A ‘Kiss-and-Tell’ Medical Blog

There’s a very interesting Boston Globe story about Paul Levy, the CEO of Boston’s Beth-Israel Deaconess Hospital. He’s not only a CEO, but also a blogger. His blog, Running a Hospital, is, well, self-explanatory–I guess you can blog about work…if you’re the boss. Levy appears to have started a minor kerfuffle because he has been posting his hospital’s catheter-associated ICU infection rates.

Some of the other hospital heads are bothered that Levy is doing this. Personally, I think patients should be informed about infection rates when choosing a hospital, since hospital-acquired infections kill roughly 90,000 per year in the U.S. If Levy wants to drum up business with the slogan: “Come to Beth-Israel Deaconess and you’ll be a lot less likely to die from an infection”, all power to him.
Levy also proposes an interesting idea, similar to one that I’m working on regarding antibiotic resistance in Massachusetts:

More seriously, a state-sponsored website could be set up for a few thousand dollars. In fact, I will donate the time of our Chief Information Officer to design the site. Hospitals could voluntarily post their data on three or four categories of infections (e.g., ventilator-associated pneumonia, ICU central line infections) along with any explanation they would like. The public could then watch each hospital’s progress month to month and year to year.
This is not a game to compare hospitals one to the other: It is a crusade to see how each hospital improves its own processes. So, Valerie, you don’t have to have a standard across all hospitals. Sure, that would be an added bonus, but if you wait for that, you will wait for a long, long time. And, Nancy, the internet obviates the need to have a one-size-fits-all standard.

Now, there is one problem, which is that I don’t think prospective patients will have the information needed to really tease apart these data: for example, elderly people are more likely to acquire certain infections. If one hospital has more elderly patients, then its infection rates could be higher even thought the hospital’s infection control is quite good. But there definitely needs to be some kind of accountability for hospitals. Part of the antibiotic resistance problem is due to antibiotic therapy for infections in hospitals (e.g., MRSA). Reduce the number of hospital-acquired infections, and you lower the selection pressure for antibiotic resistance.
The irony is that many states, including Massachusetts, do have the regulatory authority to really crack down on this, but the reporting of hospital-infection rates is either voluntary or uses “V codes” which dramatically underestimate the number of infections. These data usually are not even close to ‘real time’ either. The other CEO’s attitudes are troublesome. If they’re not going to be accountable, then it’s time to step things up in terms of regulation.

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