[Reblog] Keeping Elders Out of Hospitals as Much as Possible

From the December 4, 2013 post  by Marti Weston at As Our Parents Age

 

Anyone who has spent time with an elder parent in the hospital knows just how easy it is for one problem to be solved only to have the person discharged with different problems. This is not necessarily the fault of the medical caregivers or the hospital itself — it’s a result of a system that puts older people into beds and keeps them there. Add in bed alarms, the inability to move much, and that hospitals isolate elder patients from their routines and support communities, and you have a recipe for unsuccessful care, a result of age associated hospital complications.

So I recommend reading The Hospital is No Place for the Elderly, a November 20, 2013 article that appeared in the The Atlantic. This piece aptly illustrates the conundrum of frail elderly patients with chronic health issues admitted to hospitals where medical care focuses primarily on fixing acute health problems. The difficulty is that most of frail elders’ medical issues cannot be fixed — but the quality of their lives can improve. Author Jonathan Rauch also describes several programs in the United States — teams of physicians, nurses, and other health professionals — that collaborate to keep patients as healthy as possible and out of the hospital. The teams even save money.

Many team-based support programs for frail elders run deficits, despite that they are so successful, but Rauch reports that the climate is changing, as Medicare and some insurance companies develop a more welcoming attitude toward innovative health care programs. The Affordable Care Acthas designated money to support innovative and new models of care delivery. (To learn more about other innovative programs you might also want to read Atul Gwande’s 2011 New Yorker article about changing models of medical care.)

One of the most interesting parts of The Atlantic article was the description of the team meetings where participants collaborate and coordinate patients’ medical care in order to help elders stay as healthy as possible.

Best Atlantic Article Quotes

• The idea is simple: rather than wait until people get sick and need hospitalization, you build a multidisciplinary team that visits them at home, coordinates health-related services, and tries to nip problems in the bud.
• These people aren’t on death’s doorstep, but neither will they recover. Physically (and sometimes cognitively), they are frail…
• Patients were presented not as bundles of syndromes—as medical charts—but as having personal goals, such as making a trip or getting back on their feet. The team tries to think about meeting patients’ goals rather than performing procedures.

 

 

Related articles

• One-third of older adults admitted to ICU deemed “frail” (medicalnewstoday.com)
• Elderly patients are at risk of readmission after hospital stays (express.co.uk)

The Empowered Patient Strikes Back (Book and Web site)

From the 21 December 2012 post at The Health Care Blog

…Julia Hallisy learned about patient safety the hard way. Hallisy’s daughter, Kate, was diagnosed with an aggressive eye cancer when she was five months old. Over the next decade, she went through radiation, chemo, reconstructive surgery, an operation to remove her right eye, a hospital-acquired infection that led to toxic-shock syndrome and an above-the-knee amputation…

…Hallisy decided to write a book that might help others. In 2008,  I reviewed it on HealthBeat…

..

At the time I wrote: “Remarkably, The Empowered Patient is not an angry book. It is not maudlin. To her great credit, Hallisy manages to keep her tone matter-of-fact as she tells her reader what every patient and every patient’s advocate needs to know about how to stay safe in a hospital.”

Recently, Hallisy emailed to tell me know that the book has now become a non-profit foundation: The Empowered Patient Coalition.

Go to their website and you will find fact sheets, checklists, and publications including, A Hospital Guide for Patients and Families that you can download at no charge. I found the Hospital Guide eye-opening. I have read and written a fair amount about patient safety in hospitals, but it told me many things that I did not  know…

[Great outline of doctor/nursing hierarchy]

[Questions Patients and Advocates Should Ask]

[What To Look For In Your Medical Record]

Related articles

• Oops! US Doctors Screw Up Surprisingly Often: Study (livescience.com)
• Patients as customers: surfing for hospital emergency departments with shorter wait times (blogs.vancouversun.com)
• My experience as an empowered patient (worldofdtcmarketing.com)
• How to Make Your Hospital Stay Safer and Cheaper: A Checklist (pbs.org)
• Hospitals Are Killing Us (lewrockwell.com)

 

Infections in ICUs Plummeting, Too Many Remain in Hospitals and Dialysis Clinics

Infections in ICUs Plummeting, Too Many Remain in Hospitals and Dialysis Clinics

http://www.cdc.gov/media/releases/2011/p0301_vitalsigns.html

ICUs show that preventing infections is possible; other health care settings must adopt prevention practices

From the press release

The number of bloodstream infections in intensive care unit patients with central lines decreased by 58 percent in 2009 compared to 2001, according to a new CDC Vital Signs report. During these nine years, the decrease represented up to 27,000 lives saved and $1.8 billion in excess health care costs. Bloodstream infections in patients with central lines can be deadly, killing as many as 1 in 4 patients who gets one….

…

“Preventing bloodstream infections is not only possible, it should be expected. Meticulous insertion and care of the central line by all members of the clinical care team including doctors, nurses and others at the bedside is essential. The next step is to apply what we’ve learned from this to other health care settings and other health care-associated conditions, so that all patients are protected,” said Thomas R. Frieden, M.D., M.P.H., CDC director.

In addition to the ICU findings, the report found that about 60,000 bloodstream infections in patients with central lines occurred in non-ICU health care settings such as hospital wards and kidney dialysis clinics. About 23,000 of these occurred in non-ICU patients (2009) and about 37,000 infections occurred in dialysis clinics patients (2008).

“This reduction is the result of hospital, local, state and national medical and public health efforts focused on tracking infection rates and then using that information to tailor and evaluate prevention programs,” said Denise Cardo, M.D., director of CDC’s Division of Healthcare Quality Promotion. “The report findings point to a clear need for action beyond ICUs. Fortunately, we have a prevention model focused on full collaboration that can be applied broadly to maximize prevention efforts.”

Infections are one of the leading causes of hospitalization and death for hemodialysis patients. At any given time, about 350,000 people are receiving hemodialysis treatment for kidney failure. Seven in 10 patients who receive dialysis begin that treatment through a central line….

Related Articles

• Patient Safety Awareness Week 3: Positive News on Infections, More Work Needed (hcfama.org)
• Rates of Pneumonia Dramatically Reduced in Patients on Ventilators in Michigan Intensive Care Units (nlm.nih.gov)
• Challenges In Stemming The Spread Of Resistant Bacteria In Intensive Care
• Simple Cotton Swab Slashes Reduce Post-Op Infection (Medical News today, June 2011)
• Infection Risk Lurks in Hospital ICUs (webmd.com)