Good ideas abound for curbing patient harms; they just need to be shared

What does it take to make hospitals safer so patients aren’t harmed? Big stuff and small, some of it surprising─and all of it mattering a lot. For instance:

  • Getting caregivers to wash their hands. It’s the top cause of debilitating and sometimes deadly hospital-acquired infections. Some institutions empower nurses to police and remind dirty doctors; some install video cameras to catch scofflaws; others run frequent and largely successful ─for awhile─ publicity campaigns.
  • Paying extra attention to hygiene with procedures, often considered routine, that break the skin, even a little bit. This has paid off in big reductions in some hospitals in infections linked to catheters put in veins and arteries, especially the central line (for IVs).
  • Preventing surgical teams from hauling into operating rooms items like backpacks, cell phones or scrubs also worn outside surgery areas. Hospitals have cut dangerous surgery-related infections by getting these bug-carrying items out, paying heightened attention to antibiotic and sterilization regimens, and other steps.
  • Ensuring medical teams focus with sick patients on warning signs of infections in the bloodstream — sepsis; 700,000 U.S. patients develop these infections annually and 200,000 of them die. The common danger signs that someone may have sepsis include extremes in heart and breathing rates and body temperatures, combined with low blood pressure. A rush blood test, with timely administration of fluids and antibiotics, experts say, can significantly cut deaths and harm from septic shock and sepsis. When caregivers increase their awareness of sepsis, death and injury rates from it dip as much as a third.

Do any of these steps sound too hard or too expensive? The New York Times ran a two-part Op-Ed by a solutions-focused journalist, detailing  ideas that doctors, nurses, hospitals, and other experts have shared to further reduce patient harms in hospitals.

Hospitals these days don’t compete much with each other, especially as institutions consolidate and get absorbed into chains, allegedly to be more cost-efficient. So why, the Times asks, can’t they do better in informing each other about best practices to deal with the array of challenges they collectively face in curbing a huge problem in healthcare? As the paper describes the core concern:

Each year, in the United States, millions of patients are harmed while receiving care in hospitals. They get infections, experience adverse reactions to drugs, develop dangerous bed sores, or come down with pneumonia from the very ventilators meant to help them breathe. The estimates of the number of people who die each year as a result of hospital errors have ranged from as many as 98,000 in a landmark Institute of Medicine report from 1999 to as many as 440,000 in a 2013 study. It’s believed that most of these deaths could be prevented if health care providers always adhered to evidence-informed practices.

The paper duly notes that the scope and scale of the care Americans demand is enormous─”35 million hospital admissions 136 million emergency room visits.” As I have written before, the Obama Administration, as part of the Affordable Care Act, has campaigned to get hospitals to slash patient infections and harms, and officials have added financial incentives and penalties for institutions to do so.

The rates are decreasing. This work isn’t easy. Just consider what might seem a simple issue: coping with the rise of advanced medical devices that beep with alarms or warnings to nurses. This technology has created bedlam in many hospital units, where nurses run from room to room to silence the cacophony; medical staff can get inured to the racket or confused as to which alarms are most urgent, leading to patient harms, including deaths (a couple of dozen annually, by some estimates). By allowing caregivers to adjust devices so they are appropriately sensitive to a specific patient, and by eliminating machines that reset their alarms on their own, one hospital it cut its alarms from 90,000 to 10,000 a week. When the medical staff doesn’t suffer alarm fatigue, it can provide better care.

A lot more needs to be done to make hospitals safer. As I have written, patients undergo incredible, lingering suffering as a result of horrible experiences in hospitals. But hospitals’ sharing best practices could be valuable, dislodging the hand-wringers in medicine to reckon with a major issue.

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