Spam Journalism #64

By Jim McVeagh 01/12/2009

Spam Journalism: The spurious use of sensational headlines to add spice to an otherwise pointless article.

It was inevitable that the sentinel event report , designed to help hospitals improve systems, would be seized upon by journalists to score some easy sensational headlines. The Dom Post supplies us with this fine headline:

Hospitals to blame in 92 deaths

Hospital errors have been implicated in the deaths of 92 people in the past year — including a patient who died after staff forgot to switch on a heart monitor alarm.

Another patient died of blood poisoning, after picking up an infection in a hospital unit. A review found that equipment was not always cleaned between patients.

And one patient died of a heart condition while waiting too long for assessment in an emergency department.

The headline is nonsense on many levels. Though it it true that some of these patient deaths were, regrettably, due to failures in the hospital system, the vast majority were not. Many were suicides in the community, a  number were neonatal stillbirths and many were simply very sick people who died or people who died from unexpected complications. To say that hospitals are to “blame” for these deaths is to completely (and, most likely, intentionally and willfully) misunderstand the purpose of the sentinel system.

Sentinel and serious events are recorded by hospitals so that they can be properly investigated to ensure no changes need to be made to hospital systems. They are part of a quality assurance program. Take community suicides, for instance. If these unfortunate people are registered with the mental health team, it makes sense to check whether it was possible to predict the event. Most times it is not (no matter how this is reported by the media or daft people like psychwatch, predicting suicides is very hard).

Take the three cases cited above. In the first case, staff did not forget to switch on the heart monitor alarm. Heart monitors are supposed to default to alarm mode when they are switched on. Either the electronics were faulty or someone had deliberately switched off the alarm after the monitor had been switched on. Most likely the former, as most monitors will not let you switch off the alarm permanently.

The second case declares “A review found that equipment was not always cleaned between patients”. This is not accurate. The review found that the process for cleaning the machine was not robust. Therefore they could not demonstrate that the machine had been cleaned between patients because the paperwork was faulty. It is actually highly unlikely that the machine was not cleaned between patient uses. In 28 years of medicine, I have yet to see this happen. There are many other ways this infection could have been passed on but dirty machinery is not likely to be one of them.

In the third case, It was deemed unlikely that the patient would have survived anyway. This makes perfect sense. ED monitoring is usually good and the ED physicians skilled at administering emergency treatment. Barring access to a coronary care unit or ICU, this patient would not have received better care anywhere else in the hospital.

The Herald is somewhat more sedate that the Dom Post and runs the line that “falls are a major cause of hospital injury“. This is indubitably true, but tells you nothing. The vast majority of falls are in elderly patients who insist on trying to walk without help, either due to senility or, often, sheer cussedness. No matter how well you assess their falls risk and warn them not to try to get up or walk on their own, their are always old folk who will try anyway – and end up on the floor. Again, this is not something you can blame on hospitals, any more than you would “blame” it on the old folk who refuse to take nurses’ and doctors’ advice.

All falls need to be investigated. Some of the time, more should have been done to prevent the fall. The investigation is there to assess this and make recommendations, not find someone to blame. Sensationalist journalism such as this merely makes it more likely that these events will not be reported (particularly the near-miss events – but even deaths can be dismissed as “inevitable” or “expected”). Witch hunts in the media are irresponsible and produce no useful outcomes. As the report itself says (in a portion the said journalists failed to read or simply ignored):

The international literature does not support the use of the number or rate of reported events as a way to judge a hospital’s safety. There are considerable variations in the degree of reporting, not just in the rate of events.

And just to conclusively demonstrate lack of journalistic integrity, let me finish with this from the Dom Post:

The Health Ministry’s third report of serious and sentinel events, made public yesterday, shows 308 patients suffered hospital mishaps or near-misses in the 2008—09 year — a rise of nearly 20 per cent on the previous year. [emphasis mine]

And from the same section of the report as the previously ignored portion:

  • The increase in reported events compared with last year means that the systems for capturing and reporting are improving. It does not mean the number of events is increasing.
  • The increase in the number of reported events was expected and is likely to increase further as reporting systems improve. This increase is consistent with international experience and research [emphasis mine]

Does put a somewhat different light on it, doesn’t it? Better reporting systems is much less interesting than a rise of 20%.

The sad thing is that there is no need for this sensationalism. There were plenty of events in the list that were worrying. Some are quoted in the article but there were a number wrong side surgery and nasty medication errors both of which denote faulty systems in place. A thoughtful article on these errors would have been useful and not taken a great deal longer than this piece of trash.

Frankly, I think that the publication of the actual report is a reasonable thing to do, but the detailed summary of events should probably not be printed next year. It is clear that journalists cannot be trusted with this information when it is too freely available. Next time they should be made to wait for an OIA request. Perhaps then they will actually apply some journalistic skills to the material.


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