Author: Hospitals must learn from errors, prevent infections
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By Liz Szabo, USA TODAY
When 18-month-old Josie King arrived at Johns Hopkins Children's Center, she had blistering burns on 60% of her body, caused by scalding bath water produced by a broken water heater.
Josie seemed to receive the best of care and had surgery to transplant skin grafts onto her scarred body.
Yet Josie's mother, Sorrel, who slept on a cot by the girl's side for weeks, noticed the baby getting sicker just days before she was supposed to go home. Josie was so thirsty, for example, that she resorted to sucking on a wet washcloth during her bath. Although Josie's mother, nurses and a pain specialist all tried to voice their concerns, the surgeons in charge of the case didn't listen.
By the time doctors recognized that Josie's dehydration was caused by a serious infection, it was too late. Josie died after a preventable catheter infection — perhaps caused by someone who failed to take proper sanitary precautions — spread into her bloodstream.
Josie was one of the thousands of patients who suffer as a result of a "toxic" hospital culture, in which doctors feel they need to be infallible and nurses and patients are afraid to speak up, says Peter Pronovost, a Johns Hopkins professor and author of the new book Safe Patients, Smart Hospitals (Hudson Street Press, $25.95).
Hospitals can't improve if they don't acknowledge their errors and try to learn from them, he says.
http://www.usatoday.com/news/health/2010-03-01-medicalerrors01_st_N.htm