Sunday, August 24, 2008

Heart surgery gymnastics

Thinking about this next Surgery, I have been frustrated by how difficult it is to choose a surgeon. Even when institutions are given ratings based on reputation and outcomes, they are controversial. Smaller institutions say that they are unfairly penalised by not being as widely known and larger institutions claim that they attract a higher number of complicated and referred cases. Others claim that, because a positive outcome is basically "being alive 30 days post surgery, outcome measures are poor indicators because institutions may have very sick children post-op which are not really successful cases.

While watching the Olympic Gymnastics, I had an idea. Why not give each case a "start value" which could provide a measure of difficulty and something by which to compare institutions. It need not be every case - a sample of a hundred cases would do. Start value would be assigned based on a coded table: coarctation = +2pts, prematurity = +2pts, respiratory distress = +2. The final outcome at 30 days would be subject to various outcome counts.

OK, this is totally unfeasible but that's what I want now. I want a table that says the mean score of case difficulty at Stanford is 55.6 and at Seattle Children's its 45.4. The outcome comparison would be interesting in light of those numbers. I am sure there is some arcane and unpopular discipline which tries to create these outcome-measures for medicine and generally I am not a fan BUT in this context, I am.

While we are on my wish list for dealing with hospitalizations. Other than the best surgeon, here it is:

1) A single "point of care" during a hospital visit. This is a doctor who takes primary responsibility for our whole stay and is available to consult daily. This is not a team effort. They should be briefed by the other doctor if they were not on shift but still 'our doctor'. They are not as elusive as an endangered species. They listen.

2) A private room.

3) Email access for routine matters of scheduling, prescription refills and non-urgen t inquiries. Never having to wait 5 minutes and leave a message on a nurses' line again.

3) Phone appointments for significant results and reports. Eg. Instead of "I will call next Tuesday or Wednesday", "I will call on Tuesday at 3.15pm." This would save me from waiting for hours in hope of a call and then receiving it by cell in the shopping center without a pen and unable to hear properly. If the call is just to say "the results aren't in yet, I am following up with the lab" that still makes me happy.

4) A better transition from ICU to floor. ICU is the 5 star hotel you never want to stay at but then its like being dumped from your dubious celebrity into a motel without a turn-down service. I would love more transitional support - partly to help to parents adjust from their state of post-traumatic stress to a feeling of competence again.

Frost needs bedtime. I shall stop my rant.


Our Family said...

Oh my gosh, I think your "requirements" are perfect! Let's add, "If in a teaching hospital, no dingles that don't know anything about cardiac cases are allowed to talk to you unless they have been given clearance by the primary doctor" Man, if insurance companies spent the time ranking hospitals based on all your statistics, it might make things easier on both ends!

Izabell said...

i like your scoering system really would like a easier way to make hard choices. not that anyway would be easier but knowing that the information your getting is clear and 100%honest would help! I am sorry that you have to wait so long for the information from Stanford and that you have to make a choice regardless. I am always amazed by your boys! they are so smart and clever! I loved seeing wren and frost today! they are both getting so big!

Shannon said...

Thank you for not writing me off as a loony. I know we all have our coping mechanisms and mine is rationality. I think this makes sense because the current measures are so subject to interpretation.

Shannon said...

About the Teaching Hospital thing. I suspect this is going to be more of an issue this time. Last time when Wren was newborn having surgery I was completely confused. Doctors came and went in a sea of faces and names of relative youth and age.

I trusted everyone.

Now I know so much more I am much more suspicious of interns and others in different specialties. So, we shall see how it goes.