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Archive for the 'MRSA /Hospital Acquired Infections' Category

An Open Letter to Hospitals

Please note that this column appeared in the Syracuse Post Standard on September 13, 2011.  It addresses the recently issued New York State Hospital Report Card.  You don’t need to be a resident of Central New York, or even New York State to gain benefit from this column.  Resources for you are found below.

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Dear Central New York Hospitals:

It’s report card time.  That time when we patients get the opportunity to learn whether or not you’ve improved your patient care and outcomes since last year.

I was hoping to find glowing reports. After all, you know exactly what will be measured and what needs to be done to earn the highest grades.  No one’s expecting miracles; just safe and timely care, a clean environment, pain management and effective communications.

But did I find stellar reports?  No.

Granted, the report card says I have less of a chance of catching pneumonia at St. Joes.  And, Community General, congratulations on your infection rate which is lower than the average hospital in New York State.  Both St. Elizabeth’s and Faxton in Utica are doing quite well avoiding Pulmonary Embolisms and Deep Vein Thromboses.

But those are only three high grades among almost four dozen measurements.  My real concerns are for those that registered lower than statewide averages – so low that some patients are dying, acquiring infections, suffering pain, and leaving your facility in worse condition than when they were admitted.  Each one of you earned the lowest possible score in at least three categories.

According to news reports, one official blamed bad scores on outdated statistics. Sorry – that’s no excuse! Your patients are human beings, not statistics.  Perhaps their pain, debilitation or death took place a few years ago, but many of those patients are still in pain, still debilitated and yes, still dead today.

As you know, beginning next year, Medicare will take patient satisfaction survey scores into account when it comes to determining reimbursements. We patients don’t require much to score you highly on those surveys.  We expect only the basics: communicate with us respectfully, prevent infections, avoid mistakes, keep us as pain-free as possible, and send us home with instructions we understand and can carry out.

Put another way:  treat us the way you would treat your own loved ones. Provide for us what you would provide for them.

Such an approach is bound to land you in the top tier on next year’s report card.

Best regards,
Trisha Torrey
Every Patient’s Advocate

PS:  Patients can find New York State hospital report cards by linking to http://www.myhealthfinder.com/newyork11/. Pay particular attention to patient safety and satisfaction measures. Then use those scores to choose where you want to be hospitalized. Your life may depend on it.

……………… ADDITIONAL RESOURCES ON THIS TOPIC ………………

More Hospital Report Cards (more states)

How to Choose the Best Hospital for You

A Patient’s Guide to Hospital Infections

How to Prevent Hospital Infections

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Hospital Gets a Plus, Communication a Minus

It’s been awhile since I posted — but you’ll understand why.

My father suffered a mild heart attack a few days ago, and (thanks for asking) is doing as well as can be expected. In his 80+ years, he has never had any indication he had a problem with his heart!  A variety of other health issues have arisen over time, but Dad’s heart was always thought to be as strong as could be….

In fact, despite protestations (“I don’t really think these chest pains are a big deal… let me just make an appointment to see my primary….”) emergency personnel arrived and whisked him off to Sarasota Memorial Hospital (Florida) where he spent the better part of the next three days.

smhospital1Some rigorous testing, a heart catheterization and an angioplasty of a small artery later, Dad is home and getting his sea legs back.

I happened to be visiting him when it struck – amazing timing, don’t you think?  I’ll be here for a few more days to make sure he’s on his feet and feeling more confident, as we review what led him to a heart attack and what adjustments he’ll need to make from here.

Of course, little did those who helped Dad know that a critique would be forthcoming once we were past the initial shock and care. I’ve been making observations throughout that might help all of us get the care we need.

I can’t say enough GOOD about Sarasota Memorial Hospital.  I’ve been admitted to, and visited, many hospitals, but by far, SMH is the best I’ve experienced.  Here’s why I say that:

The personnel were very helpful. No one was ever too busy to answer a question or explain what we needed to know.  When we had questions about the meaning of the various numbers appearing on the monitor he was attached to, each section was patiently explained to us.  When they moved Dad to a room, I was able to get easy directions to find him. When Dad was admitted, he mentioned he hadn’t eaten any breakfast or lunch, and a turkey sandwich appeared.

The hospital is immaculately clean, from the facilities to the people.  A great deal of emphasis is placed on washing and sanitizing hands and surfaces.  I watched the cleaning people use great care in cleaning up behind the patient in the next bed, wiping off every surface including the phone, the bed controls, the TV remote.  The personnel that actually touch patients (nurses, others) were diligent about washing their hands and sanitizing.  The only time either Dad or I asked them to wash their hands was in the emergency room, and then the nurse told us she had sanitized before she came in the room (although I didn’t see any dispensers outside the room.)  But she was happy to comply when Dad asked. Of course, the entire point is to avoid infections.

Dad’s nurses, in particular a young man named Eyves who was available the entire day of his procedure, and the night nurse, Bren, were particularly helpful.  Dad had a rough time of it — a lot of pain and nausea.  Both were right there for him and did everything they could to keep him comfortable.

The check-out process was excellent.  All instructions were explained to us carefully. Dad, foggy from so much painkiller, had some trouble processing instructions, but the discharge nurse was very patient, taking it very slowly so it could sink in.

Even the food in the restaurant is good!  Add that to the free parking, great signage (very easy to find my way around) and the fact that we could use cell phones, had free internet access and no restricted visiting hours…

The ONLY fly in the hospital ointment was communication from the doctors — a problem that was a much larger minus than it needed to be.  The problem was this:  we were told that both the proceduralist who performed the heart cath/angioplasty and another doctor would visit us a few hours afterwards to explain the findings and next steps.  It never happened. In fact, the proceduralist NEVER visited, and Dad’s new “assigned” cardiologist (the recommendation from his primary) didn’t visit until the next day.  Both he and the primary get a few points for phoning me (it was 7:30 AM, and I hadn’t gone in to the hospital yet).

This problem was not about the actual communications; rather, it was about managing our expectations.  If we had been told we wouldn’t be contacted by either doctor until the next morning, we would not have expected it, nor would I have been upset when we didn’t.

And this is where Dad’s nurse, Eyves, gets more brownie points. When I made it clear how peeved I was many hours after we expected the proceduralist to arrive, he tracked down another doctor in that same practice who then called me and explained in a very detailed manner exactly what the findings were during Dad’s procedure.

This won’t be our last experience with Sarasota Memorial Hospital. My parents are both older and both have health issues. I expect I’ll get to know much more about this facility. I’m very thankful to know there is so much emphasis on the important aspects of care.

One more point to make:  as mentioned, Dad was “assigned” his new cardiologist.  I helped him understand that he is under no obligation to accept that assignment.

The same is always true for you.  Referrals can work out well, or they may not.  Just because you are referred to a specific doctor does not mean you are obligated to stay with that doctor.  You may always choose your own doctor, as may Dad.

No one ever wants to be hospitalized, but if you’re in Sarasota and you need hospital care, give Sarasota Memorial Hospital a try.

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More Infection Warnings – Tools to Prevent Germy Spread

Betsy McCaughey, director of RID (Reduce Hospital Deaths) reminds us in her latest Wall Street Journal article that those hospital germs, the ones that cause death and debilitation, are everywhere.

In her most recent article, she points to doctors’ and nurses’ scrubs, coats, ties — their clothing.  MRSA, C.Diff. and other infectious pathogens cling to the fabric and get passed from patient to patient.

So — imagine that for a moment — the doctor brushes you with his white coat, that very item that represents his/her MD-dom — and passes an infection on to you which will make you very, very sick, or even kill you.

From Dr. McCaughey’s article:

The problem is that some medical personnel wear the same unlaundered uniforms to work day after day. They start their shift already carrying germs such as C.diff, drug-resistant enterococcus or staphylococcus. Doctors’ lab coats are probably the dirtiest. At the University of Maryland, 65% of medical personnel confess they change their lab coat less than once a week, though they know it’s contaminated. Fifteen percent admit they change it less than once a month. Superbugs such as staph can live on these polyester coats for up to 56 days.

Do unclean uniforms endanger patients? Absolutely. Health-care workers habitually touch their own uniforms. Studies confirm that the more bacteria found on surfaces touched often by doctors and nurses, the higher the risk that these bacteria will be carried to the patient and cause infection.

According to Dr. McCaughey, hospitals used to provide laundered uniforms and scrubs to their personnel, but that practice has gone by the wayside.

So, it seems like it would be a good practice to bring back.  Especially since Medicare is no longer paying for care for patients who acquire infections in the hospital, it seems that laundering that clothing would be far less expensive than having to eat the cost of caring for so many infected patients.

Today’s second warning comes from Bottom Line Health, one of my favorite publications.  I like Bottom Line because it doesn’t accept advertising, and it always brings in multiple points of view, e.g. the best of Eastern and Western medicine and ideas.

This notation comes from Jean-Yves Maillard, PhD from Cardiff University in Wales, UK who tells us that those disinfectant wipes we use on surfaces to kill bacteria (think clorox wipes, or those wipes they put near the shopping carts at supermarkets) may actually just spread those germs around.  We may not be killing those buggers at all!  Dr. Maillard suggests instead that we use one wipe per surface — or one swipe per wipe.

When it comes to these killer germs, we patients just can’t be too careful, can we?

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Never Events — Shooting the Messenger

Beginning October 1, 2008, Medicare, and many health insurance companies, will no longer pay hospitals for the additional services needed for patients who suffer from “never events.”

Never Events, as defined by the National Quality Forum, are those events which should never happen to a patient.  There are 28 errors on the list ranging from wrong site surgeries to drug errors to crimes committed by medical professionals.

Not included on the list from the NQF are HAIs (hospital-acquired infections).  There may be many reasons for this, but there are many groups and organizations that believe HAIs like MRSA, C.Diff and VRE SHOULD be included on the list.  Many of them, although not all of them, are preventable.

Regardless of what the left hand is doing (NQF), the right hand of payers (Medicare and many insurers) have decided that these infections will no longer be covered.  That means that any hospitalized patient who contracts, or at least presents with, an infection during a hospital stay may not be charged for the extra cost of treating the infection, nor will the hospital be paid by Medicare or many of the health insurance companies.

I don’t have the expertise to say whether this is right or wrong.  On the one hand, I believe it’s absolutely necessary to force hospitals to figure out ways to decrease the numbers of patients who contract these infections, estimated to be upwards of 5 million patients per year.

On the other hand, I know that sometimes patients arrive with pre-existing infections that may be apparent when they are admitted.  Can they be tested upon arrival?  Of course they can — although some hospital personnel point out how expensive that is, and that insurance won’t cover that either.  I have no doubt that there will be some problem for patients that crops up from this new ruling.  Hospitals will refuse to admit patients at risk, or they will discharge them too early so they can — at least in the paperwork — ignore an infection just as it begins.  Hospitals will do whatever they need to to protect their *sses — and it will be at the expense of patients.  Unintended consequences, all based on money.  What else is new?

During the past few days, a dialogue has taken place… wait… make that a diatribe…. on the blog of a certain “buckeye surgeon” where complaints and barbs have been thrown at a newspaper reporter who wrote about this October 1 date for reimbursement stoppage.  On just about the same day, the Wall Street Journal printed an article by Dr. Betsy McCaughey, founder of RID (Reduce Hospital Deaths) that gave some statistics about hospitals that have addressed infection problems — and have successfully reduced their numbers, one (claims) to 0 patients over a span of years.

So –I pulled some quotes from Dr. McCaughey’s WSJ article and posted them to the blog — and you would have thought I was the devil-incarnate…. whoa!  A regular lightening rod!  All those doctors so quickly turned their ire on me.  And I thought angry patients got worked up!  They can’t hold a candle to posters like “white coat” and “anonymous” who — God forbid — don’t even use their real names.

No — they attacked me one after the next.  In fact, it began when I suggested that SOME hospitals were actually trying to help patients!  SOME hospitals are actually asking their doctors and personnel to adhere to a checklist that — (you won’t believe this) — actually prevents infection!

Oh — one even attacked me for not being grateful that I was misdiagnosed with cancer.  She told me I should not have been upset at the misdiagnosis — I should have been relieved that I didn’t have it.  (My standard reply, which I didn’t bother with is — “gee — you didn’t get hit by a car today.  Are you relieved and grateful?”)  Of course — what on EARTH does this have to do with infections?  I’m not sure.

What’s the bottom line?  What can we learn from this?  Honestly — I do NOT believe that including HAIs on the list of never events Medicare and some insurances will no longer pay for was the right approach.  While some infections could have been listed and it would have been helpful, instead I think Medicare has only thrown down the gauntlet for hospitals to go underground.  Patients will pay the price in even worse health problems.  We must be more vigilant and be prepared to stand up for ourselves and our loved ones, and once October 1 rolls around, that will be even more difficult.

What the Trisha-bashing on the Buckeye Surgeon’s blog has shown me is that when we patients begin to stand up for our NEED for decent healthcare, we become the enemy.  The point I tried to make on a couple of the blog posts was that I think patients and providers need to remember that we have the same goal — improved patient care.  But those folks didn’t want to go there.  They just wanted to bash me.

I pray none of them is ever hurt by a medical error.  I hope none of them ever suffers at the hands of a medical practitioner who is probably just in a big hurry because he doesn’t get reimbursed well enough for his work.  I hope they don’t lose a loved one, like I did, after she acquires MRSA.

But mostly I hope they will stop taking their frustration out on the messenger.  Afterall — excuse me — I THOUGHT we all had the same goal?

Don’t we?

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