It seems there is a "crisis" afoot in America's hospitals: in-hospital cardiac arrests. According to the American Heart Association (AHA)'s National Registry of Cardiopulmonary Resuscitation (NRCPR) investigators and now rocketed to the media to increase the fear factor:
In-hospital cardiac arrest is a major public health problem. During 2005 and 2006, more than 21 000 in-hospital cardiac arrests were reported to the AHA NRCPR from approximately 10% of the hospitals in the United States. The principal finding of this study was that survival to discharge following in-hospital cardiac arrest was lower during nights and weekends compared with day/evening times on weekdays, even after accounting for many potentially confounding patient, arrest event, and hospital factors.In an amazing move to justify their existence, the investigators' cardiac arrest database has identified the obvious: hospital wards staffed by the lowest numbers of individuals who have received the short-straw of night and weekend duty because of their junior status have poorer outcomes during cardiac arrests.
Well no kidding, ace. We needed a study to show this?
It seems so. Bureaucrats need to find things to "improve" in their ever-expanding quest to raise the cost of providing healthcare to our sick and injured while securing their fitful place in the Quality Assurance Hall of Fame.
But what was truly scary is not the problem; it was their solution proposed to fix this "major public health problem:"
Night staff proficiency in cardiac resuscitation could be enhanced by additional training, such as "mock codes" and cardiac resuscitation simulation training. Chronobiologic scheduling, naps, or use of medications such as modafinil may also improve nighttime staff performance.That's right. Dope the doctors and the nurses.
These investigators, at a loss to offer concrete staffing solutions, feel the use of drugs is the way to go. They reference two other studies: one in ER doctors and the other from sleep researchers touting the benefits of modafinil. Never mind that this drug prevents fitful sleep. It seems there is a move afoot amongst our clipboard-carrying colleagues to promote performance-enhancing drugs as a means to improve physician and nursing performance in all sorts of arenas.
I can see it now: George Mitchell will soon be hired by the hospitals' Bud Selig look-alike, Richard Umbdenstock, president and CEO of the American Hospital Association. Patients will be aghast at the findings. News media lights will shine. The scandal will be exposed. Performance enhancing drugs will "sully" the very game that is healthcare today. Doctors will be called before Congress, or worse: called to the witness stand to explain their drug-seeking behaviour to a jury of their peers.
Ridiculous, you say?
Not really. It is a sad commentary that there are really bozo's who think that the use of drugs should be condoned to improve outcomes in cardiac arrest.
That, my friends, makes my heart stop.