Saturday, April 15, 2017
Hospital Report Cards Out Again
If you are wondering whether I have an opinion about the recent release of safety report cards on Long Island hospitals, I do.
Hospitals may do better or worse on such evaluations, (and many LI hospitals didn’t fare very well) but in the end it’s mostly down to individuals.
Another tool for rating your hospital is welcome, but what can we actually do with this information? We can’t really do much to change the hospitals, so for the past 20 years I have been swimming upstream to change us — the patients and our families who support us. Patient safety is a lonely commitment. It’s not warm and fuzzy like toys for kids or snuggling with pets. It’s not helping those already struggling with a disease that is no one’s “fault.” Patient safety is about preventing harm when simply using the healthcare system. It’s not unlike wearing a seatbelt even though it won’t be your fault if a car hits you. It’s about protecting yourself from the other driver who might fall asleep at the wheel – not illegal, just an accident.
Let’s think about measurement of hospital safety. Does this mean you won’t be injured at one of the best hospitals? Maybe not. Hopefully you won’t be injured at any of them, but there are never any guarantees. No matter how good a hospital’s patient safety culture may be, there will always be a risk from individuals who are casual in their adherence to the hospital’s error-prevention practices.
Think about the patients at these hospitals: some are at greater risk of adverse outcomes than others. Are the hospitals with the best “report cards” serving a high percentage of immigrants who don’t speak English and maybe have not seen a doctor in five, ten or 20 years? Are they serving a person who weighs 400 pounds, is an alcoholic and doesn’t see a doctor for his high blood pressure? Are the patients at these hospitals young girls giving birth with no prenatal care? Maybe, maybe not . . . . but patients’ backgrounds and histories affect their outcomes.
Are the hospitals with lower ratings seeing the gunshot victims, dealing with angry and unruly families, or patients with no health insurance? Again, it’s a possible factor.
We don’t want to blame the hospital, if it has a culture of safety. I have had a number of experiences suggesting that even in such hospitals there are individuals at the bedside who just don’t get it. Where is this reported?
When a surgeon was asked, “Can you please wash your hands before examining the surgery site?” the surgeon responded dismissively, “I did wash and I showered today too”. I know that this facility takes hand washing very seriously. Yet an individual employee had no problem not supporting the patient’s right to safe care.
I asked a nursing assistant and nurse to please be sure a patient’s tray table was close by, so she wouldn’t fall trying to get it. Whenever I visited, it was again out of reach. The family noticed that she was not eating: that was the reason.
A doctor came in through the swinging doors leading from outside with his coat still on and a stethoscope around his neck, walked over to the (bleeding) patient I was with, and attempted to examine him. I stopped him and asked the patient to refuse care until the doctor washed. When the doctor refused I went to the desk in the emergency room and asked for a different doctor. The staff knew of this doctor’s attitude and accommodated us. This could have happened even at the hospitals receiving top safety grades.
When I asked a nurse to state whom a medication was for before putting it in a patient’s IV, the nurse’s reply was “It’s for her. Did you think it was for you?” Then the nurse called the same patient by the wrong name. It could happen in nearly any hospital.
Hospital report cards are one way of knowing more about the inner workings of what happens on a larger scale. There are also the NY State Department of Health and the Joint Commission keeping watch on safety for us – but if each one of us took responsibility for the patient’s safety — our own, our families’ and our friends’ — maybe we could help Long Island’s three million residents get the best care possible.