MASSDEVICE ON CALL — Doctors at publicly reported hospitals may be negatively influenced by public reporting protocols, according to a presentation at last week’s Society for Cardiovascular Angiography & Intervention 2014 Scientific Sessions.
When doctors know that rates of admissions and deaths are reporting publicly, they may be less willing to take dramatic steps with emergency patients in order to avoid tying a death to an intervention.
Medscape reported that Massachusetts General Hospital’s Dr. Kenneth Rosenfield presented the audience with the case of a patient brought in for cardiac arrest, for whom efforts at resuscitation and shocks had restored heart rhythm. Physicians had then to determine whether to provide the patient with conservative care, take her to surgery to look for a blocked blood vessel, offer brain scans, or a number of other options.
Most doctors in the audience voted for percutaneous coronary intervention to look for a "culprit vessel" responsible for the cardiac arrest. Those doctors may choose differently if they were in reporting hospitals, Dr. Rosenfield maintained.
"What if your mortality this year is already high, compared with your peers?" Rosenfield said. "What if your hospital has already been identified as an outlier, with more PCI deaths than other hospitals? What if it had already undergone an external review."
Doctors at those types of institutions may begin to balance proactive care with maintaining the reputation of the hospital.
Certain elements of public reporting are valuable, Rosenfield said, but the system as it is now also discourages doctors from high-risk patients. Other doctors may choose to offer more interventions to patients that are highly likely to have good outcomes, in order to boost the hospital’s numbers, according to Medscape.
"Public reporting leads physicians to consider factors beyond the individual patient when making decisions regarding high-risk emergent procedures," Brigham and Women’s Hospital’s Dr. Frederic Resnic said.
Is medtech a whistleblower minefield?
Attorneys at Hodgson Russ LLP warn that the medical device industry is “fertile ground for future whistleblower activity."
Read more
Catheter-maker VistaMed looks to hire 125 more
Ireland-based catheter-maker VistaMed will hire an additional 125 workers to run an expansion to its manufacturing facility, hoping to fill the roles by the end of the year.
Read more
New efforts at 3D-printed blood vessels
A team of researchers from Brigham and Women’s Hospital is developing technologies to 3D-print blood vessels, meeting with early success in fabricating micro-channel networks for embedding into hydrogels.
Read more
Transplant beats dialysis for kidney failure patients
Patients who received kidney transplants were more likely to be hospitalized in the first year after surgery, but they also had better outcomes and lived longer than patients undergoing home hemodialysis, according to new study results.
Read more