As health reform sets in, hospitals are gearing up for many challenges. While some of these are new to the health industry, several are against the backdrop of old problems that have plagued us for decades. Speaking as a doctor who has worked in a number of different hospitals up and down the east coast, I would like to identify 5 of these that I believe are fairly universal.
1. Medication reconciliation. This is being certain about what the patient’s correct medications should be, and is both a problem on admission and upon discharge. Not knowing the patient’s correct medications when they are first admitted to hospital can naturally start off a chain of events that leads to adverse medical events. The same applies to when a patient is discharged, when any medications changes (including new ones) must be made clear.
How does the confusion arise? Well, for a number of reasons including the fact that a patient who takes several pills may not always remember the names and exact dosages. There’s often nowhere for the doctor to go, especially outside of regular business hours, to obtain an accurate list. What hospitals need is a simple “no ifs, ands or buts” medication list. Studies are increasingly showing that pharmacists are the ones who are best placed to do this. Having a pharmacist stationed in the ER is a great idea, to hand every doctor who is admitting the patient a complete and accurate list. The same should happen on discharge, and can be targeted to high-risk patients. Think this is expensive for hospitals? Imagine the money (and lives) saved by reducing medical errors.
2. Dealing with patients’ most basic complaints. Nowadays, hospitals and health care organizations are using too many gimmicks when it comes to improving patient satisfaction and enhancing the patient experience. These include things such as flashy surveys, customer service agents, and computer apps.
Forget these. Why not just listen to your patients’ most basic complaints? Two of these would be getting a good nights’ sleep and tastier food! These are by far the two biggest complaints that I hear each and every day. Hospitals everywhere are failing to grasp the fact that what patients want is really quite simple. The list would also include more time with their doctors. It’s not rocket science. Listen, learn and create the right hospital environment.
3. Poor information technology systems. Unfortunately, most of the current IT systems are slow, cumbersome and inefficient. They make life more difficult for doctors and nurses, and take precious time away from patients. This applies both to computerized physician order entry (CPOE) and medical documentation. I’ve seen many people in health care informatics very enthusiastic about the new technology that’s being introduced into hospitals. Often many of them are the first to admit that the platforms are terrible. This would be akin to getting excited about delivering an awesome new traffic solution for a big city, knowing full well that the roads are completely broken! Hospitals shouldn’t make the mistake of planning a multi-million dollar investment in the wrong technology. The solutions of the future will be well thought-out and also utilize smart devices instead of PCs with keyboards and mouses.
4. Standardizing rounding. The way that hospital doctors round on their patients up and down the country is completely haphazard at the moment. One patient may get seen at 7am and another at 3pm. Often there’s no rhyme or reason behind the timing — it’s just about where the patient happens to be located in the hospital. Communication between nurses and doctors is also often sadly lacking. It’s not untypical for there to be no communication at all between the doctor and nurse either before or after seeing the patient. That’s unacceptable. A way to improve on this is to institute a full multidisciplinary rounding model. In this system, rounding is standardized to include all members of the care team, ideally also going into the patient’s room together.
5. Discharge. The discharge process is fraught with potential problems by its’ very nature. It needs to be as thorough and flawless as possible. Medications need to be checked and double checked, and all follow-up instructions should be made crystal clear. There are many ways to accomplish this — from a thorough patient handout to a dedicated discharge coordinator. Either way, the patient and family need to know the exact diagnosis and plan. This goes a long way to helping reduce readmissions and keeping the patient on a healthier path for the future. Having a good amount of time with the doctor sitting down with the patient and family immediately prior to discharge is also something to strive for.
If we could just solve the above 5 problems in our health care system, we will be taking a huge leap forward. The answers aren’t necessarily complicated or particularly expensive. They will require focus and collaboration across a range of professionals involved in hospital processes. When we address them in a standardized and evidence-based way, it will not only save the system money, but also make medical care safer and a better all round experience. Let’s get to work.
Suneel Dhand is an internal medicine physician and author of Thomas Jefferson: Lessons from a Secret Buddha and High Percentage Wellness Steps: Natural, Proven, Everyday Steps to Improve Your Health & Well-being. He blogs at his self-titled site, Suneel Dhand.
