The VA became the largest U.S. hospital system to switch completely to electronic record keeping, reducing errors caused by handwritten charts and prescriptions. Other changes included putting disinfectant dispensers on the walls of patients' rooms and creating computerized "tool kits" that include things like printable checklists and signs to help reduce patient falls. One problematic drug, the topical anesthetic benzocaine, was removed from the entire VA system. "It wasn't like asking a physician, 'Please don't use it,'" Bagian recalls. "It's just not there!"
Judging the results of preventive measures is tricky, but Bagian points to some markers. One study found that the number of patient falls in the VA system had been reduced by 31 percent. Another showed that the incidence of hand washing in patient rooms had almost doubled. What pleases Bagian most, though, is the psychological change. For instance, VA staffers now report "close calls," making it possible to identify problems before a patient is harmed. "They're not worried about getting punished," he says. "And things actually get fixed!"
Bagian has no more respect for social pretensions than he does for academic ones. For years he drove either motorcycles or $700 junkers, believing that spending money on new cars was wasteful. Finally, on his fiftieth birthday, he guiltily bought himself a sporty Subaru WRX. Still, he insisted his four kids learn basic mechanics before he let them take their driver's tests. (His wife, Tandi, is an engineer.)
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