Shortly after Curtiss’s father had a lung transplant in 2005, he fell as he tried to make it from the bathroom to his bed without waiting for a nurse. Hospital staff put him in horizontal traction until a neurologist could examine him, even though that position can cause fluid to pool in the lungs. The fall occurred on a Friday, and the neurologist didn’t come until Sunday evening; by then, Curtiss’s father had developed pneumonia, which compromised the newly transplanted lung. Other complications followed, including a blood clot to his lung and a staph infection. He died soon afterward.
“His death certificate said he died of complications of pulmonary fibrosis,” said Curtiss, who has written a handbook for families with loved ones in the hospital. “I think it should have listed every single thing: the complications, the blood clot, a fall, infections, pneumonia.”
Fixing the system
Although the federal government, nonprofit groups and insurers want to improve the system, efforts to boost coordination and teamwork still have a long way to go.
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 taken steps to improve communication, assigning color-coded ID tags or scrubs to staff members so patients know who’s a nurse and who’s a doctor, and installing white boards in patient rooms, where 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 and relatives business cards or sticky notes with their photos.
A few hospitals have gone further. At the Mayo Clinic in Rochester, Minn., patients having surgery attend a pre-admission education class so they know “almost to the hour, let alone to the day, what’s going to happen,” said Michael Rock, chief medical officer of Mayo Clinic Hospitals.
In Pennsylvania, Geisinger Health System has developed a checklist on laminated cards that fit in caregivers’ pockets. It includes questions that doctors and nurses need to keep uppermost when reviewing cases, such as: “Is the patient taking high-risk medications? When is the patient going home? Does the patient have any catheters or lines that should come out?”
Consumer advocacy organizations, meanwhile, advise patients entering the hospital to have a relative or close friend, or even a hired hand who has some training, who can communicate on their behalf and be at their side through the hospitalization. [See sidebar]
But not all patients have such advocates, and even when they do, playing that role can place a difficult burden on families or make second-class citizens of those who do not, said Wachter, the hospitalist.
When his own mother had lung surgery in Miami several months ago, “I went down there and didn’t leave her bedside,” he said. “We have to figure out a way to have a system where a patient doesn’t need that.”
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.