When Less (Diagnosis) was More (Effective) - the Cook County ED Hospital Experiment.

Effective Cures Can be Cheap

Cook County (ER) Hospital Experiment

It was mentioned in Chapter 4 of the book "Blink" Malcolm Gladwell, a famous writer of  New Yorker,  wrote about the Cook County Hospital Emergency Department experiment on diagnosing emergency heart cases.   Cook County hospital, a government hospital was famous for many pioneering work like reattachment of severed fingers and work on trauma.  It was the inspiration for the TV series ER.

Dr. Brendan Reilly

The experiment started under Dr. Brendan Reilly;  he found the ER to be in a mess;  people not wanting to join the long lines (because they did not have health insurance)  preferred to be admitted via the ER. For the heart patients, the diagnosis and treatment were long and inconclusive.  MDs would differ on the their DX of the same patient with the same set of tests results.  So more or less they were guessing.  Somewhere between 2 to 8% of patients were sent home but in fact having a heart attack.

The cardiac center of ED is as anywhere in the world resource based and expensive something like $2,000 a day;  and because of lack of definitiveness in the diagnosis, some patients had to stay longer than usual.  There were three sections of the heart unit:   observation,  the intermediate staffed mostly by nurses (costs $l,000 a day) and the intensive Coronary Care unit (the $2,000.00 per day)

Dr. Lee Goldman

Reilly turned to the work of Dr. Lee Goldman, a cardiologists who used algorithm to decide on what diagnositcs results actually predicated heart attacks.  So he fed heart cases results into the computer to find out.

He determined that a decision tree would be made using ECG results in combination with any of the 3 factors:   l.    Does the patient have unstable angina      2.   Is there fluid in the lungs? 3.  Is the patients systolic BP below l00.

Thus, if through the ECG is found to have ischemia, it was proven that  patient does not have any of the three, he would be sent to the observation unit and eventually sent home,  for just one to the intermediate unit,  for two to three risk factors, to the coronary care unit.

95% Accurate

Congestion was solved at the heart unit, and most of all, accuracy in determining who had heart attack went up by 70%;   Left on ther own Drs guessed 75 to 89% most of the time;  using the Goldman protocols, they were right 95% of the time.

As the book Blink is about making decision without thinking (or using intuition) this Cook County hospital experiment is relevant to that thesis;  in the healthcare field, less diagnostics means less expenses for health care this makes the system more efficient and humane.

Less is better

As it is in the search for sophistication and efficacy (and also more earnings) and to show diligence in case of malpractice suits, a myriad of tests is ordered by the MD.  In the end, the data might drown the MD from making the correct and right treatment.