David Nash is Dean of the School of Population Health at Jefferson University (@JeffersonJSPH) in Philadelphia. Last week at the Maine Hospital Association’s (MHA) Summer Forum he and I both spoke. His talk was titled “Demand Better: Revive Our Broken Healthcare System.”
I hear a lot of speeches, and this one hit me between the eyes in a number of ways, combining some facts I’d heard before in new ways, mixed in with personal experiences. I hope to blog about several of these points (with his blessing); this is the first.
The story
The appendix of Let Patients Help is titled “Stop the Denial.” It’s about the reality that medicine is inherently hazardous, and medical staff pretty much work without a net. As I like to say, “In my own work I live through the Undo key, but clinicians don’t have one.” And they don’t work in a system that prevents human error.
Result? As the book says,
Did you know that in the best hospitals in America, 1 in 20 surgical patients dies of a complication? After the surgery? [HospitalSafetyScores.org] (In the worst hospitals it’s 1 in 6.) Hard to believe, yes?
If you were considering surgery, wouldn’t that change your thinking? Wouldn’t it make “Let’s wait a bit” seem like a prudent thought?
A commonly cited example is hospital acquired infections (“HAIs”). They’re impossible to prevent 100%, but there sure are things we can do to reduce the risk – like washing hands between patients. But on average, providers only do it about half the time. (Some are great – Kingston General Hospital in Ontario is at 96% – but still, 1 in 25 visits don’t get a wash!)
One way to immediately help with this is to always have a relative or advocate present at the bedside. In 2002 Dr. Nash had back surgery, and his wife was that relative. She had a cot to sleep at his bedside. One morning a resident came in to change a 12 hour dressing, and without washing his hands, reached out with them to remove the dressing, to expose the wound on his spine and put on a new dressing.
His wife’s hands got there first, grabbing the resident, and making him wash.
As Dr. Nash said, who knows what lovely things he’d touched in the hour before? But his wife was there and vigilant: patient and family engagement blocked a medical error – a failure to follow hand washing protocol.
Vigilance is valid. Enlightened providers know it.
It’s important to understand that safe practices are not automatic or easy – we want better hand washing but it’s not effective to just yell at people. Vigilance is valid. Let Patients Help. It’s often said that patients are the most under-used member of the healthcare team. They can be a second set of eyes for the busy clinician.
But: some hospitals won’t let visitors stay overnight. That’s exactly as if you shut off an alarm overnight.
Limited visiting hours are toxic. Avoid them.
The more I learn about this – and Dr. Nash’s story nailed it home – the more I realize, a hospital with limited visiting hours is in denial about both the risk of human error and the opportunity to let patients help.
From this moment on, whenever I have any choice, I will avoid any hospital that doesn’t allow family at the bedside around the clock.
When Jen S. McCabe was in Shock Trauma after her accident, the nurse came in, hung blood, and walked out not to be seen for a couple hours. I was the one in shock. I compared the label on the blood bag to her armband just to be sure.
I’m a big advocate of a family member at the bedside 24/7. We did that with my mom’s cancer surgery and the many hospitalizations that followed. We kept a notebook so the next one keeping watch had continuity.
Thanks for the reminder to encourage patients and family members to “speak up” (that’s what Regina Holliday painted on my laptop bag!).
thanks God, we don’t have visiting hours problems here! hospitals have extra lean nursing staff and without family around 24/7, no patients could make it alone! relatives in Greece assume real nursing roles changings IVs, watching taking of medicines. reporting symptoms, feeding and cleaning the patient and more…