategies to improve quality by curtailing opportunities for medical error and harm. They're also saving hospitals millions in unnecessary spending.

This article appears in the January/February 2014 issue of HealthLeaders magazine.

A decade ago, young doctors fresh out of residency would loyally follow their senior mentors, diligently emulate their sage practices, and rarely second-guess. That's just the way it was in medical training.

But in a dozen or so hospitals—from San Francisco to San Jose and Boston to Baltimore—the tables are turning on the senior physician guard.

On these wards today, it's upstart youngsters now teaching their seasoned attendings and physician leaders about a new world order of hospital medicine—one that improves quality while it reduces waste, inappropriate care, and often, the opportunity for medical error and harm.

And by the way, these new doctors say, their strategies also avoid millions in unnecessary spending: a few tens of thousands here, a few tens of thousands there. It's adding up to real money, and that has brought smiles to the C-suite.

Reexamining appropriate utilization

Physicians for Responsible Ordering is one such effort started by residents and faculty at the approximately 565-bed Johns Hopkins Bayview Medical Center in Baltimore who created the group in 2010 and raised questions about several routine practices; the new protocols they launched have eliminated some interventions, with no evidence of patient harm.

Now, when the subject of PRO comes up among senior physicians, Bayview's Executive Vice President and Chief Operating Officer Charles Reuland says, "My faculty leaders and I jokingly recite this quote attributed to Gandhi, 'There goes my people. I must follow them, for I am their leader.' "

"We love it that they're doing this because they're putting us on the right course," Reuland says. "The fact is, it's many of our trainees and younger physicians who are helping us control utilization and cost."

These aren't big ticket items, like the purchase of an expensive robot. But these thirtysomething clinicians are digging into the weeds of routine hospital processes and scrutinizing order sets, eliminating tests or imaging that almost never change a diagnosis but instead often prompt further testing and invasive procedures that needlessly waste resources.

Questioning routine practices

They're avoiding medical errors by switching patients from higher-risk intravenous medications to safer and less resource-intense oral doses.

They're "questioning the practice of daily lab ordering in all hospitalized patients, many of whom are already in a weakened state. These efforts may reduce hospital-acquired anemia," according to 36-year-old PRO lead organizer Anthony Accurso, MD. The group seeks to organize physicians in the hospital who share an interest in high-value care and agree to question the utility of these daily practices.


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