On the outside, most American hospitals appear completely modernized. If resources are utilized correctly, they appear equipped for any disaster, any CMS audit and any surprise joint commission inspection that may come. The procedural appearance of hospitals seems robust and reflective to medicine in the 21st century. However, the framework for the daily function of many American hospitals is architecturally weak and weathered (metaphorically speaking). With the progression of times comes the evolution of disease processes and the divergence of various patient populations. Many hospitals have yet to adjust to this phenomenon.
As a result, the foundation is insidiously cracking, and many factors yet to be addressed are culprits for its chipping. We are in serious need of a structural upgrade. And here are examples as to why.
After a patient is admitted to a facility, they are often placed in a joint room with another patient. This decision is often due to bed availability within a given hospital. As part of their diagnostic workup, previously undiagnosed illnesses can be discovered. Patients may have an extended spectrum beta-lactamase urinary tract infection, Clostridium difficile colitis, or Methicillin-Resistant Staphylococcus Aureus colonization. With the joint room system, the task of having to move the infected patient to a private room to isolate them from other patients, including their roommate, is not uncommon. However, time does not allow regression to prevent exposure of such illnesses. We must seriously re-evaluate the use of the joint room system in patients deemed at risk for infection/colonization that could cause potential transmission to others.
Another problematic issue with the joint room system is the ongoing drug epidemic. This leads to vulnerable patients potentially being exposed to patients who have high-risk behaviors which may be disruptive to their care. Patients with substance use disorders will often attempt to find methods to use their substance of choice while they are being treated in the hospital for conditions that are or aren’t related to their ongoing drug use. Opioid-dependent, as well as other drug-addicted patients, are a special group of patients who have unique and particular needs.
Often times, the process leading to intervention and treatment for our drug addicted patients is difficult physiologically and psychologically. This requires their health care team to provide undistracted, distinct and specialized care. Therefore, a private-room policy for patients with substance use disorders will allow more directed treatment in providing education and counseling. In turn, this will greater promote the chances for remission.
In many hospitals, an operator announces the conclusion of visiting hours. Recently, I came to the realization that this announcement was more of a formality and not an enforced rule. In my almost ten years of being a medical doctor, I have never seen a hospital staff member escorting visitors to the elevators after “visiting hours” are over.
If a patient wishes to have a family or friend stay with them during the night that wish should be honored. Hospitalization is often accompanied by fear, and many of our elderly patients experience delirium and sundowning that can complicate their care. Having a familiar face present for patients can be therapeutic and promote an optimal hospital outcome. However, these specified individuals need to be made known to the medical staff and appropriately identified.
With the current system in place in many hospitals, any person can enter the wards with no true surveillance of their activity. With the exception of the locked units, the medical and surgical wards are open, free and available for anyone to enter. Typically, there is no routine placement of security guards on each floor or unit. A security guard may be sitting at the entrance of the hospital, but it is not in their common practice to question each individual that enters the facility.
Unfortunately, there are more security measures found in concert halls, stadiums, and hotels than provided in many hospitals. If we truly want to do no harm, we must work to stop an opportunity for harm to occur. An upgrade in security practices is a must for hospitals in the 21st century. We are severely lagging in this particular area, and drastic measures need to be taken to ensure the safety of hospitalized patients and the medical staff.
In conclusion, I hope my words serve as a spotlight to some of the issues at hand. Many hospitals in our country may be addressing these very issues currently. But a more uniform effort is greatly needed. I fear we are in grave danger of hospitals no longer being safe havens. Undoubtedly, this will have a negative ripple effect in families, communities, and our overall health care delivery system.
I write in hopes that a policymaker, a politician and/or a hospital administrator will allow my commentary to be the voice in generating discussions on how to address these issues. Yes, there will be disagreement about approach. Yes, it will be costly. But in order to preserve the quality of our health care system in hospitals, these discussions and changes are absolutely vital in preserving the practice of hospital medicine in America. We need to reboot progression and reorganize hospital care congruent to our complex societal and medical problems we face in the 21st century.
Andrea Lauffer is a hospitalist.
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