RSNA: Healthcare is disjointed; better care is on HORIZON, Gawande says

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CHICAGO--Integrating a simple checklist before surgery and using a team-based approach to patient care can improve outcomes, but something must be done to slash the increasing healthcare costs, Atul Gawande, MD, a general and endocrine surgeon at the Brigham and Women’s Hospital in Boston, a writer for the New Yorker, and a professor at Harvard Medical School in Boston, said during the Eugene P. Pendergrass New HORIZONs lecture Nov. 29 at the 96th annual scientific meeting of the Radiological Society of North America (RSNA).

“Every country is now struggling with healthcare and how to afford it,” offered Gawande. “We want to say that the problem is the government, we want to say in other parts of our series of global argument that the problem is the market and money, but the truth is that it goes deeper than those problems and questions.”

Despite having the resources (almost 6,000 drugs and 4,000 different medical and surgical procedures) to treat patients, Gawande said that still 40 percent of the patients in our communities do not receive appropriate or complete care. For mental illness, these numbers approach 80 to 90 percent of patients who are not receiving the care they need.

Healthcare costs are continuously climbing and are growing two to three times faster than the economy, healthcare costs soak up 20 percent alone. "Twenty percent of all the dollars Americans earn go towards paying for healthcare,” he said.

“If we are unable to stem that growth … just to maintain the amount of coverage we have [currently] will mean that state budgets will have to double at a time where people believe that state budgets should fall.”

However, why we have identified 13,600 different diagnoses and categories of disease, the goal now is to impart thesee resources to all people in every community, which Gawande called “the greatest human endeavor that has ever been attempted.”

He said that there are multiple bell curves within the healthcare system and the outcomes, care and healthcare costs vary and depend on geographic location.

“The places that are getting the best results in the world are turning out not to be the most expensive … they are often among the least expensive, that are the most effective in being order to perform care for people without waste,” he said.

To help curb this problem, Gawande said that the best method is integrating coordinated and meshed approach to care. “Can we treat people in a more systematic way?” he asked.

Currently, imaging exams are being performed excessively and there are a total of over 230 million major surgeries performed each year. The death rate for these major surgeries is 10 to 100 times higher than child birth and leaves almost seven million people dead or disabled by avoidable surgical complications.

Gawande said that these system failures are due to the fact that hospital teams are failing to work together and look at how to prevent infections and bleeding events.

Using devised checklists—before an incision, before anesthesia is administered and before a patient presents for surgery—can ensure that antibiotics are being administered on time and the operation and condition is understood. Studies have shown that use of these checklists can cut rates of death by 45 percent.

“If this [checklist] were a drug, I’d be a multi-billionaire,” said Gawande. “But it’s just a piece of paper and a different culture and a way of thinking about what we do, a way of thinking about failure and understanding the ineptitude is just as important as ignorance.”

He said that less than 20 percent of hospitals have implemented the checklist system, but “system innovations will save more lives in the next decade than all of our efforts and bench signs discovery will—more than cancer vaccines and stem cell research. “The effort to provide for a basic human need is beginning to zap the energy and success and prosperity," he said.

All we need now, concluded Gawande, is the first town to to step up to the plate and slash healthcare costs, while at the same time improving care.