How To Stop One “Never Event”
Posted by WhiteCoat on August 17, 2008
I’ve just about gotten the “never event” bug out of my system for the time being, but there has been an interesting thread going on over at Buckeye Surgeon’s blog about “never events” that has kept my interest.
One of the anonymous commenters made a great suggestion about how to prevent surgical site infections for “elective procedures” which is yet another “never event.”
Don’t close the wounds.
Leave all wounds for elective procedures open after surgery. Let them heal by secondary intention. Everyone will have a larger scar, but no one (OK, well almost no one) will get a wound infection.
Of course, the hospital stays will be significantly longer and the wound care will cost thousands of dollars more, but then there won’t be an issue over whether Medicare and the insurers will pay for it.
Clipboard clinicians and the bureaucratic bullhokey they come up with are going to destroy the practice medicine – and they’ll make everyone pay more for medical care in the process.
Be careful what you ask for.
You just may get it.
ERP said
How in God’s name did someone come up the term “never event”. There are NO nevers in medicine! Never, ever! WTF were they thinking? They must have completely lost touch with the practise of medicine.
crankylitprof said
Dear GOD. Is that a pilonidal cyst gone terribly wrong? I’ve heard of ripping someone a new asshole, but…
medrecgal said
OMG…that’s utterly nasty! And I’ve seen nasty up close and personal, too, left to heal by secondary intention, but that pic is just horrific! Is that what you get from neglect of decubitus ulcers? (I’ve seen that those are to be classified as a never event.) Yikes!!
Nurse K said
This topic is related to your other soap box, antibiotic resistance—prevention of “never events” will cause more abx to be prescribed (why not prescribe everyone abx when they’re admitted to prevent hospital-acquired whatever) than is necessary, causing more drug resistant infections, causing more superbugs which cause more never events.
mottsapplesauce said
This whole ‘never event’ horsepuckey gives new meaning to the phrase “slippery slope”.
Don Salva said
Oh jesus, I was eating….sheeeet!
Christian Sinclair said
“Possibly related posts: (automatically generated)
* See BetterECM at the Office 2007 Launch Tomorrow – 1/30/07
* Men and Prostitutes
* Stop By RCB, Girls (Boys Can, Too)”
Interesting ‘automatically generated (possibly) related posts.’ Men and prostitutes? What does that have to do with elective surgery and Medicare never events?
WordPress may need to recheck the algorithm on that widget.
Dr. Dredd said
Is that a breast tumor that’s eaten its way through the skin? YECCHH!!! I think I’d rather deal with the men and prostitutes…
That is a sacral decubitus ulcer – an advanced bedsore on the buttocks.
Don Salva said
Ok, I’m no doctor nor even remotely related to the health departemend. Just somebody who happens to be interessted in a wide variety of topics. But what the hell is that? Somebody wanna elaborate?
I can make out an anus, or I think it is, and a huge hole between the buttocks if those are buttocks. What’s this green stuff?
ernurse said
Looks like a decubitus ulcer on the sacrum that’s been debrided.
Ron Miller said
Are you practicing defensive medicine? Are you putting your malpractice concerns ahead of your patients? Let me guess… no. You have malpractice insurance and you care too much about your patients even if you did not. You are in the vast majority of doctors. Ironically, as I’ve said many, many times on the Maryland Injury Lawyer Blog that discusses medical malpractice claims from the plaintiff’s perspective, I believe most doctors are ethically doing a great job. I would think you would agree which is why I’m surprised you are so outraged by this unwanted byproduct of malpractice claims. No doctor – virtually no doctor – is not going to close a wound that should be closed because it might help them avoid a malpractice claim.
I agree it exists, of course, the question is the frequency of how much is done to avoid claims. My guess is very little.
WhiteCoat said
Ron,
There isn’t a simple answer to your question. “Defensive medicine” is itself a continuum. I like to think I practice medicine according to clinical findings and outcome-based studies, but I also admit that there are times where I will sometimes do a test with little clinical value solely to avoid the possibility of liability. Maybe it’s the seventeenth CT scan of the head in the perpetually intoxicated patient who whacks his head on the sidewalk outside the bar. I’m not going to risk my life savings or family’s income at even the remote chance of missing the patient’s injury. You know as well as I do that fewer and fewer plaintiff lawyers are settling for policy limits when they win med-mal cases.
Maybe it’s the upset parent wants an x-ray on their child’s obviously unbroken arm. I’d rather do the test than worry about all the administrative hassles of a patient complaint because I was “rude” when I tried to explain to the parent why the exam wasn’t needed.
“Never events” are foremost an issue with payment. Medicare won’t pay for care when these events occur. Of course, not every medical provider is going to make drastic changes to avoid patients who develop these conditions, but there will be a change in inertia toward doing things that are necessary to receive payment. That change won’t happen overnight – there will be early adopters of avoidance behaviors and then when other physicians are hit with increasing numbers of such patients, the Bell curve will pick up and avoidance behaviors by healthcare providers will become commonplace.
For example, imagine the effect upon the practice of law if malpractice insurers suddenly stated that they would no longer pay for any defensive motions that were lost in court. You spend dozens of hours creating a motion and then don’t get paid a penny if you lose. Would you still file as many motions? I bet not. Over time, the standard of care for defense attorneys would probably change to the point that few, if any, pre-trial motions are ever filed.
Tangentially, never events will become a legal issue. If the government says these events should “never” happen, then creative plaintiff attorneys will use these overarching assertions as some de facto (and incorrect) standard of care.
The trick in keeping this term out of the courts is to get the government to admit that never events are common occurrences in medical care but that the events just will “never” be paid for. Such a statement still won’t have an effect on the practice patterns of medical providers, but it would head off all of these pending “class actions” cited in the WSJ article.
Kula said
OK, I will be so glad when, after a few more posts, that picture is banished to another page or at least the bottom of the page.
YUCK!
SeaSpray said
Good post! Why don’t all providers unite and fight this nonsense??
gmlevinmd123 said
This goes on and on because hospitals are gutless wonders, who suck off insurers and medicare, when they should stand up and confront insurors.. Instead they are too busy running ads, and sucking up to madison avenue and their “Institutes” and “Centers for Excellence” for ortho, heart, cancer, etc etc….
There is no such animal as a ‘never event’ This sounds like the ‘war on cancer’ and the ‘war on drugs’ Feed the masses more pulp and b.s. I can just imagine the higher math and graphs some statistician came up with to make this work.
How about no illnesses allowed in the hospital….
Ron Miller said
White Coat, thanks for taking the time to spell our your response to my comment in this blog post. I suspect we agree on more things that you think. Medicare is on the wrong side of this. They can be because they don’t really have to answer to anyone. Lawyers are not going to be able to use the “never events” designation offensively and that is only fair.