Ernest Amory Codman was born in Boston, Massachusetts, on December 30, 1869.odman was a pioneer in many different fields including contributions to anaesthesiology, radiology, duodenal ulcer surgery, orthopaedic oncology, shoulder surgery, and the study of medical outcomes. Codman entered Harvard College in 1887, graduated cum laude in 1891 and subsequently entered Harvard Medical School. During his time there, he met and became best friends with Harvey Cushing, the famous neurosurgeon. While he finished his studies in 1894, he spent his last year as an intern at the Massachusetts General Hospital and graduated in 1895. He subsequently obtained the position of Assistant in Anatomy at MGH and was apprenticed to Francis Harrington, the Chief of the Surgical Services he was an advocate of hospital reform and is the acknowledged founder of what today is known as outcomes management in patient care.
Codman was the first American doctor to follow the progress of patients through their recoveries in a systematic manner. Codman kept close track of all of his patients by using “End Result Cards” which contained basic demographic data on every patient treated along with the diagnosis and the treatment he rendered. Also the outcomes of each case were closely logged. All patients were followed up on for at least one year, to observe the long-term outcomes of treatment. This lifelong pursuit to establish an end results system, lead Codman to track the outcomes of patient treatments. This passion, also lead him to use this tracking as an opportunity to identify clinical mistakes, bad treatment, and to serve as the foundation for improving the healthcare of future patients. Codman also believed that all of this information should be made public so that patients could be guided toward good healthcare in their choices of physicians and hospitals.
To spite this, in 1914 the hospital refused his plan to evaluate surgeon competence and he lost his staff privileges at that hospital. Dr. Codman eventually established his own hospital, and called it the “End Result Hospital”. The focus of this hospital was to pursue a performance measurement and improvement objective that he believed in so fervently. To support this end results theory, Dr. Codman made available to the public the end results of his own studies and statistics at his hospital in a privately published book, A Study in Hospital Efficiency. Out of the 337 patients discharged between 1911 and 1916, Dr. Codman recorded and published 123 errors.
Dr. Codman also helped to found the American College of Surgeons and its Hospital Standardization Program. He also established the first bone tumor registry in the United States, which was an idea which had first been suggested by the British physician Sir Thomas Percival in 1803. Dr. Codman’s name is also attached to “Codman’s Exercises”, a series of exercises for the purpose or regaining range of motion, and “Codman’s Tumor” a benign tumor of the cartilage.
A famous quote by Earnest Codman said, “We believe it is the duty of every hospital to establish a follow-up system, so that as far as possible the result of every case will be available at all times for investigation by members of the staff, the trustees, or administration, or by other authorized investigators or statisticians.” In 1996 in tribute to Ernest Codman, M.D., the Joint Commission published the book: Codman A Study in Hospital Efficiency. The Commission also established the Ernest A. Codman Award for the use of outcomes measures to advance the quality and safety of patient care.
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