REVIEWED BY GLENN W. MITCHELL, MD, M.P.H.
SAFE PATIENTS, SMART HOSPITALS: HOW ONE DOCTOR'S CHECKLIST CAN HELP US CHANGE HEALTH CARE FROM THE INSIDE OUT
BY PETER PRONOVOST AND ERIC VOHR
Hudson Street Press, 2010
304 pages, $25.95
SUPERBUG: THE FATAL MENACE OF MRSA
BY MARYN McKENNA
Free Press, 2010
271 pages, $26
Two recent books concerning hospital-acquired infections place today's efforts to control and eliminate these infections into recent historical context — and both are cautionary tales for all readers about health care today.
In Safe Patients, Smart Hospitals, co-author Dr. Peter Pronovost is well known to most readers both as a national leader in patient safety and as the Johns Hopkins doctor most closely associated with the patient-safety response to the hospital death of toddler Josie King. Pronovost's story is that of his own journey in patient safety.
Maryn McKenna, author of Superbug, is less well known but has a solid record of success in medical and scientific journalism. Hers is the patient-centered tale of the emergence of methicillin-resistant Staphylococcus aureus (MRSA) as a universal and devastating medical threat.
The story of 18-month-old Josie King's 2001 death due to medical error at Baltimore's Johns Hopkins Hospital sets the stage for Pronovost's personal account of how patient safety has advanced over the past decade. He follows Josie's story with that of his father's death from questionably managed cancer, since these events catalyzed his decision to concentrate on the field of patient safety. In his writing, the pain inflicted by these unnecessary deaths on those around the victims is palpable.
The remainder of the book describes how Pronovost developed, tested and promulgated the checklist tools and safety techniques now familiar to health care workers nationwide. There is enough detail to help readers unfamiliar with the field to understand what was done and how significant the results were. For example, the book emphasizes and clearly discusses the significance of capturing, analyzing and publishing valid data from deployments of new tools, such as checklists for placing central intravenous lines. It also realistically and truthfully portrays the background interactions with political forces that are so necessary for facilitating the large-scale impact of new tools, and it details the processes for funding tool deployment and starting research centers. The book ends with the challenges facing us today in fully adopting the many tools we have identified as helpful in reducing medical errors.
The book's intended audience is wide. Medical professionals will relate to the challenges and may learn from Pronovost's successes. Lay readers will gain further understanding of the overall field of patient safety, the scope of its problems and emerging solutions and a picture of the difficulties with change and with ego management in medicine.
Worth the read alone are the authors' detailed description of the "Michigan experience" with reducing central-line bloodstream infections and the problems with its replication elsewhere.
The major potential downside to the book is its intensely personal focus: Pronovost's role dominates. First-person pronouns are rampant, although I can only assume that this apparent self-importance is due to his co-author's writing style, as Pronovost personally does not project this image at all. The book's focus on the singular importance of Johns Hopkins will put off some medical professionals from other institutions that are also effectively engaged in the patient safety movement. On balance, though, Safe Patients, Smart Hospitals is a must-read for those involved or even interested in the patient safety movement and the improvements being implemented in quality of care today.
In Superbug, McKenna uses riveting stories of patients and medical teams struggling with the emergence of a new and accelerating microbiological threat over the past 50 years. The result is a chronology of the effects of medical tunnel vision and hubris when confronting a new disease.
We all know these attitudes exist and interfere with rapid adoption of needed change. By weaving together the emergence and transmission of antibiotic resistance and the spread of pathogen strains between hospitals and communities, McKenna illustrates the continuing need for healthy skepticism of medical dogma.
Clearly, she has listened to criticisms aimed at her previous book, Beating Back the Devil (2008), that chided her for lack of emotion and poor editing in her tales of the Epidemic Intelligence Services, health professionals who travel around the world to investigate public health threats. The stories McKenna relates in Superbug are both clearly written and frightening!
The intended audience appears to be lay readers, but medical professionals would also benefit — they need to see themselves more clearly as the public sees them. Superbug is a fast read, but it stirs the emotions with stories of devastating outcomes. Both lay and medical professional readers will come away with a better understanding of the evolution of superbugs, the problem of change for practitioners and the high threat level of MRSA and other superbugs today. If it does no more than make readers more sensitized to the current misuse of antibiotics and its terrible secondary effects, this book rewards the reading time.
GLENN W. MITCHELL is chief medical officer, Sisters of Mercy Health System, Chesterfield, Mo.