Codman, Clin Orthop Relat Res 2013 - The Classic: A Study in Hospital Efficiency: As Demonstrated by the Case Report of First Five Years of a Private Hospital. 1918
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The Classic: A Study in Hospital Efficiency: As Demonstrated by the Case Report of First Five Years of a Private Hospital. 1918
Codman·Clin Orthop Relat Res·2013·86 citations·Case series
Codman argued that hospitals should follow and record the end result of every patient, and he applied this End Result System to five years of cases from his own private hospital.
Abridged 2013 reprint of Codman's 1918 report reviewing his private hospital's opening 5 years of cases.
Methods
Design
Classic essay with hospital case report
Published 1918, abridged reprint 2013
Patients
Cases from Codman's private hospital over its first 5 years
Follow-up
Outcome recorded each year after discharge
Outcomes
End result of each case
Cause assigned to each failure
Key Points
Codman proposed an End Result Card for each patient, recording symptoms, diagnosis, treatment plan, in‑hospital complications and the outcome every year after discharge.
Every unsuccessful case was analyzed so that responsibility for the failure fell on one of four causes.
Codman estimated that, with the cards, the chief of a 60‑bed service could review it in 1 hour a week.
Codman's report disclosed every failure in his own hospital, down to the smallest shortfall, and marked imperfect results with symbols in the margin.
Codman argued that reducing complications such as sepsis, phlebitis and cystitis was among the easiest ways to save hospital money, because each lost patient‑day had a cost.
Board pearl
Codman's End Result System asked of every case whether the patient fully recovered, and if not, whether the surgeon, the disease or the patient was at fault and how a similar failure could be prevented.
Codman argued that hospitals should follow and record the end result of every patient, and he applied this End Result System to five years of cases from his own private hospital.
Abridged 2013 reprint of Codman's 1918 report reviewing his private hospital's opening 5 years of cases.
Methods
Design
Classic essay with hospital case report
Published 1918, abridged reprint 2013
Patients
Cases from Codman's private hospital over its first 5 years
Follow-up
Outcome recorded each year after discharge
Outcomes
End result of each case
Cause assigned to each failure
Key Points
Codman proposed an End Result Card for each patient, recording symptoms, diagnosis, treatment plan, in‑hospital complications and the outcome every year after discharge.
Every unsuccessful case was analyzed so that responsibility for the failure fell on one of four causes.
Codman estimated that, with the cards, the chief of a 60‑bed service could review it in 1 hour a week.
Codman's report disclosed every failure in his own hospital, down to the smallest shortfall, and marked imperfect results with symbols in the margin.
Codman argued that reducing complications such as sepsis, phlebitis and cystitis was among the easiest ways to save hospital money, because each lost patient‑day had a cost.
Board pearl
Codman's End Result System asked of every case whether the patient fully recovered, and if not, whether the surgeon, the disease or the patient was at fault and how a similar failure could be prevented.