Tuesday, November 16, 2010
The latest headlines from the Medicare should make us all worry. Hospitals area dangerous place where there is a distinct likelihood that mistakes will happen that will affect your care and potentially cause you harm or possibly death. After studying the care of 780 patients, researchers found that 1 in 7 experiences an error in their care that caused permanent harm or required emergency intervention. Of those 780 patients, 1.5% died due to an error. When you consider the million Medicare patients admitted to hospitals each month, it adds up to 15,000 potential preventable deaths every month; a huge and somber numbers.
The approach by the Department of Health and Human Services is less than acceptable was to concentrate on a variety of areas. Their report recommended that hospitals concentrate on common problems like preventing blood clots and controlling blood sugars in patients with diabetes. Government should hospitals accountable for better care and should work faster to adopt evidence based practices that reduce medical errors. Hospitals should embrace patient care systems like the electronic medical record to avoid mistakes.
It may sound trite, but hospitals don’t look after patients, people do and it’s the doctors, nurses, pharmacists and every other person who touches a patient that needs to step up and take responsibility for the care that they provide. The hospital is the opportunity for that care to happen. Unfortunately, patients have turned into consumers and hospitals into factories. Waiting times, throughput, central receiving and just in time supplies, allow patient care to be streamlined. Discharge planning happens even before the patient is admitted.
The efficiencies allow the scarce resource of a hospital bed to perpetually fill but the pressure to minimize how long a patient stays in the hospital and maximize the hospital’s income, strips away opportunity. Instead of allowing nurses to spend time visiting with a patient and their family, they are spread thin caring for more patients who are sicker and more complicated than just a few years ago. And while any worker can stop a factory production line if a problem occurs, there is no stopping the constant flow of patients who need care.
The fix is not pleasant and is painful. With an aging population, more people will need medical care that has become more sophisticated and complex. Allowing nurses to nurse at the bedside is expensive. Hospitals cannot increase their payroll cost if the federal government, the insurance company who pays for elder care, pays less. The alternative is to accept less quality and skill at the bedside or increase taxes to pay the bill.
Most people who work in the health care field work nights, weekends and holidays because of their devotion to the patient and not necessarily for the paycheck. The money doesn’t compensate for not tucking kids in at bedtime, or sitting around the table with family at a holiday meal. The errors that occur are devastating to the people at the bedside just as they are to the patient and their family.
The hospital is just a building. If errors are to be decreased, then people who touch the patient need to be empowered to stop the assembly line. When the workload becomes overwhelming or there is too much time pressure, error will happen regardless if the pharmacist has 20 years experience or a new grad. People need to be given permission to say that they need a break to collect their thoughts before proceeding. The solution ofr preventing errors will not be found in the wisdom of high tech but instead in the low tech caring of high touch at the bedside.
The elephant in the room is that there are too many patients and their needs exceed the ability to meet them. Just as the financial crisis taught us that society cannot live beyond their means and those bills eventually need to be paid, so too must that lesson be learned in health care. A population with 91 million smokers, who is increasingly overweight and sedentary, builds a heavy burden for the next generation to pay the price of lung cancer, diabetes, heart attack, and stroke.
Hospitals errors will decrease when the flow of patients decreases and that happens when the population of the country decides to live healthier lives. The first medical error happens each time a neighbor lights up a cigarette, chooses an all-you-can-eat buffet over going for a walk or forgets to take their medication to control their high blood pressure or diabetes. How about that for a headline.