Doctor Leads Quest for Safer Ways to Care for Patients
Dr. Peter J. Pronovost, 45, is medical director of the Quality and Safety Research Group at Johns Hopkins Hospital in Baltimore, which means he leads that institution’s quest for safer ways to care for its patients. He also travels the country, advising hospitals on innovative safety measures. The Hudson Street Press has just released his book, “Safe Patients, Smart Hospitals: How One Doctor’s Checklist Can Help Us Change Health Care from the Inside Out,” written with Eric Vohr. An edited version of a two-hour conversation follows.
Chris Hartlove for The New York Times
SAFETY FIRST Dr. Peter J. Pronovost of Johns Hopkins Hospital in Baltimore.
Q. WHAT GOT YOU STARTED ON YOUR CRUSADE FOR HOSPITAL SAFETY?
A. My father died at age 50 of cancer. He had lymphoma. But he was diagnosed with leukemia. When I was a first-year medical student here at Johns Hopkins, I took him to one of our experts for a second opinion. The specialist said, “If you would have come earlier, you would have been eligible for a bone marrow transplant, but the cancer is too advanced now.” The word “error” was never spoken. But it was crystal clear. I was devastated. I was angry at the clinicians and myself. I kept thinking, “Medicine has to do better than this.”
A few years later, when I was a physician and after I’d done an additional Ph.D. on hospital safety, I met Sorrel King, whose 18-month-old daughter, Josie, had died at Hopkins from infection and dehydration after a catheter insertion.
The mother and the nurses had recognized that the little girl was in trouble. But some of the doctors charged with her care wouldn’t listen. So you had a child die of dehydration, a third world disease, at one of the best hospitals in the world. Many people here were quite anguished about it. And the soul-searching that followed made it possible for me to do new safety research and push for changes.
Q. What exactly was wrong here?
A. As at many hospitals, we had dysfunctional teamwork because of an exceedingly hierarchal culture. When confrontations occurred, the problem was rarely framed in terms of what was best for the patient. It was: “I’m right. I’m more senior than you. Don’t tell me what to do.” With the thing that Josie King died from — an infection after a catheter insertion, our rates were sky high: about 11 per 1,000, which, at the time, put us in the worst 10 percent in the country.
Catheters are inserted into the veins near the heart before major surgery, in the I.C.U., for chemotherapy and for dialysis. The C.D.C. estimates that 31,000 people a year die from bloodstream infections contracted at hospitals this way. So I thought, “This can be stopped. Hospital infections aren’t like a disease there’s no cure for.” I thought, “Let’s try a checklist that standardizes what clinicians do before catheterization.” It seemed to me that if you looked for the most important safety measures and found some way to make them routine, it could change the picture.The checklist we developed was simple: wash your hands, clean your skin with chlorhexidine, try to avoid placing catheters in the groin, if you can, cover the patient and yourself while inserting the catheter, keep a sterile field, and ask yourself every day if the benefits of catheterization exceed the risks.
Q. WASH YOUR HANDS? DON’T DOCTORS AUTOMATICALLY DO THAT?
A. National estimates are that we wash our hands 30 to 40 percent of the time. Hospitals working on improving their safety records are up to 70 percent. Still, that means that 30 percent of the time, people are not doing it.
At Hopkins, we tested the checklist idea in the surgical intensive care unit. It helped, though you still needed to do more to lower the infection rate. You needed to make sure that supplies — disinfectant, drapery, catheters — were near and handy. We observed that these items were stored in eight different places within the hospital, and that was why, in emergencies, people often skipped steps. So we gathered all the necessary materials and placed them together on an accessible cart. We assigned someone to be in charge of the cart and to always make sure it was stocked. We also instituted independent safeguards to make certain that the checklist was followed.
We said: “Doctors, we know you’re busy and sometimes forget to wash your hands. So nurses, you are to make sure the doctors do it. And if they don’t, you are empowered to stop takeoff on a procedure.”
Q. HOW DID THAT FLY?
A. You would have thought I started World War III! The nurses said it wasn’t their job to monitor doctors; the doctors said no nurse was going to stop takeoff. I said: “Doctors, we know we’re not perfect, and we can forget important safety measures. And nurses, how could you permit a doctor to start if they haven’t washed their hands?” I told the nurses they could page me day or night, and I’d support them. Well, in four years’ time, we’ve gotten infection rates down to almost zero in the I.C.U.
We then took this to 100 intensive care units at 70 hospitals in Michigan. We measured their infection rates, implemented the checklist, worked to get a more cooperative culture so that nurses could speak up. And again, we got it down to a near zero. We’ve been encouraging hospitals around the country to set up similar checklist systems.
Q. IN YOUR BOOK, YOU MAINTAIN THAT HOSPITALS CAN REDUCE THEIR ERROR RATES BY EMPOWERING THEIR NURSES. WHY?
A. Because in every hospital in America, patients die because of hierarchy. The way doctors are trained, the experiential domain is seen as threatening and unimportant. Yet, a nurse or a family member may be with a patient for 12 hours in a day, while a doctor might only pop in for five minutes.
When I began working on this, I looked at the liability claims of events that could have killed a patient or that did, at several hospitals — including Hopkins. I asked, “In how many of these sentinel events did someone know something was wrong and didn’t speak up, or spoke up and wasn’t heard?”
Even I, a doctor, I’ve experienced this. Once, during a surgery, I was administering anesthesia and I could see the patient was developing the classic signs of a life threatening allergic reaction. I said to the surgeon, “I think this is a latex allergy, please go change your gloves.” “It’s not!” he insisted, refusing. So I said, “Help me understand how you’re seeing this. If I’m wrong, all I am is wrong. But if you’re wrong, you’ll kill the patient.” All communication broke down. I couldn’t let the patient die because the surgeon and I weren’t connecting.
So I asked the scrub nurse to phone the dean of the medical school, who I knew would back me up. As she was about to call, the surgeon cursed me and finally pulled off the latex gloves.
Q. WHAT CAN CONSUMERS DO TO PROTECT THEMSELVES AGAINST HOSPITAL ERRORS?
A. I’d say that a patient should ask, “What is the hospital’s infection rate?” And if that number is high or the hospital says they don’t know it, you should run. In any case, you should also ask if they use a checklist system.
Once you’re an in-patient, ask: “Do I really need this catheter? Am I getting enough benefit to exceed the risk?” With anyone who touches you, ask, “Did you wash your hands?” It sounds silly. But you have to be your own advocate.
Reference Link
http://www.nytimes.com/2010/03/09/science/09conv.html?ref=science
Donating a kidney doesn’t boost risk of premature death
Live kidney donation is a safe, effective procedure that poses little risk for the premature death of the donor, reports a new study in the Journal of the American Medical Association. That’s welcome news to the more than 106,000 people on the United Network for Organ Sharing (UNOS) transplant list who are waiting on potential donors as of this writing.
The JAMA study is the first of its kind to review the health of live kidney donors over an extended period of time. Researchers looked through more than 80,000 records of people who had donated a kidney between 1994 and 2001. They found that for every 10,000 donors, there were only 3.1 deaths within 90 days of the transplant. Being over age 50 or obese at the time of the transplant did not increase a donor’s risk of dying prematurely.
“Kidney donation surgery is an extraordinarily safe operation in terms of…risk of death, the most serious surgical complication,” explains Dr. Martin Zand, medical director of the Kidney and Pancreas Transplant Programs at the University of Rochester Medical Center.
Zand says that recipients worrying about potential kidney donors’ health has become major point of concern during the transplant process, even though the number of live kidney transplants performed annually has nearly doubled over the past 15 years. Today nearly 6,000 live kidney transplants happen every year.
“By donating a kidney, they’re concerned their donor will put themselves at risk for everything from minor surgery to development of kidney disease to death,” says Zand. “These donors are family members or partners but also people that come forward from the community.”
The hope within the transplant community is that this information will ease some of the concerns expressed by both potential donors and their recipients, particularly because no other research has followed so many live kidney donors for so long.
Generally donors must complete an education process that outlines the risks associated with transplants, before they can donate a kidney. The goal is to make sure each donor is as informed as possible about the surgery they’ve elected to have.
“There’s an enormous value to this, in terms of public health, in terms of medical practice, ” says Zand.
Reference Link
http://pagingdrgupta.blogs.cnn.com/2010/03/09/study-donating-a-kidney-doesn%E2%80%99t-boost-risk-of-premature-death/?hpt=Sbin
'A new liberation for Indian women'
India’s upper house has approved a bill to reserve a third of parliamentary seats for women. Dancer Mallika Sarabhai, who stood in general elections last year, explains what such a move means to her.
Women comprise nearly half of India’s population
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India has taken its the first step towards redemption of promises made to women 62 years ago when it attained freedom.
It was a promise of living with dignity, opportunity, self pride, fearlessness.
Today India awakens to the fact that a nation, like a human body, can not be free if it is torturing half of itself. Mutilating, destroying, deriding, wishing away. No such nation can ever be healthy.
Today we may have opened the door towards a healthy nation.
India may have unleashed forces who could bring succour to her poor, her deprived, her unsung and unheard.
And yet we might lose our way yet again.
Many men will ask: “But they will only think of their own gender. What about us?”
Well what about the men? What about all those men, who even given the opportunity, did not ask, “What about the women?”
Not once in 62 years.
Instead, some of them plundered our bodies and souls, and dishonoured us, made us afraid of further sanctions. For the women are too often the loot – our bodies, our minds, our thoughts, our wombs.
“But they will be the rubber stamps of their men,” the men cry.
So what, even if some are? What are the men today but rubber stamps of their own deviousness, greed and lust for power?
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  The women need to be chosen, trained, tutored, equipped  Mallika Sarabhai
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“But aren’t women as greedy and corrupt as the men,” the men will cry.
Yes some are, trapped alone in the gutters called the male corridors of power, tutored by a patriarchal society that equates selfish self-interest and greed as cleverness.
And even if they are like that, it will change nothing from the status quo. Except that the women WILL be in.
And then there will be a possibility that the women will not play the game by the same rules.
That they will, in a group, be able to let their instincts of co-operation, inclusiveness and caring, of nurturing and problem solving prevail.
And that they will at last get down to the brass tacks of solving this country’s fundamental problems, just like they have in their homes or in their work places for ever.
Today might not change our world.
But it will be a first step.
The road is long. The women need to be chosen, trained, tutored, equipped – not in corrupt ways but in governance, in delivery of benefits and empowerment to the last in line, in transparency. And in not succumbing to the air that prevails.
A new, liberating journey for Indian women has now begun.
Reference Link
http://news.bbc.co.uk/2/hi/south_asia/8554937.stm
Maldives Ban Fishing of Sharks
PARIS — The Maldives will make its territorial waters into a shark sanctuary, a government official said Tuesday, lending momentum to efforts to protect the fish at a United Nations endangered species conference that begins this week.
“We’ve decided to go ahead with a shark fishing ban,” Ibrahim Didi, the fisheries and agriculture minister of the Maldives, said by telephone from Male, the capital. “Beginning July 1 there will be a total ban on exports.”
Maldives becomes the second nation to announce blanket protection for its sharks. Palau, a tiny Micronesian state, in September announced a ban on shark fishing. Like the Maldives, Palau is regarded as one of the world’s top scuba-diving destinations.
The Maldives exclusive economic zone covers about 90,000 square kilometers, or 35,000 square miles, roughly equivalent to the land area of Portugal.
In one sense, the bans represent pure economic logic. Researchers from James Cook University in Australia last year estimated that a single gray reef shark was worth $3,300 a year to the Maldivian tourism industry, compared with the one-time value of $32 that a fisherman would get from the same shark. They found a similar dynamic with regard to sharks on the Great Barrier Reef.
But the bigger issue is a rapid decline in global shark stocks that has alarmed scientists. Up to 30 percent of shark species is threatened with extinction, said Matt Rand, director of global shark conservation at the Pew Environment Group. “If we don’t leave enough in the water, they won’t recover.”
On Saturday, member nations of the Convention on International Trade in Endangered Species of Wild Fauna and Flora begin meeting in Doha, Qatar, where they will consider giving protected status to eight species of sharks, including the scalloped hammerhead and oceanic whitetip, which inhabit Maldivian waters. The measures call for restrictions, but not a ban, on international trade.
In the United States, the Shark Conservation Act, which would sharply curtail the practice of “finning” — cutting off sharks’ fins and throwing the rest of the animal back into the sea — has passed the House of Representatives and is awaiting approval in the Senate.
Mr. Rand said more than 70 million of the fish were killed each year just to support the sharkfin trade. The vast majority of those are sold in China, Hong Kong and Taiwan, where they are used in sharkfin soup. Fins can fetch as much as $120 per kilogram, or 2.2 pounds, in Hong Kong.
“Sharks don’t have the ability to rebound,” he said. “They grow slowly and they’re late to mature.”
Some sharks do not reach maturity until they are more than 10 years old and even then have only a few pups, so the stock cannot reproduce rapidly enough to make up for overfishing.
The value of sharks to the Maldives “is clearly in tourism and diving,” Mr. Rand said. “Any diver will tell you that you get a rush of exhilaration when you see a shark, but you’re not scared. O.K., maybe sometimes you’re scared.”
Mr. Didi, the Maldivian fisheries minister, said his government began planning for a ban last year, but objections from fishermen delayed the decision. Now, he said, “they understand that it isn’t a sustainable fishery.”
The government will provide the fishermen with financial support and retraining, Mr. Didi said.
Shark meat is not a part of the traditional Maldivian diet, he said, and all of the fish were being caught for their fins, which were exported. But the value of the trade had shrunk by more than 80 percent over the last 12 years, to just $230,000, as the sharks became scarcer.
The Maldives’ shark-fishing ban could also give impetus to a thorny discussion in London over an initiative to create the world’s largest marine reserve in British territorial waters around the Chagos islands, the Indian Ocean archipelago where the Diego Garcia military base is located.
The Maldives has become particularly sensitive to environmental issues amid concern over global warming. In October, ministers donned scuba gear for the first cabinet meeting ever held underwater, to publicize the country’s vulnerability to rising seas. The highest natural point in the Maldives is just 2.4 meters, or less than eight feet, above sea level.
Reference Link
http://www.nytimes.com/2010/03/10/world/asia/10iht-shark.html?ref=world
Public asked to avoid plastic
“Anti-plastic campaign is going on in six corporations to create awareness of the harmful effects of plastic waste”
TIRUNELVELI, India: Collector M. Jayaraman has appealed to every resident of the district not to use non-recyclable and non-degradable plastic products like plastic cups and bags which pollute the environment and irreparably damage the soil.
Inaugurating the science exhibition, jointly organised by Tamil Nadu State Council for Science and Technology and St. Xavier’s College’s STAND (Students’ Training and Action for Neighbourhood Development) here on Monday with the theme, ‘Environment protection,’ Mr. Jayaraman said the anti-plastic campaign was going on in six corporations of Tamil Nadu including Tirunelveli to create awareness among the public on the harmful effects of plastic waste.
Listing the efforts being taken by the district administration to eradicate plastic waste completely, the Collector said the public, particularly the students should play a very active role in the crusade against the manufacture, use and sale of non-recyclable and non-degradable plastic products.
When Mr. Jayaraman saw the students of Rose Mary Matriculation Higher Secondary School offering the visitors buttermilk in earthen pots, he also tasted it. “All teashops in the district may use these environment-friendly mud cups,” he noted.
Students from good number of schools had put-up stalls in the exhibition. Rector, St. Xavier’s Educational Institutions, Palayamkottai Rev. Fr. Britto Vincent SJ, Principal of St. Xavier’s College, Palayamkottai Rev. Fr. Alphonse Manickam SJ spoke.
Reference Link
http://www.hindu.com/2010/03/09/stories/2010030951940300.htm
Courtesy
The Hindu
Short film to remove misconception about mental illness among people
It also portrays Anbalayam’s approach of look, touch and heal
One step further:Film director Prabhu Solomon, second from left, releasing the first copy of the short film ‘Azhukku Sattai’ in Tiruchi on Monday.
Tiruchi, India: Anbalayam, the non-government organisation looking after the wandering mentally ill people, went a step further to remove public ignorance about the ailment by getting its short-film titled ‘Alukku Sattai’ (soiled cloth) released here on Monday.
The CD of the 45-minute short film directed by D. Radhakrishnan with a theatre artiste Jayanth in the lead was released at the St. Joseph’s College by Cine Director Prabu Solomon in the presence of the Founder Director of Anbalayam and alumnus T.K.S. Senthil Kumar, the Principal Rev. Fr. Rajarathinam, Psychiatrist Dr. G. Gopalakrishnan of Sowmanasya Hospital.
The first copy of the CD was received by Sasidharan Chinnasamy, an IT professional and social worker based in London.
Incidentally, Mr. Prabu had launched the short film project at the same venue over two years back with an element of novelty. A part of money for the project was generated from the sale of used shirts of students from city colleges, and the rest was mobilised through public contributions.
Cinema being a powerful medium will be able to rectify the public misconceptions about mental retardation and illness, Dr. Gopalakrishnan said, explaining that the mentally ill people possessed normal intelligence but were unable to express themselves due to a combination of factors like fear, loneliness and confusion. It was imperative for the public to know that the ailment is controllable, he said, while emphasising that it was the duty of the Government to look after the mentally ill, he said.
Citing a biblical allusion, the Principal said the short film portrayed Anbalayam’s approach of look, touch and heal. Anbalayam has exemplified its uniqueness by venturing into a task that even commercial filmmakers will hesitate to undertake, Mr. Prabu pointed out.
Professors G. Ravindran and Joseph Irudayaraj and retired Professor N. Arunachalam, who presided over, recalled the dedication with which Mr. Senthil Kumar attended to the needs of the wandering mentally ill during his student days.
Reference Link
http://www.hindu.com/2010/03/09/stories/2010030959850200.htm
Courtesy
The Hindu
Welfare assistance given to folk artistes
SALEM, India: Secretary, Department of Tourism and Culture, V Iraianbu, disbursed welfare assistance to 429 folk artistes from the districts of Salem, Namakkal, Coimbatore, the Nilgiris, Erode, Krishnagiri and Tirupur to the tune of Rs 4.65 lakh here on Monday. Collector J Chandrakumar presided. Mr. Iraianbu said that Tamil Nadu Government had formed a welfare board for the folk artistes and 2000 had been registered as its members. Through the board various welfare schemes were executed for the artistes. Assistant Director, P Hemanathan and Music School Principal S sankararaman were also present.
Reference Link
http://www.hindu.com/2010/03/09/stories/2010030952640300.htm
Courtesy
The Hindu
Steel Plant employees win exemplary worker award
SALEM, India: Eight employees of Salem Steel Plant have won the State Government’s ‘Exemplary Worker Award’ (Uyarndha Uzhaipalar Virudhu) instituted by National Safety Council and Factories Inspectorate, Tamil Nadu.
T. Saravanan, Senior Technician (CRM-Mechanical) won the first prize followed by P. Mathaiyan and R. Manohar, Senior Technicians (CRM-Mechanical) who shared the second prize. S. Elumalai, R. Sekar and R. Selvam, Senior Operators (CRM-Operation) were given third prize for the year 2006.
G. Shanmugavadivel, Senior Technician (HRM-Electrical) won the first prize and K. Karuppiah, Senior Operator (CRM-Operation) got the second prize for the year 2007. The winners received the award from the Minister for Labour Welfare TM Anbarasan at a function held in Chennai on March 5.
Besides, under metal sector category, Salem Steel Plant bagged the first prize for reduction in accident ratio and third prize for lowest accident-free period for the year 2006. It may be noted that Salem Steel Plant has bagged one out of 3 first prizes, 2 out of 6 second prizes and 2 out of 15 third prizes for 2006.
For the year 2007, the plant had won one out of 3 first prizes and one out of 6 second prizes, says a press release.
The Exemplary Worker Award is given to workmen who made suggestions for the improvement in safety standards, working environments and increase in productivity.The scheme is applicable to workers in factories covered by Factories Act to recognise their ingenuity at State-level and to encourage them towards greater efforts in making contribution in this direction.
Reference Link
http://www.hindu.com/2010/03/09/stories/2010030953680300.htm
Courtesy
The Hindu
Women advocates offer to donate organs, receive certificates
To commemorate International Women’s Day
Coimbatore, India: A group of 25 advocates of the Coimbatore Women Advocates Association received the certificates from District Collector P. Umanath pertaining to their offer to donate organs.
The advocates had registered for organ donation along with their family members.
Led by president C.N. Yogalakshmi and secretary M. Vennila, the office-bearers along with the members met the Collector and received the certificates, which included an identity card declaring the assurance to donate organs and the phone numbers to be informed on the demise of the donor.
The total number of people who had registered for donation was 50.
The gesture was to commemorate the International Women’s Day.
The association has also planned to organise an awareness meeting in this connection.
Our Tirupur Staff Reporter adds:
At a function organised by the district administration, Minister for Highways and Minor Ports M. P. Saminathan gave away Rs. 20,000 each as maternity assistance to 666 women beneficiaries identified under the State-sponsored Moovalur Ramamritham Ammaiyar Ninaivu Marriage Assistance Scheme.
Mr. Saminathan said that a total of 1,834 women were benefitted under the marriage assistance scheme in the district during the current fiscal till now.
“The scheme is aimed at helping the poor get their daughters married,” he added.
District Social Welfare Officer Sherin Philip and Collector C. Samayamoorthy were present.
In another function organised by SAVE, a Non-Governmental Organisation, women Self-Help Group members, who had excelled in increasing their earning through self employment ventures, were felicitated.
Reference Link
http://www.hindu.com/2010/03/09/stories/2010030960320300.htm
Courtesy
The Hindu
When a doctor donated her kidney to a patient
American nephrologist Susan Hou explains what made her do it — Photo: M. Vedhan
SETTING AN EXAMPLE:Dr. Susan Hou (fifth from left) interacting with students at a programme in Chennai on Monday.(From right) Dr. Georgi Abraham, founder trustee, TANKER Foundation, and Latha A. Kumaraswami, managing trustee, are in the picture.
CHENNAI, India: “It is much harder to do the right thing everyday when no one is looking. Donating a kidney is much easier.” Susan Hou says that because she really believes it is true.
Seven-and-a-half years ago, Dr. Hou, U.S.-based nephrologist, gave her kidney to her patient. “I’ve had patients ask me for a kidney, but the woman I finally gave it to never asked me. My only criterion was that I should give it to someone smaller than me, and that really narrows it down,” the rather petite nephrologist with a cracking sense of humour says.
“The question is not why I did it, but what took me so long. There was much reluctance to use unrelated donors in the U.S. then,” Dr. Hou explained in a chat after a lecture on renal disorders in pregnancy organised by the Tanker Foundation on Monday.
The strongest criticism came from India, where people said women without rights would be forced to donate one of their kidneys to their husband. Now there are drugs to make unrelated transplants work.
The process of evaluating a donor’s intent and physical condition is crucial, she says. There can be a lot of coercion; people are not so convinced that they should be donating. “When I donated, nobody was pressuring me. If you believe in the brotherhood of man, then there are no unrelated donors.”
One has to ensure that there is no money changing hands. “If we have the feeling a donor doesn’t really want to donate, then we tell them they cannot do it.” The donor also has to be healthy enough and with good kidney function that will likely be good in future. It is essential that the donor has no infection or cancer that he could give to the recipient.
She herself had a “not-so bad” recovery from her traditional nephrectomy. But that is Dr. Hou as usual underplaying the drama. Twelve days after surgery, she flew to Philadelphia for a lecture and 13 days later, she was on a flight to Budapest. None of her children was surprised she had donated her kidney to a patient, and “Mark [Molitch, her husband, an endocrinologist] was very happy later, but very worried…on the day before the surgery.”
When colleagues ask her if she recommends every nephrologist donate a kidney to a patient, she says matter-of-factly, “You don’t have to do it unless you want to. You can do something else.” “Everyone pats you on the back and gives you a plaque when you donate a kidney, but they don’t do that when you hold the elevator door open or refuse a drug company,” Dr. Hou says. On Monday, Georgi Abraham, founder-trustee of Tanker Foundation, honoured her, and yes, a plaque was in the picture.
Reference Link
http://www.hindu.com/2010/03/09/stories/2010030961310500.htm
Courtesy
The Hindu
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