I just found out about an article that appeared in Forbes online 7 months ago. It said that a certain hospital system’s postoperative infection rate was 5% and then said, “For US hospitals, this is not an unusual rate of error—even though it is about 100 times higher than most manufacturing plants would tolerate. No automaker would stay in business if 5% of their cars had a potentially fatal mechanical flaw.”
The piece was written by Leah Binder, who is president of The Leapfrog Group, a well-known patient safety advocacy organization. I’m sure Ms. Binder is a smart woman. After all, she follows me on Twitter. And advocating for patient safety is a good thing.
But the two sentences I quoted are so misguided that it is hard to know where to start. Comparing infections to a manufacturing plant’s error rate is not appropriate, nor is the automaker analogy.
Of all the possible industrial references, the use of automobile manufacturers as a comparator is almost laughable. For example in the year 2012, Toyota, the paragon of Lean methods, sold 9.75 million vehicles worldwide and recalled 10.1 million in the months of October and November of that year alone. That’s a little more than 5%. By the way, this has been going on for years, as I noted back in 2010.
Infections, which are not always preventable, are not all the result of errors. Yes, the incidence of infection can be decreased by good practices, but it is not possible to completely eliminate them. Several recent research papers have shown that even near perfect adherence to the Surgical Care Improvement Project’s standards has not resulted in a significant decrease in the rate of wound infections after surgery.
Now it gets even more interesting. As her source, Ms. Binder cited a paper from JAMA. After reading the paper, it turns out that the figure of 5%, which according to Ms. Binder represented the infection rate, was actually the rate of all surgical complications and not just infections. The real surgical site infection rate was only 0.7% with another 1.1% of patients suffering from sepsis. The remainder were complications such as venous thromboembolism, stroke, pneumonia, and myocardial infarction, which are not necessarily due to errors.
Some surgical complications are preventable, and we should try to prevent them. I have no doubt we can do better.
Reasoned and constructive criticism of the medical profession would be more helpful than taking pot shots.
Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last three years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 1200 page views per day, and he has over 7600 followers on Twitter.