[ Tuesday, February 22, 2005 ]


"Get out as fast as possible." I began this blog because I was introduced to blogging by Glenn Reynolds, law professor at UTenn. I read his Instapundit blog daily. Over the last few days, his wife, filmmaker Helen Smith, went in to have a cardiac catheterization done to look at an apparent heart arythmia, and ended up having a pacemaker implanted. This has led to lots of discussion on (i) medical technology and (ii) what it's like to be in the hospital. The former topic has cast the health industry in a favorable light; the latter topic, not so much. Why the constant sleep interruptions? Why is the patient awakened from a sound sleep so she can be weighed? Isn't that what we do in Abu Ghraib and Guantanamo that's got Amnesty International so exercised? That's led other bloggers to note that a hospital is a terrible place to recover from a stressful medical condition.

This past 4th of July, we were staying with a family of doctors in Houston and actually drove to the top of a hospital parking garage to watch fireworks. From that vantage point, we could see into one of the hospital room windows, and could see a very frail old lady lying in bed, which led my daughters to speculate about what might be wrong with her (and led me to silently and morbidly think about the odds of how soon she would be dead). You're probably more likely to die in a hospital than any other location on earth. A large percentage of people in the hospital at any time will be dead within months, if not days. Those are misleading statistics, because cause and effect are reversed (those poor folks are in the hospital because they are near death; they aren't near death because they're in the hospital). But it does raise the question of whether hospitals are good or bad for your health.

What's my point here, other than spewing Helen Smith's PHI around like a dropped fire hose? Much of what is done in a hospital is done that way because it's always been done that way. Patients aren't empowered to question how or why something is done (they're sick, they're weak, they're out of their element, they are intimidated by "militant people in uniforms," you get the picture), and there are too many entrenched minds involved in the stream of care to consider, much less attempt, changing the way things are done.

Much of the sleep deprivation is unavoidable: certain meds must be given at certain times, or certain readings must be taken at certain times. When making a decision of whether to run a patient's schedule based on the hospital's schedule versus the patient's schedule, there are many times when the hospital's schedule simply must be the default. But couldn't the meds be given via IV, and couldn't the reads be done via telemetry? And when there's no way to accomodate the patient's schedule, shouldn't the nurses tell the patient why it's imperative to wake them?

Are there efforts in the nursing profession to re-engineer the way care is delivered to the bedside, not to streamline the efforts of the hospital, but to minimize the sleep-deprivation, schedule-obliteration of the patients? Shouldn't some of these W. Edward Demming, Six Sigma, TQM folks be looking at this sort of "rubber hits the road" avenue to improve healthcare?

Update: this is getting some traction at this week's Grand Rounds, and also here and here (great blog name, BTW - hat tip to Gruntdoc for the intro).

Jeff [11:00 AM]

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