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Saturday, July 28, 2012

Flu shots for hospital staff -- should they be mandatory?

Backed by a number of studies, healthcare policy experts at the CDC and elsewhere have advocated for some time that all healthcare workers be immunized against influenza.  There are two reasons for this.  First, during an epidemic, an infected healthcare workforce can dangerously strain our national infrastructure at a time we need it most.  Secondly - and this is the major argument - infected professionals can unknowingly transmit this virus to susceptible patients with potentially serious consequences.  This is especially true when the patient is an infant or an individual of any age who is debilitated by chronic disease or an impaired immune system.

Is there any plausible counter-argument to mandatory, universal immunization for hospital staff?  One might doubt this, when experts recommend a flu shot (with rare exceptions) for every healthy child and adult, every year, and when hospitals will immunize their staff members on site and for free.

And yet, predictably, there are naysayers.  This is not a scientific controversy, but a disagreement over the rights of nurses, respiratory therapists, and even doctors as regards a health intervention with a non-zero risk.  (The benefits of the vaccine, which in its most common form contains no infective material, are believed to far outweigh the remote possibility of severe allergic reaction or neurological side effects.)

Whose rights prevail - those of the many (the patients) or of the one (the professional)?   This is no more or less than the familiar red/blue debate of our day.  In the current instance, however, it is colored by other considerations.  How far does our professional obligation go in compelling us to sacrifice for the good of our patients?  "Professionalism" clearly mandates physicians to place the patient's interest before all others.  Does this extend to flu shots?  And does it extend to the rest of the team?  The boundaries of professional obligation (and perquisites) are determined jointly by society and the profession itself.  What do YOU think?  Write a reply and share your thoughts.  And, by the way, don't forget to get your flu shot this Fall.

Friday, July 20, 2012

And the winner is...

Earlier this week, US News and World Report published its most recent ratings of hospitals nationally.  And my hospital made the top ten list - twice!  Huntington Hospital in Huntington, NY, a member of the North Shore LIJ Health System, was ranked 9th in the metro-tristate area and an impressive 7th among all hospitals in NY State.  And as number 1 though 6 were large university medical centers, I can say accurately, and with much pride, that we were the top-ranked community hospital in the state.

Which raises the question, what does it mean to be a "better" hospital?  The answer is as hard as "what makes a better university"?  Or a better community?  US News looks at a range of data, from nursing ratios to medical equipment, complication rates to patient satisfaction, and importantly, "survival" - or what we call the "risk-adjusted mortality index."

One concept that fascinates me is standardization in healthcare.  Quality gurus from the halls of industry have migrated to healthcare to spread a religion that makes holy war on "variation."  Variation causes inefficiency and errors, and is to be suppressed.  This is not so odd as it at first seems.  If three patients in the ER are being admitted with the same kind of pneumonia, why should they receive three different drug regimens, just because their various physicians were "trained that way." Surely this drives up cost (while driving harried nurses up the wall).

And even more important, with all these differing orders to keep straight, this kind of random variation taxes our limited resources, slows down care and even increases the likelihood of an error.  So you can keep your doctors' prerogative and your "autonomy."  Pass the standard order set, and if it works for my patient, I'll sign it.

But can we embrace standard protocols while also paying close attention to each patient as a unique individual?  Whose illness experience is her own?  Can we adopt an industrial model of patient "throughput" while also making certain that NO one refers to the kidney infection in Bay 6? This is Medicine's other great challenge.  And if it's me in the hospital bed, I hope my team can be scientific, a little OCD, and possessed of hold-my-hand warmth and connection, all at the same time.  That's a great hospital.