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Saturday, September 22, 2018

Mass. ICU Nurse Staffing Regulations Did Not Improve Patient Mortality and Complications | BIDMC

Similarly, lack of better clinical outcomes were found when increasing critical care physician staffing in ICUs. Having doctors (intensivists) around the clock in the ICU did not confer better outcomes but did increase the number of things done (lab orders, studies, procedures, etc) and did increase the patients' bill. Doing more did not mean saving more [lives, complications, cost, or days in the hospital]. A paradox in healthcare policy making is that we seem to make regulations and laws before we have determined benefit (or lack thereof). Medicine is meant to be evidence-based meaning we test a hypothesis for benefit, harm or no effect before ever applying a practice to patients. This is how medical science is done. Yet, in the realm of healthcare policy making this is not so. We make policy without testing whether the assumption is true or false. In this case, the hypothesis may be that, "Decreasing ICU patient-to-nurse staffing ratios affects mortality rates, medical complications and length of stay." Legislators could then request such a study, collect and analyze the data then make or not make legislation based on the evidence. In this case, the premature making of a law by Massachusetts lawmakers is not supported by post hoc evidence--putting the cart before the horse as the saying goes. And we all know, once on the books, how difficult it is to recall a law, regulation, policy, or rule. This type of premature legislating without evidence basis is the norm in healthcare policy making (ACA, HITECH Act, Meaningful use, and many, many others from federal level to state to the local policies of hospitals in your town). Healthcare policy makers should be required to take a course in the scientific method: 1) Step 1: Ask a question. 2) Step 2: Form a hypothesis. 3) Step 3: Test the hypothesis. 4) Step 4: Observe and Record. 5) Step 5: Draw conclusions. 6) Step 6: Share findings with stakeholders. 7) Step 7: Formulate policy. Let's make health care policy with the same rigor with which we practice health care.
from Rajesh Harrykissoon, MD