Coordinated care, promoted as the key to better, more cost-effective care, is being encouraged through financial rewards and penalties under the 2010 health care overhaul, as well as by private insurers. But experts say communication failures remain disturbingly common, according to Kaiser Health News (KHN).
Advocates for hospital patients and their families say confusion about who is managing a patient’s care and the failure of caregivers to collaborate contribute to an estimated 44,000 to 98,000 deaths from medical errors each year. A report by the Institute of Medicine in 1999 cited the fragmented health care system and patients’ reliance on multiple providers as a leading cause of medical mistakes. A 2010 federal report projected that 15,000 Medicare patients every month suffered such serious harm in the hospital that it contributed to their deaths, KHN reported.
“Nobody is responsible for coordinating care,” Lucian Leape, a Harvard health-policy analyst and a nationally recognized patient safety leader, told KHN. “That’s the dirty little secret about health care.”
Patients are often surprised to discover that their primary-care physician isn’t the doctor overseeing their hospital stay and is unlikely to be informed about their progress. Instead, hospitals have staff doctors called “hospitalists” who are supposed to manage a patient’s care — coordinating the various specialists, managing medications and then overseeing the transition back home.
But, KHN said, this system is vulnerable to breakdowns. Nearly four in 10 hospitalists responding to a survey from the Johns Hopkins University School of Medicine said they struggle with unsafe workloads. Nearly a quarter believed their workload “likely contributed” to patient complications and even deaths.
Last summer, the Joint Commission, the nation’s hospital accrediting group, developed a tool for hospitals to help guide communication when a patient is transferred from one hospital setting to another — for instance, from an intensive care unit to a regular floor.
Some medical centers have now assign color-coded ID tags or scrubs to staff members so patients know who’s a nurse and who’s a doctor and have installed white boards in patient rooms so that a nurse starting a shift can jot down his or her name. At some facilities, hospitalists write their names on those boards and hand patients business cards or sticky notes with their photos.
A few hospitals have gone further, KHN reported. At the Mayo Clinic in Rochester, Minn., patients having surgery attend a pre-admission class so they know what’s going to happen.
Meanwhile, consumer advocacy organizations advise patients entering the hospital to have a relative or close friend or even a hired hand who has some training, to communicate on their behalf and stay at their side through the hospitalization.
KHN offered these suggestions for patient advocacy:
The patient has a right to know the name and position of the physician who is overseeing his or her hospital care. All care providers should introduce themselves when they come into the room; if they don’t, remind them.
Patients also have a right to review their medical records at the bedside and to receive information about the benefits and risks of any suggested procedure or treatment. If the patient is mentally competent, he or she can give an advocate permission to see the records; it can be done verbally, and the advocate’s name can be put in the medical chart.
The patient safety organization, PULSE, has drawn up a checklist for patient advocacy that uses the acronym FILMS:
Falls: Make sure the staff knows when a patient is at risk of falling. Have the patient evaluated if you’re concerned. Falls are a leading cause of hospital injuries.
Infections: Don’t be shy about asking care providers if they have washed their hands or asking them to do it again in front of you.
Literacy: Read any forms the patient is asked to sign. (He or she may be unable to absorb the information completely.)
Medication: Doctors and hospital staff members should always explain to the patient which drugs they are being given. Ideally, medication should be in the original wrapper. Medication errors injure 1.5 million people each year.
Surgery: Before an operation, make sure the site of surgery is marked and verified by the doctor. The advocate can be present when this is done. There are 40 cases every week of surgeries done on the wrong body part, according to PULSA. If the patient has not been given antibiotics, ask if there is a reason; taking antibiotics preventively before surgery has been shown to reduce infection risk. Also, make sure the patient has a warm blanket before and after surgery. Staying warm reduces infection risk.
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