Health Ministry recommends surgery dept. changes
Report calls for improvements in documentation, preventing infections, and better explaining procedures.
Doctors (illustrative) Photo: REUTERS/Swoan Parker
Public and private hospitals’ surgical departments should improve their
documentation of operations; do more to prevent in-hospital infections,
especially by giving prophylactic antibiotics and using better disinfection
techniques; closely watch all patients in serious conditions; and give them
better explanations before patients sign consent forms.
These were among
the recommendations of a report by the Health Ministry’s quality survey
department on 31 surgical departments (among 40) of various sizes in public and
private hospitals around the country, except for Jerusalem, at the end of
The report was originally released for publication on February 26,
but the ministry extended the embargo to Sunday, March 3, and then again to
Monday, March 4.
The ministry’s spokeswoman’s office released a new
version of the 60-page, Hebrew-language report on Friday, without stating what
corrections were made. Her office said the differences were minor and resulted
from the hospitals covered in the report – but not mentioned by name – taking
their time to read it and give feedback, resulting in the ministry making
insignificant changes on how many hospitals were large, medium and small. The
corrected report will be placed on the ministry’s website on Monday.
ministry report did not give any names of hospitals with high or low marks; thus
surgical patients cannot assess where they can receive better care.
to heads of the ministry and the four health funds, the document also said that
private hospitals should be required to write down the official codes of
diagnoses, use alcohol gel instead of the less effective Polydine solution for
disinfecting the skin before surgery and ensure that a senior physician is
always accessible for serious cases after surgery.
departments in smaller hospitals with up to 300 beds; 14 departments in
hospitals with between 301 and 800 beds; and six departments in larger hospitals
with more than 800 surgical beds were examined.
One department was
studied without informing management in advance in each hospital. The
departments were checked for receiving patients, preparing them for surgery, the
operations themselves, post-operative care, medical documentation, giving blood,
safety and rights of the patients, contact with the family, prevention of
infection, and medical staffers on late and weekend duty.
score was 90 percent, with the largest hospitals ranking 94.5%, followed by the
medium-sized hospitals at 90.3% and the smaller ones at 82.7%. The privately
owned hospitals had the lowest scores, averaging 82.7%; these for-profit
hospitals constitute over half of the the smaller hospitals, and the variation
among them was the largest. Hospitals owned by the largest health fund, Clalit
Health Services, had the best achievements, compared to the government-owned and
The factors for which hospitals received the lowest
grades were preparation for surgery, explanations given to the patients before
signing consent forms and their documentation. One hospital didn’t document the
staffers’ going over the type of operation before it was to be performed, and at
seven medical centers, the documentation was only partial. Private hospitals
performed better on documentation before the operation than public ones. In
addition, it was found that a fifth of reports on operations were unreadable and
not computerized, and in private hospitals, documentation on surgical followup
and treating pain was less satisfactory than in public ones.
Donchin, director of the Patient Safety Unit at Hadassah-Hebrew University
Medical School in Jerusalem and a long-time anesthesiologist at Hadassah
University Medical Center in Jerusalem’s Ein Kerem, commented that “transparency
is not desired by hospitals. The fact that the Health Ministry cooperates with
these assessment is due only to the fact that the names of the hospitals are
But, Donchin continued, “if the ministry itself takes the
data and reaches conclusions on what should have been done by the hospitals
according to ministry instructions in any case – if it doesn’t realize that it
is in charge of most of the hospitals and supervise what is going on there, the
time has come to increase supervision of the weaker hospitals. The ministry,” he
said, “must form teams to study the nurses and manpower in general, as well as
budgets and crowding and improve results as well as giving the hospitals the
means to do so.”
Instead, said the senior Hadassah anesthesiologist and
quality-control expert, “as I constantly point out, following the ministry’s
directives does not cost money but ensure that instructions are
Without giving names and ratings of hospitals, or practical
conclusions on how to improve,” the ministry report “is laughable, and not even
a fig leaf.
“Perhaps,” Donchin concluded, “the hospitals are wearing an
eye patch so as not to see what is really going on, why and especially how to