As part of The Globe and Mail's series on the changing healthcare landscape as seen through the eyes of Sunnybrook Health Sciences Centre, a recent article focused on the idea of redesigning hospitals to enhance patient safety and comfort. While some steps in that direction could prove positive, there is no need to spend hundreds of millions of scarce healthcare dollars to create a safer and more comfortable experience for patients and families. An inexpensive dose of common sense might be all that is required.
Having spent more than 12 hours a day at two Ontario hospitals over the course of six months involved in every aspect of my elderly mother's care following her traumatic brain injury, I, too, have experienced first-hand what it's like to "live" in the hospital setting. But before anyone starts rearranging patient rooms and hospital signs at great expense in Ontario, a province that too often refuses to provide life-prolonging medication to cancer patients, let's look at what can be done today to avoid placing patients at needless risk -- and inflicting more avoidable distress on their families.
Redesigning hospital beds is suggested as one idea that would make patients safer. But when I saw my comatose mother left in her ICU bed in a totally flat position while on life support and with pools of fluid overflowing from her mouth to the point where her gown and bedding were soaked, I knew something was terribly wrong. And it had nothing to do with the bed. Universally recognized protocols warn that patients on life support are at serious risk of developing ventilator-associated pneumonia unless the head of the bed is maintained in an elevated position. My concern was soon elevated when I was unable to find my mother's nurse, even though in this ICU, and in many others across Canada, the ratio of care is one nurse to one patient. Shortly after that incident my mother was diagnosed with ventilator-associated pneumonia. This is often a life-ending condition in the elderly patient, but the hospital never apologized for creating a risk that was entirely avoidable.
On the night my mother suffered a devastating cardiac arrest, a redesigned ICU would not have been necessary in order for nurses to be more aware of her deteriorating condition. She was already on continuous monitoring equipment for cardiovascular issues. But when nursing staff finally responded to the alarm that sounded, her oxygen level had plunged to 14 percent, according to the monitor print out. By that time, she was "code blue."
The hospital could never explain why it would take that kind of crisis before an ICU nursing team responded. But here's a clue. In the cardiac ICU where my mother was recovering after her arrest, the night nurse was so engrossed in surfing the Internet for grocery coupons that she ignored the alarm that showed my mother's blood pressure plummeting to life-threatening levels again. When repeated efforts to get her attention failed, I had to frantically search for a doctor, who immediately acted to restore her blood pressure. The hospital never apologized for this event, either.
Having equipment clearly marked and safely accessible is another part of the hospital redesign paradigm. But in her third month in the hospital, I walked into my mother's room to find her tracheostomy tube disconnected from the oxygen supply, while oxygen was still spewing out of the wall. The cork for her tracheostomy was missing and could not be found anywhere. The device monitoring her oxygen rate had inexplicably been turned off. And the observer/sitter, who was supposed to be ensuring that my mother did not disconnect any tubes in a bout of confusion, was asleep in the room. It had been hours, according to the chart, since a nurse had performed any care or even entered the room.
Reducing hospital noise is another laudable design objective. This is especially important for brain-injured patients who need more quiet and rest than many other patients. Unfortunately, this large hospital did not seem to know about that, or care for that matter. My mother had been placed in a room with a loud speaker located in the wall directly behind her head. It barked out pages and announcements to nursing staff day and night, making her room seem more like a supermarket or car showroom. I could see how much this noise distressed her, but there was no way of turning off or reducing the volume.
Want to know another proven and really cheap method of improving patient safety? Wash your hands. So serious is the failure of doctors, nurses and other clinicians to follow this simple age-old motherly dictum, that the Ontario government requires hospitals to regularly report their level of pre-patient and post-patient hand hygiene compliance. Experts report a clear link between hand hygiene and the spread of hospital acquired infections, another usually avoidable, often deadly, and extremely expensive form of harm to patients. Sunnybrook, the focus of the Globe series and one of Canada's foremost teaching hospitals, scores just at the average of similar sized hospitals for pre-patient contact, while only one, St. Joseph's Hospital in London, reports a perfect compliance score. You can check out your hospital's compliance score here.
Evidence-based research, along with the experiences that patients and families regularly share with Patient Protection Canada, show that variations on these anecdotes are played out in hospitals big and small every day. They contribute to the epidemic of hospital errors and patient harm that claims tens of thousands of Canadian lives every year and injures many thousands more. This harm adds significantly to the cost of the healthcare system. Addressing this issue on a comprehensive basis will do much more to reduce spiraling healthcare costs, including litigation costs, and improve patient safety and family experiences faster than redesigning hospital rooms or changing floor plans.
And it could save countless more lives.
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