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an overlooked topic on which life depends • Below the line



Illustration: Blejec Method

Last autumn, the public reiterated the achievement of two Slovenian surgeons at the Clinical Center in Ljubljana. Patients, who needed to amputate their nose from cancer, raised the new one with themselves. The nose was then placed on the cheek by the patient and restored his normal life.

The UCCC Ljubljana doctor was supposed to be the first in the world to carry out such an operation. That is why they became personalities in 2018 from the daily Delo.

The success of the doctors in this case is undoubtedly commendable. When she had to wear a prosthetic prosthesis, the hospital suffered from persistent colds and headaches. Namely, during the winter, the nasal prosthesis did not adequately heat the air that breathed. Nose transplantation from a foreign donor is not taken into account. Drugs against the rejection of a foreign nose can cause the patient to recur from cancerous formations. The patient said after the procedure that she felt she was born again.

This exceptional story also has the second side of the medal. The reason is that the nose had to be amputated at all. The cause was a medical error. Another doctor at UCC Ljubljana was unintentionally found late when the patient had cancer in the nose. For this reason, the hospital had to pay the patient 42,000 euros in compensation.

The above example is not isolated. UKC Ljubljana has significant problems in ensuring quality of its work for many years. Of these, life is often dependent. As we announced in 2016, a much larger proportion of patients died in the biggest hospital after a stroke, than in hospitals in the German-speaking world, comparing UCC Ljubljana.

How critical the situation in other areas of treatment in UCC Ljubljana is not known in most areas. UKC Ljubljana has no integrated program for monitoring the quality of work in its clinics.

UKC Ljubljana is no exception. In the country, there is no independent system that will surely determine the quality of our doctors and hospitals. As a result, the quality of your treatment, if or when you are in hospital, depends largely on the head of the department who will treat you. Some of the leaders give high quality assurance. Other managers do not care about this, observers say.

The result is diametrically opposite statistics for the success of the treatment by field. In the area of ​​stroke treatment, according to the OECD, we are among the worst member states of this organization. It is a turning point in preventing death from a heart attack, where we are among the best countries.

The cost of the quality of neglect in health is measured in human lives. According to the Ministry of Health estimates for medical mistakes that could be prevented, even 1000 patients die annually in Slovenia.

At the same time, many people can rightly surprise just how simple they are often actions on which human life depends. Let's look again at UCC Ljubljana. As we have said, they suffered from very high mortality due to a stroke at the hospital. Then, in 2017, they made an analysis of the condition and realized that unusually many patients with cardiac brain died of pneumonia. What was the reason for this? At the hospital, they were also orally fed to those patients who could not normally swallow due to a stroke. In this way the food was drained from the esophagus to the trachea, which caused pneumonia. Pneumonia can often be fatal in such weakened patients.

What was the solution? According to their own assurances at UCC Ljubljana, they are now making a test for swallowing patients within 24 hours after their arrival at the hospital. If they find that the patient's swallowing reflux does not work, it is fed through the infusion. With this measure, it is expected only in 2017 that tens of thousands of patients will be saved who will die a year earlier.

Certain measures, of course, are more complicated. For better treatment of heart failure in UCC Ljubljana, for example, they use expensive and complicated blood circulation technology outside the body. Patients whose heart stopped completely and could not be brought back, were all sentenced to death several years ago without exception. With the introduction of a circulation outside the body, it is possible to save about 20 patients a year in a clinical center that will die without it.

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But all these successes are the fruit of a dedicated work of individual doctors in the system, which (still) does not encourage the continuous and systematic improvement of the quality of health work. No one systematically controls doctors to determine whether they are doing their job well, or may need additional training or knowledge to avoid unnecessary errors. No one controls the heads of departments to find out how much attention is paid to the quality of work done by doctors in the departments they lead. No one controls the hospitals to determine whether they require supervisors of departments to monitor the quality of work of their departments and systematic efforts to improve the quality of work.

In 2016, we published a series of articles in the Pod line, in which we were convinced that there is virtually no quality healthcare system in Slovenia. We also examined the consequences of this, including the unnecessary death of patients.

Even the then-cabinet of Mira Cerar promised an improvement in this area. The new legislation that will serve as a basis for monitoring and improving quality in hospitals is promised in 2017. Such legislation has not been adopted to date.

According to ministry officials, the Ministry of Health, which is currently headed by Samo Fakin, is aware of the problem. At least this was written in response to our latest questions about the quality of health. Despite the start of activities in the field of quality, this area is fragmented and does not guarantee a "balanced and equitable development of all dimensions of quality," they say. We are also informed that they have managed to obtain the technical assistance of the European Commission for "developing an integrated quality approach that will ensure the determination of responsibilities, responsibilities and carriers of specific areas". Currently, the Ministry is preparing a tender for the selection of a contractor, and the project is expected to last for two years.

Will this project be another bureaucratic exercise without effects or actually help to raise the quality of our health, so we can (we hope) evaluate it in two years.

Until then, it's just advice. The next time in the media, you will read the report on the new achievements of Slovenian doctors who first performed a new operation or treatment, of course, look forward to this success. Remember also a quotation from our interview with Dr. Marko Nochim, who most deserves to reduce death due to a heart attack in Slovenia:

"Unfortunately, we are often satisfied with sensationalism. The first in the world, we performed such an operation and such an intervention, others in the world discovered it and that … Then all the media report this. Everything is nice and correct, but at the same time forgets that the results of treating successive patients over a period of one or more years are the result of treatment of the real quality of work. "


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