The best way to spend September 11: Rapid response teams

Eight years later, today on Sept. 11, I still feel the impact of the terrorist attacks.

I had the pleasure of spending much of the day in planning how to greatly improve the health of people in Eastern Massachusetts. Babra Rabson of Massachusetts Health Quality Partners and Prof. Stuart Altman are leading a large-scale collaborative called Aligning Forces for Quality (AF4Q), and I'm participating on its Leadership Team.

In today's meeting we discussed broad goals we might pursue. My own vote was to encourage the use of rapid response teams in hospitals to prevent cardiac arrests in the hospital. Cardiac arrests in the hospital are very common; there are hundreds of thousands of them in the US each year, according to an article by Dr. Kerry Voorhis and Dr. Tina Willis in Pediatric Clinics of North America in 2009. Resuscitation attempts are made on roughly 30 hospital inpatients a day in Massachusetts, but they usually fail to save the patient's life. Warning signs like a change in the breathing rate, blood pressure, or confusion usually appear several hours before the cardiac arrest. Doctors and nurses can be trained on the hospital's process for intervening before a resuscitation (a code team) is needed. Family members can be informed that they can urge a rapid response team if they notice their family member's condition has deteriorated suddenly. This is a new law in Massachusetts; it's a requirement by the Joint Commission on Accreditation of Healthcare Organizations, and is a recommendation of the Institute for Healthcare Improvement.

The wide use of these rapid response teams should save many people's lives. The cost of doing so is slight. There may even be a financial reason to do this, as surviving inpatients will live on to keep paying insurance premiums.

The leaders of the AF4Q collaborative will choose an ambitious goal that will save lives of Massachusetts residents. They may well choose a different focus. In any event, I feel grateful to contribute to the discussion, and I feel this was the best way to spend September 11.

Advice for September 11: Spend the day in community service to make life better.

Read another story about rapid response teams.

Thanks to Helen Haskell of Mothers Against Medical Errors for emailing the source articles, and for inspiring South Carolina's Lewis Blackman Act.

Too little and too much: Inappropriate treatment

On Tuesday, I had the great pleasure of participating in the kickoff of a group of 60 health care leaders who are coming together in the Aligning Forces for Quality (AF4Q) project in Eastern Massachusetts. The group is setting a bold goal to provide healthcare more appropriately. Barbra Rabson and Prof. Stuart Altman are the primary investigators on the planning grant awarded by the Robert Wood Johnson Foundation.

There are two kinds of inappropriate care: too little, and too much. In my own family we've had both, with great harm to my aunt and uncle. My Aunt Anne lived for many years in Denver, by herself, and enjoyed traveling widely and taking part actively in the city's cultural events. I never heard her complain about poor health, and we assumed she was fine. I only learned, after her death, that she had had adult onset diabetes. She herself had learned that only late in life, when she had a blood test before having cataract surgery. She hadn't trusted doctors, and had seen them too rarely. One day she complained to a close nurse friend of pain in her foot, and showed her the foot. Already black and gangrenous from the poor circulation caused by diabetes, much of it had to be amputated – which greatly reduced her mobility and crushed her spirit. Within a year or so, she had a fatal heart attack. When we cleaned out her possessions in her apartment, we found many pill bottles, each almost full. She would comply with a new prescription only for a couple of days, and if the medicine didn't work immediately, she apparently would stop taking it.

She got too little treatment, and too little education, for her diabetes. She didn't partner with her doctors, or any other health professionals, costing this vibrant woman years of life.

My Uncle Leon lived in the Washington DC area for most of his adult life. He trusted his doctor fully – to the extent of having him perform multiple angioplasties. Even so, he had several heart attacks. It's hard to believe that all of the angioplasties were appropriate. It seems he had too much inappropriate surgery, and too little effective education about self-care and prevention.

Neither Anne nor Leon received appropriate care. The partnerships they had with their medical teams were ineffective at keeping them healthy. The AF4Q brings together clinicians in hospitals with insurers, government agencies, and consumers. Hopefully this collaboration will strengthen the partnerships between doctors and patients, to make treatment more appropriate.

Read a story on unnecessary surgery.