Showing papers by "Atul A. Gawande published in 2010"

National Costs Of The Medical Liability System

Abstract: Concerns about reducing the rate of growth of health expenditures have reignited interest in medical liability reforms and their potential to save money by reducing the practice of defensive medicine. It is not easy to estimate the costs of the medical liability system, however. This article identifies the various components of liability system costs, generates national estimates for each component, and discusses the level of evidence available to support the estimates. Overall annual medical liability system costs, including defensive medicine, are estimated to be $55.6 billion in 2008 dollars, or 2.4 percent of total health care spending.

Effect of a 19-item surgical safety checklist during urgent operations in a global patient population.

Abstract: Objective:To assess whether implementation of a 19-item World Health Organization (WHO) Surgical Safety Checklist in urgent surgical cases would improve compliance with basic standards of care and reduce rates of deaths and complications.Background:Use of the WHO Surgical Safety Checklist has been s

Perspectives in quality: designing the WHO Surgical Safety Checklist.

Abstract: The World Health Organization's Patient Safety Programme created an initiative to improve the safety of surgery around the world. In order to accomplish this goal the programme team developed a checklist with items that could and, if at all possible, should be practised in all settings where surgery takes place. There is little guidance in the literature regarding methods for creating a medical checklist. The airline industry, however, has more than 70 years of experience in developing and using checklists. The authors of the WHO Surgical Safety Checklist drew lessons from the aviation experience to create a safety tool that supports essential clinical practice. In order to inform the methodology for development of future checklists in health care, we review how we applied lessons learned from the aviation experience in checklist development to the development of the Surgical Safety Checklist and also discuss the differences that exist between aviation and medicine that impact the use of checklists in health care.

Adopting A Surgical Safety Checklist Could Save Money And Improve The Quality Of Care In U.S. Hospitals

Abstract: Use of the World Health Organization's Surgical Safety Checklist has been associated with a significant reduction in major postoperative complications after inpatient surgery. We hypothesized that implementing the checklist in the United States would generate cost savings for hospitals. We performed a decision analysis comparing implementation of the checklist to existing practice in U.S. hospitals. In a hospital with a baseline major complication rate after surgery of at least 3 percent, the checklist generates cost savings once it prevents at least five major complications. Using the checklist would both save money and improve the quality of care in hospitals throughout the United States.

The incidence of hypoxemia during surgery: evidence from two institutions

Abstract: Purpose The incidence of hypoxemia in patients undergoing surgery is largely unknown and may have a clinical impact. The objective of this study was to determine the incidence of intraoperative hypoxemia in a large surgical population.

A comparative analysis of incident reporting lag times in academic medical centres in Japan and the USA

Abstract: Background Delays in reporting of medical errors may signal deficiencies in the performance of hospital-based incident reporting. We sought to understand the characteristics of hospitals, providers and patient injuries that affect such delays. Setting and Methods All incident reports filed between May 2004 and August 2005 at the Kyoto University Hospital (KUH) in Japan and the Brigham and Women’s Hospital (BWH) in the USA were evaluated. Lag time between each event and the submission of an incident report were computed. Multivariable Poisson regression with overdispersion, to control for previously described confounding factors and identify independent predictors of delays, was used. Results Unadjusted lag times were significantly longer for physicians than other reporters (3.6 vs 1.8 days, p<0.0001), longer for major than minor events (4.1 vs 1.9 days, p¼0.0006) and longer at KUH than at BWH (3.1 vs 1.0 days, p<0.0001). In multivariable analysis, lag times at KUH remained nearly three times longer than at BWH (incidenceerate ratio 2.95, 95% CI 2.84 to 3.06,

National Costs of the Medical Liability System

Abstract: This paper estimates the national costs of the medical liability system, including indemnity payments, administrative costs, defensive medicine costs, and lost clinician work time, synthesizing data from a variety of sources. Total costs are estimated at $55.6 billion in 2008, including $45.6 billion in defensive medicine costs, $5.7 billion in indemnity payments, and over $4 billion in administrative and other expenses. The quality of the evidence underlying the estimates is discussed. We conclude that although the liability system is costly in absolute terms, because it accounts for only a small proportion (2.4%) of total health care spending, medical liability expenditures cannot be the main, or even one of the most important, drivers of rising health care costs.