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Biel L. ProPublica. October 2, 2018.
This news article reports on systemic weaknesses that enabled a surgeon with poor skills to continue to perform procedures after numerous surgical errors that resulted in patient harm. A past PSNet perspective explored the risk of recurring medicolegal events among providers who have received unsolicited patient complaints, faced disciplinary actions by medical boards, or accumulated malpractice claims.
Journal Article > Study
Complications of daytime elective laparoscopic cholecystectomies performed by surgeons who operated the night before.
Vinden C, Nash DM, Rangrej J, et al. JAMA. 2013;310:1837-1841.
Considerable research has shown that sleep deprivation can affect cognitive performance, but the link between fatigue and clinical outcomes, particularly for surgeons, remains unclear. This case-control study sought to determine whether there was an association between sleep deprivation—defined as having performed an emergency procedure the night before—and complication rates for elective laparoscopic cholecystectomy. Although a prior single-institution study found increased complication rates for daytime procedures performed after operating the night before, this study used a much larger population-based database from Ontario, Canada and found no evidence of greater complications in patients whose surgeons had operated the night before. As duty hour restrictions for resident physicians appear to have had no effect on clinical outcomes, this study provides an argument against restricting practicing physician's duty hours.
Journal Article > Study
Public reporting of antibiotic timing in patients with pneumonia: lessons from a flawed performance measure.
Wachter RM, Flanders SA, Fee C, Pronovost PJ. Ann Intern Med. 2008;149:29-32.
Efforts to improve the quality and safety of care are being driven in part by a growing focus on public reporting. This commentary shares the potential for the unintended consequences of reporting on flawed performance measures, using time to first antibiotic dose (TFAD) in patients with pneumonia as an example. The authors discuss the background data for this particular quality measure, how it was translated into a performance standard, and the response it generated from emergency departments as well as payers, regulators, and professional societies. The authors conclude with a number of lessons learned from this case example, including the tension that results from having providers balance their desire to do the right thing with the public's view of their quality of care when they are in conflict with each other. A past AHRQ WebM&M commentary discussed the unintended consequences of achieving a good report card on such measures.