Miami Hospital Targets Waste in Use of Antibiotics

A recent article in the Miami Herald describes efforts by a team at the University of Miami-Jackson Memorial Hospital to eliminate waste, but in an area I hadn’t seen discussed before – overuse of antibiotics.

Such drugs often are overused, and as the article (by John Dorschner) points out, too much medicine can be a bad thing.

Though proper use can mean cost savings, ``the key factor for this program is patient safety,'' said Thomas Hooton, a University of Miami professor who was once head of the antimicrobial program for the Infectious Diseases Society of America. ``And there is a cost to society.''

Microorganisms are constantly becoming resistant to antibiotics, which are everywhere these days. A patient flushes them out of their body and into the sewer system. Livestock get fed them by the ton.

As bugs become resistant to the older drugs, doctors have to use newer, often more expensive alternatives. That's why institutions around the world have developed antimicrobial programs.

The article notes that antibiotics should be given to certain surgical patients, but the patients should stop receiving the drugs within 24 hours of surgery. To make sure this is done, the hospital has made the anesthesiologist responsible for administering the antibiotics.

That is a process improvement, in keeping with lean principles (though lean is not mentioned in the article).

A more challenging problem is doctors in private practice who prescribe unnecessary antibiotics because patients insist that they do something, and don’t want to hear that the drugs won’t do anything for their particular illness.

Goldschmidt, the UM dean, said the University of Miami and Jackson are working together to establish an evidence-based system that can serve as a blueprint for efficient, effective care by using computerized physician order entry, in which doctors work from a template for specific conditions, in ordering tests, prescribing drugs and such.

I’m not sure that is a lean solution, though it might be considered standard work. I’d like to hear other approaches, if any of you know of some.

But certainly any effort to eliminate waste is positive, if done properly. And that’s the kind of lean thinking I like to see.

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