Recently available statistics gathered by the US federal
government show that doctors and hospitals in the US fail
with alarming frequency to deliver essential lifesaving
treatments for some of the most common causes of death,
including heart attack, pneumonia and heart failure.
The treatments are not controversial. Aspirin and beta
blockers for a heart attack, antibiotics and immunizations
for pneumonia, a simple test and drug for heart failure
— are established, straightforward procedures. Yet they
have proven difficult to deliver reliably in many
hospitals.
"Hospitals are busy places, and doctors are fallible, and
things will fall through the cracks, and they'll fall through
the cracks a lot," said Ashish K. Jha of the Harvard School
of Public Health, author of a study on hospitals' performance
that appeared in the New England Journal of Medicine last
month.
There is a 30 percent increase in the survival rate for
patients who take aspirin in the first 24 hours after a heart
attack. Yet hospitals in the US neglected to give aspirin to
more than 12,000 people, one of every 16 heart attack
victims, in the first half of 2004. Beta blockers also give
big survival benefits, but one in eight patients who should
have received them didn't.
Some hospitals said they were treating patients but just
failing to document the treatment. But the American Hospital
Association, doesn't agree.
"If the medications and tests are delivered and there's no
documentation, that itself is a quality problem," said a
spokesman.
The new numbers represent the first time all hospitals have
publicly reported performance data. More than 3,500 hospitals
are participating in the program, called Hospital Compare, in
exchange for a bonus in Medicare payments.
Massachusetts led the states in basic heart attack care,
delivering the appropriate therapy 97 percent of the time.
Other New England states also performed better than most, as
did some in the Northern Plains, like Minnesota and
Montana.
Arkansas was last, with 85 percent compliance. Hawaii and
Nevada were also low. Southern and far Western states tended
to do less well on heart care measures.
Some hospitals had 100 percent compliance, but some were at
50 percent. St. Vincent Medical Center, a financially
struggling 350-bed hospital in Los Angeles, delivered the
appropriate care just 64 percent of the time.
Hospitals that did best realized they had problems, and
systematically set out to fix them with checklists, patient
safety rounds, even firings of administrators.
"We have zero tolerance for people not meeting these
objectives," said an administrator in charge of quality for
the chain that owns 350-bed Caritas St. Elizabeth Medical
Center in Brighton, Mass. The hospital had 632 opportunities
to deliver needed treatments to heart attack victims, the
figures show. It did so 632 times.
