Don’t Wait Or It Will Get Worse

We're always so critical of the press whether its print or TV. The least we can do is when we find something we like we should be as quick to praise as we are to criticize. This morning we found some real stars and some great stories. We shouldn't be so surprised but we are.

Most notable as we constantly quote them, The Atlanta Journal Constitution (AJC), the New York Times (NYT) and Associated Press (AP) not surprisingly. It's not that they don't do good work consistently but they don't remain the source of all news.

We're not a big fan of research that reviews research to reach a conclusion but the story was called: "Deaths After Surgery - Researchers looked at 84,730 people who underwent inpatient surgery at 186 hospitals from 2005 to 2007. They found that death rates varied widely from hospital to hospital, from 3.5 percent to 6.9 percent."

The study of a study was published in the New England Journal of Medicine (NEJM): "Hospital mortality that is associated with inpatient surgery varies widely. Reducing rates of postoperative complications, the current focus of payers and regulators, may be one approach to reducing mortality. However, effective management of complications once they have occurred may be equally important..."

"...In addition to efforts aimed at avoiding complications in the first place, reducing mortality associated with inpatient surgery will require greater attention to the timely recognition and management of complications once they occur."

The researchers of the study of the research were: Amir A. Ghaferi, M.D., John D. Birkmeyer, M.D., and Justin B. Dimick, M.D., M.P.H. The Atlanta Journal Constitution (AJC) reports and you should read the entire story: "Though the new study does not directly address ways to manage surgical complications, "we can speculate," Dimick said. "A number of things in previous studies have been associated with mortality."

"Hospitals with lower surgical death rates tend to have fully-staffed, 24-hour intensive care units with physicians trained to handle post-surgical emergencies. They have high nurse-to-patient ratios in their intensive care units and their wards. "The more nurses the better because there are fewer patients per nurse," Dimick said..."

"A less tangible factor -- "just the culture of the hospital" -- also is involved, he said. "Do people feel afraid to call the surgeon at night, are they afraid to go up the chain of command, are they not afraid of pushing the button?"

We blog so blogs that blog on science and medicine are kindred souls. This time we praise SCIENCEBLOG.com and suggest you read their full story on the study: "The study found similar patterns in the outcomes of specific complications. For example, very high mortality hospitals had similar rates of postoperative bleeding compared to other hospitals, but patients were 50 percent more likely to die if bleeding occurred..."

..."Our study was not designed to identify the 'silver bullet' underlying why some hospitals are more successful than others in rescuing people after surgical complications. However, a patient in need of a major operation should be thoughtful about choosing where and by whom their surgery is performed."

Our obsession is with the lack of available hospital facilities and staff in our jurisdictions. It's not that we believe the sky is falling or that we're in imminent danger for terrorism or pandemic. We believe that the local jurisdictions don't want us to know how wholly unprepared we are for a large disaster. We're just not terrified so it. So far what we anticipate seems like a question of three weeks of more of severe discomfort and deaths. This is horrible and unthinkable but we will survive. Then we can hold the guilty accountable and establish policies to prevent its recurrence.

The AP says that our fears aren't unrealistic. That's most disturbing. "If a third of people wind up catching swine flu, 15 states could run out of hospital beds around the time the outbreak peaks, a new report warns Thursday. The nonprofit Trust for America's Health estimates the number of people hospitalized could range from a high of 168,000 in California to just under 2,500 in Wyoming..."

The story heading is: "Flu might fill up hospitals in 15 states" And continues: "Even though only a fraction would be sick enough to be hospitalized, health officials are bracing: When H1N1 first appeared in the spring, more than 44,000 people visited emergency rooms in hard-hit New York City, the report noted. Just sorting out which patients are sick enough to be admitted from the vast majority who need to go home is a big job. And hospital capacity varies widely. By the outbreak's peak, the new report suggests Delaware and Connecticut hospitals would fill up soonest. Also on that list: Arizona, California, Hawaii, Maryland, Massachusetts, Nevada, New Jersey, New York, Oregon, Rhode Island, Vermont, Virginia and Washington."

At the telephone press conference today Healthy Americans.org released the details of their report. You can listen or download an MP3 of the questions and answers as well as review their report on the District of Columbia and other jurisdictions.