Danger in Surgical Care, Too! (Part 3 of 3)
Drugs used for comorbid conditions must be continued unless they add risk. Patients and family should reinforce history of allergies or sensitivities. Clarify nonprescription drugs like Aspirin, Advil and other supplements. Understand what new drugs are being used and reasons.
Include self-monitoring appropriate diet. Steak on your tray the day after abdominal surgery should be rejected.
Do not hesitate to question diet, drug deliveries, and infusions if they do not make sense. Participate!
There is old knowledge and experience. There is new knowledge that is available for all and clinically useful. There is other knowledge learned in medical school. There are guidelines for classes of patients that must be interpreted and integrated into individual decision making. Knowledge and facts change with time, studies, and participants. Statistics are interpreted differently depending on viewpoint. Decisions are made by interpreting facts and knowledge, Logic, intuition, and experience all contribute.
What seems simple is sometimes difficult. Difficult means different things to different surgeons for different reasons. Simple things can develop into difficult problems that can get more difficult in a difficult environment and suboptimal support system.
Maybe WATSON will solve this problem!
Meanwhile ask for comprehensible explanations.
Referring Physicians usually have a good handle on the competence of known specialists from past experience. But, in Hospital Systems, the Administration and ED frequently determines who cares for admission and specialty problems. COMMUNICATE AND GET AN EXPLANATION THAT MAKES SENSE and assure that you are under the care of the appropriate specialist, especially if you had a PCP referral.
This short paragraph refers to “preventable adverse events.”
This is a big deal. Some data is available through medicare but is incomplete. Hospitals have DASHBOARDS based on difficult to obtain and substantiated data.
Just think, if there are fifty small procedures contributing to surgical care, besides the main surgery, and each has an adverse risk of occurring of 1-2%, the additive potential risk is very significant. Standardized procedures can minimize many occurrences. This will be reflected by efficient routine organization of services.
The compulsive and tenacious surgeon can minimize most risks but this dedication will be interpreted as annoying by other caregivers. Examples are: intravenous line infection, hematomas, inflammation or thrombosis, leg vein thrombosis (local clots), clots traveling to lungs, urinary catheter infection or trauma bed sores, nerve injuries, falls while walking or in bathroom, falls out of bed, aspiration causing pneumonia, compromised breathing from pain causing pneumonia, displaced wound dressings of tubes, over hydration, under hydration, electrolyte imbalance, errors in medication, premature discharge, inadequate pain control. None of these include errors in diagnosis, ED delays, or issues occurring during anesthesia and in surgery that occur outside the control of the surgeon or the anesthesiologist.
10-“OUT PATIENT BLACK HOLES”
Confirm organized and timely followup and instructions plus an acceptable contact person and access. With early discharge, issues that were identified during hospitalization in the past now occur at home.
11-“SMALL THINKING; LOOK FOR SAFETY AS A PRIORITY”
I discussed a lot of this above.
24 hours of visiting hours facilitates family participation and surveillance. Assure that the hospital is committed to participation by family by providing comfort to visitors at all times.
Are communication systems like WiFi and telephone reception effective at all sites?
Are floors dry and spills immediately dried? Is heating and air conditioning controlled?
Is a topical antiseptic ubiquitously available?
Are hand washing sinks available?
Are showers safe and showering supervised?
“Clinicians want to do the right thing but find themselves on a “hamster wheel,” going faster and faster, and are unable to control the patient care for which they are responsible. Patience with the system and Corporate mandates are not unlimited. Many physicians, previously independent in practice, have been captured in this new system with productivity demands and their enthusiasm curbed.
”Community” or “Voluntary” Surgeons practices have been severely impacted by the many changes in the overall Medical Corporate Economic system.
Hospital Systems are forming as insurance companies aim to maximize Corporate profit. Insurance companies are taking over hospitals. The physician has become a cog in the Corporate Medical Industrial Complex. Independence is rare in a system controlled by Corporate Hospitals, Insurance Companies, Government, pharmaceutical Companies. Informatics, IT, and is also influenced and preyed upon by lawyers. Practicing Medicine and Surgery is a different profession than doctors expected and prompted commitment as a youth, years of training, and financial debt.
These factors rarely impact patients during their isolated experience but is a constant trauma to Physicians who get BURNED UP and then BURN OUT.
No Firemen in sight!
The End of Dangers in Surgical Care, Too!