Neil H. Baum, MD, is a urologist in private practice in New Orleans. He is the author of "Marketing Your Clinical Practice-Ethically, Effectively, and Economically."
Dr. Dowling is president of Dowling Medical Director Services, a private health care consulting firm specializing in quality improvement, clinical informatics, and health care policy affecting specialty care. He is the former medical director of a large,
These 30 best practices incorporate compelling evidence that, if implemented, effectively reduce the risk of harming a patient.
Positively identify patients. Has your nurse ever put the wrong chart on an exam room door? Put the wrong patient's name on a biopsy jar, PSA, or urine cytology? If you have never had this experience, give your staff a pat on the back, and just imagine the consequences of such an error if it went unrecognized.
Prevent surgical infections. Review the AUA guidelines for antibiotic prophylaxis in patients with total joint replacements, and anticipate the soon-to-be-released guidelines for other urologic procedures. When the antibiotic sensitivity panel comes from your local hospital this year, read it before you throw it away. What percent of Escherichia coli isolates in your community are resistant to quinolones? Review the American Heart Association guidelines and indications for antibiotic prophylaxis in patients with valvular heart disease ( http://www.americanheart.org/presenter.jhtml?identifier=3004539).
Evaluate renal function before contrast studies. Patients over age 65, those with diabetes, and those with a history of renal insufficiency or previous renal surgery are at increased risk for preventable contrast-induced nephropathy and should be evaluated (glomerular filtration rate calculated) before administration of intravenous contrast. The point-of-care blood analyzer (i-STAT, Abbott Labs, East Windsor, NJ) has allowed physicians who perform these imaging studies in their offices to rapidly screen patients for diminished renal function before administering contrast.
Practice good hand hygiene. The installation of alcohol gel dispensers just outside or inside your exam rooms serves several purposes. It reminds you to wash your hands between patients, prompts your staff to wash their hands frequently, shows your patients that your office is committed to patient safety and proper hygiene, and reduces the risk of disease transmission in your office. Encourage your staff to remind you to wash your hands, and then lead by example.