Je peux comprendre vos craintes de déléguer des actes médicaux aux paramédiques. Après tout on peut s'attendre à ce qu'ils soient moins bon que les MDs. Qui ne sont déjà pas très bons.
Read : "It's the systyem stupid" On fait TROP confiance au MDs et pas assez au système Mais ce n'est pas grave Les gens ne s'en portent pas plus mal Charles --------------------------------------------------------- August 7, 2005 L.I. Hospitals Are Graded on Basics By FORD FESSENDEN JUST about everyone in medicine agrees that a patient who shows up in the emergency room with a heart attack should be given aspirin. That simple treatment has been proved to cut death rates by nearly a quarter. But hundreds of patients at hospitals on Long Island do not get that treatment or nine other crucial therapies for heart attacks, heart failure and pneumonia, a review of recently published hospital data shows. Some hospitals are better than others, but none delivered all the treatments to eligible patients, in spite of their well-known benefits. Last month, the New England Journal of Medicine reported that hospitals across the country were neglecting many life-saving treatments, although their performance had improved somewhat between 2002 and 2004. The Journal also reported on a second study that found hospitals around Boston and Oklahoma City performed better than other large regions, but even in those places hundreds of patients did not get basic therapies. A review of the data by The New York Times showed that care on Long Island was about average when compared with hospitals nationwide. Three hospitals ranked in the top 10 percent nationally on treatments for at least one of the conditions. Two were in the bottom 10 percent in treating pneumonia. Over all, Long Island hospitals delivered appropriate treatment to heart attack victims 92 percent of the time, to heart failure patients 84 percent of the time, and to pneumonia patients 75 percent of the time. While the islandwide averages were similar to those in Manhattan, there were more highly ranked hospitals in the city. Five Manhattan hospitals were in the top 10 percent in at least one of the three conditions. The hospital performance data is collected by the Department of Health and Human Services under a program called Hospital Compare, and covers 10 treatments considered essential for most patients. They include only admissions from January 2004 to June 2004. Detailed information is posted at www.hospitalcompare.hhs.gov. "We really should be close to 100 percent on all of these measures," said Dr. Ashish Jha, a Boston physician and author of one of the national studies published last month. "There's not much controversy about whether giving antibiotics to someone who has pneumonia is good or not." Besides aspirin for heart attack and antibiotics for pneumonia, the measures include beta blockers for heart attack, angiotensin-converting enzyme inhibitors for heart failure and heart attack, and vaccinations for pneumonia. Some of the hospitals on Long Island that performed best are small. Conversely, one of the country's busiest heart-surgery centers was middling compared with others on the Island and nationwide in delivering simple treatments to heart patients. Eastern Long Island Hospital, a tiny 80-bed facility in Greenport, was in the top 10 percent in the country for heart-failure and pneumonia treatments. Southside Hospital in Bay Shore and Southampton Hospital were in the top 10 percent for heart attack care. Administrators in these hospitals said they had worked with their staff to insure the treatments were delivered. "The culture of this hospital really pushes this and buys into it, and that's the difference between this hospital and others," said Paul Connor, the president of Eastern Long Island Hospital. "In some ways, it's easier to get the attention of the staff because you are small." At Southside, a 371-bed hospital affiliated with the 15-hospital North Shore-LIJ Hospital System, administrators began planning three years ago to meet the standards. Emergency room physicians were given checklists, on paper and electronically, that specify what to do for heart and pneumonia patients. "They don't have to remember everything, because they get reminders," said Frank del Giudice, vice president for quality management. "Everybody's busy. It's easy to miss something if you're not looking at it very carefully." Physicians at Stony Brook University Hospital, whose emergency room is one of the busiest on Long Island, sign a form that automatically orders the necessary treatments for heart patients. If a patient should not get aspirin or beta blockers for some reason, "you have to go to the trouble of unordering them" said Dr. David Brown, chief of cardiology. Stony Brook was in the top quarter of hospitals nationwide for heart attack patients, and was one of the better large hospitals on the Island on all three of the Hospital Compare measures. Still, it failed to deliver appropriate care in dozens of cases. "There are a lot of doctors who don't follow the guidelines, and aren't up to date on the literature," said Dr. Brown. "That's what these public scorecards are designed to do - embarrass or educate people to do things the right way. They may think they're doing pretty well, but when you actually show them the numbers, it's clear that they're not." St. Francis Hospital in Roslyn, which calls itself "the heart center" and had consistently posted below-average death rates for coronary bypass operations on a state report card until 2002, was not in the top third of hospitals nationwide on any of the Hospital Compare measures. The hospital failed to deliver appropriate care 203 times out of 2,098 cases involving heart attack and heart failure patients. Dr. Lawrence Reduto, the hospital's vice president for medical affairs, blamed the way the government counts. If a patient should not have aspirin because of other circumstances, for instance, doctors often do not write down the contraindications. When they do not, the case is considered a failure to treat, even though it may not actually be, he said. "I think true omissions, where the doctor forgot to give an appropriate therapy, the number of those patients is small," Dr. Reduto said. Still, he said, the hospital was working to improve. "I'm hard pressed to say we'll ever hit 100 percent, but scores will improve," he said. The worst hospital on Long Island in delivering treatments was one of biggest, Winthrop University Hospital in Mineola. It failed to deliver the appropriate treatment to pneumonia patients more than 400 times out of 1,004 opportunities, putting it in the bottom 10 percent of hospitals in the country. Hospital officials said they believed the problem was not in treatment, but in abstracting the data from charts. "We initially did a little worse than most hospitals," said Dr. Steve Fishbane, director of quality for the hospital's department of medicine. He said the numbers have improved since last year. The measures used in the studies cover a narrow band of the range of care the hospitals deliver, and Long Island hospital officials stressed that there were many other ways to judge hospital quality. "I think the quality of the care in Long Island hospitals is excellent," said Paul Rowland, the chief operating officer for the Nassau-Suffolk Hospital Council. "To say it's perfect wouldn't be accurate. To say that hospitals are working to improve it, definitely." Dr. Jha's study showed that a hospital that did well treating one of the conditions did not necessarily do well treating another, so a hospital's overall quality would be better judged by a wider range of measures. But, he said, these are common ailments, and the treatments are widely acknowledged to be necessary and crucial. "These are the bread and butter of medicine," Dr. Jha said. "We know a tremendous amount about how to take care of these people. We know that if you walk in with a heart attack and I give you an aspirin, your chances of surviving have improved dramatically." And he urged patients to use the ratings to make health care decisions. "They can say, I am not going to hospital X and instead go to hospital Y," he said. If circumstances make it hard to go to another hospital, he said, "they can ask their doctors and nurses and administrators, 'Why are we not doing better?' " Copyright 2005 The New York Times Company Home Privacy Policy Search Corrections XML Help Contact Us Work for Us Back to Top --- URG-L Pour quitter URG-L, envoyez un message a la liste ([email protected]) avec, COMME SUJET, le mot REMOVE (rien d'autre).
