Safety=Cost control?

In Patient Safety on October 3, 2010 at 8:46 am

Obviously gaps in patient safety behaviors would lead to greater expenditures in a healthcare system but can highlighting safety concerns actually save money?

A blog post by David Williams uses a new radiation law in California as an example. The law requires healthcare providers to disclose excess radiation exposure from CT (computerized tomography) scans. This includes a patient needing a rescan because a machine malfunctioned, a wrong body part was scanned or when the dose exceeds the normal protocol by 50% (Bisnar, 2010). Mr. Williams surmises that patients will …begin to self-limit the use of CT scans as they see the actual data on the radiation exposure, thereby reducing costs. While he is probably correct in his thinking, this would imply that many people do not need to have the CT in the first place. If these are not needed, who is ordering them and where in the system has the incentive been created to order them? Some suspect that the value of the physical exam has been replaced by the value placed in technology. Dr. Verghese of Stanford Medical School shed some light on the topic in an NPR interview: “I sometimes joke that if you come to our hospital missing a finger, no one will believe you until we get a CAT scan, an MRI and an orthopedic consult,” Verghese says. “We just don’t trust our senses.”
This is an example of an over-reliance on mitigating human limitations.

Would costs truly be reduced if patients who really needed the CT for a diagnosis refused them and experienced less timely diagnosis and treatment?
What has happened in healthcare if CTs are routinely being ordered without weighing the risk of radiation versus the risk of a mis-diagnosis? Mr. Williams’ view of exposing safety risk to reduce cost is a bit too simplistic. Transparency in radiation exposure is a good thing but how do we as an industry find the right balance between health promotion and disease treatment? And between promoting safety and worrying patients to the point that they may decline evidence-supported effective treatments?

Some statistics figure the rate of medical error applied to the airline industry would produce one plane crash a week. Would a shut down of the airline industry produce more deaths than the crashes from lack of transport of medicines, sick patients, food etc?

Any safety changes must always be examined in a larger context.

Read Mr Williams’ full comments here


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