Long
Island Hospitals’ Grades in Latest Patient Safety
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.
