Quality improvement

Our length of stay is too long. That means on average, we are keeping people in the hospital longer than we should, given their diagnosis. But we will be penalized for bounce backs, which is where a patient is readmitted within a month. So, we need to get people out earlier and ensure they don't come back. Our A1c's are too high. We are not keeping diabetes well enough in check. Our blood pressures are not well enough controlled. We are not getting enough yearly mammograms.

Quality improvement can be frustrating at times, because there are so many places where a quality standard is being imposed, either now or in the future, and many of these standards have no evidence whatsoever that they actually improve patient outcomes.

So let's be honest here. These goals are not to improve quality. They are to save cost. There's nothing wrong with that. We waste a lot of money in health care and trimming our expenditures is reasonable for any business. But I resent the idea that I am not delivering quality care because I don't hit some arbitrary target, or document something so some quality maven can review it.

A few years ago, I had a patient with HTN and diabetes who was passing out frequently. So I changed his meds so SBP was >140 and A1c was >8.0, and he hasn't passed out since. I think he would say that he's getting quality care.


Anonymous said...


Don't really know any way else to reach you.

Great blog. I was wondering if you could write a post about how you were able to cope with any arrogance or elitism with students (if you found such a thing) or instructors during your medical school years? After thoroughly reading through many of your posts, I still maintain that medicine is something I would still love to do.

I've been told that I'm very bright, kind, caring and very calm/collected. I've tried always remembering not what I've done and the what I've been awarded, but how I make others feel. Having meaningful conversations and being involved in someone's (anyone's) health in the way that you are really fills my bucket.

I'm sitting on the fence right now. I received some medical school acceptances worried about some of the things I'd have to sacrifice. Namely, relationships and my youth! I've never been in a serious relationship before. I've never traveled or been on an epic road trip. How can I tell if these are things I'm willing to sacrifice if I've never experienced them before? Are these sacrifices petty, insignificant? Does this type of thinking make me soft, emotionally mature, pathetic, weak?

Sorry for posting in the wrong place. Just felt like ranting on a blog which has more depth then most of the interviewees I've met before.

PBJ_Time said...

Hi again,

I'll go by "PBJ_Time" for an alias on my lengthy rant I just sent you.


Anonymous said...

Can I ask you something? What did you major in in college? Do you have any advice for succeeding in these premed courses and college in general? How good did you do in premed classes? Did you ever get a "B" in any premed classes? I just got my first premed B :(

I've finally gotten to your "R-E-S-P-E-C-T" post and I'm working my way from the bottom up in your blog slowly. It's awesome. Seeing who are is really inspirational but I'm a college student in my second year and I want to see how your experience went so that I have some direction. Thanks! :)

Anonymous said...

Worse is when it's because it's just to make the politicians look better - such as imposing a 4 hour time limit from triage for patients to be admitted to the wards from emergency.