Hospital ER goals contradict one another

Isn't it just possible those increased tests are due to exhaustion, and not just a fear of lawyers?

Two stories have hospital administrators upset today. See if you can spot the contradiction:

  1. The Accreditation Council for Graduate Medical Education, the people who manage medical schools, are recommending hospitals allow naps so residents don't have to work more than16 hours at a time. The idea would be that 5 hours of sleep might be followed by 9 more hours of work, meaning 30 hours on-site at a stretch, but that's the limit.
  2. Emergency rooms are doing more tests than ever, citing fears of malpractice suits, and there is evidence increased medical testing is raising the risk of cancer to patients.

(The illustration originally appeared in a ZDNet story from Michael Krigsman about corporate chief information officers, in 2008.)

What are the administrators whinging about? Isn't it just possible those increased tests are due to exhaustion, and not just a fear of lawyers? Wouldn't a doctor who hasn't been on-duty for over 16 hours be more likely to make a call on what's wrong, and not rely on the machines?

It doesn't take a medical degree to know that working 120 hours a week, as some residents were doing routinely before the guidelines were first relaxed in 2003, might lead to a few mistakes. Does it?

The fear of hospitals is that shorter hours for residents will mean they have to bring on more residents, thus train more doctors. They worry about a labor shortage. With national unemployment of 10% they worry about a labor shortage?

Part of the answer to this could lie in technology. Systems like GE's Qualibria, introduced earlier this year, bring decision support and best practices to the patient's bedside, even in emergency rooms.They can tell whether a test should be done, and what the correct interpretation of symptoms might be.

The software was designed in collaboration with the Mayo Clinic and Intermountain Health of Utah, both considered leaders in maintaining quality while keeping costs down.

And solving the problem that way, proving the meaningful use of decision support software, would also put hospitals in line for more of that sweet, sweet stimulus cash.

While all this news seems to involve medical and legal professionals, administrators and physicians, questions of labor and management and liability, it all comes down to your health.

If exhausted residents are performing needless tests and putting your life at risk because they're afraid of lawsuits, simple common sense says we need to bring some intelligence to bear.

Now we can. Are administrators going to complain about the cost, or are they going to try and solve the problem?

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