Have a Story to Tell? Had a medical error?
Frustrated with a health problem?
Wednesday, August 31, 2016
Wednesday, August 17, 2016
Monday, August 1, 2016
Friday, July 22, 2016
A Patient Family Advisory Council’s reduction of waiting room anxiety: I think about who’s coming after me
Wednesday, July 20, 2016
Tuesday, July 5, 2016
Friday, July 1, 2016
Another story from Dr. Maren Batalden:
A few months ago, I treated an elderly gentleman with cancer who was getting chemo, so his immune system was compromised. He got a urinary infection and ended up in the ICU [intensive care unit] with sepsis, needing specialized attention to support a very low blood pressure. He got better surprisingly quickly with antibiotics and fluids. He came to the regular medical unit late the following afternoon where I became the doctor in charge of his care. I met him the next morning and he told me he felt fine and was ready to go home. He’d been quite sick, so I wanted to watch him another day, especially because we didn’t yet have the culture results from the bacteria which caused his infection and we didn’t know which antibiotic would be safe for discharge.
I explained my concerns to him. “When will you have the culture results that describe my bacteria?” he asked. I said tomorrow. So he asked, “How about if you give me a dose in the hospital of an IV antibiotic that works for 24 hours, give me a prescription that is your best guess about an antibiotic pill that you THINK will treat my infection, let me go home, and call me tomorrow if we need to change the antibiotics. If we need to change it, we’ll change it then.” I thought it was a great idea! He said, “Why should I sit in the hospital waiting for lab results?! If I feel terrible, I’ll come back.” He did great! I called him the next morning; the culture results confirmed that his bacteria was sensitive to the antibiotics I had prescribed. He felt well and continued his recovery without complication at home.
It used to be that when it was time to discharge someone, I figured it was largely my decision to make. Many patients assume the same. “You’re the expert, doc. You tell me.” But I have come to realize that it’s NOT my decision; it’s a shared decision. I understand what the labs and the physical exam are telling me. But I don’t know really know how the patient feels compared to his or her usual state; I don’t really know what kinds of supports they have or don’t have at home. Decisions about whether and when to admit a patient to the hospital and whether or when to discharge have to made together. To my surprise this framework has pretty significantly changed my practice. I find myself keeping people in the hospital for another day or two, when left to my own devices, I might have discharged them earlier, or vice versa. The best care, I have come to believe, is always “co-produced.”
Thanks to Dr. Maren Batalden for her story. Read her article in the British Medical Journal on co-production of medical care.
Monday, June 27, 2016
Thursday, June 16, 2016
Friday, June 3, 2016
This is Part 2 of Debi Janway’s story about her mother’s care at Planetree. You can read Part 1 here.
It was a home-like feeling. I was here late in the evening, and my family would come. The waiting room in MedSurg is home-like, with round tables to eat at and relax with nice chairs, on the same floor as my Mom. So you know if the doctor or nurse wants to see you, you’re right there. You can heat up your own food in the kitchen that’s right there. If your family member is allowed to eat the same food while she’s in the hospital that she eats at home, you can cook that food for them.
They did aromatherapy. Mom absolutely loved the lavender they’d put in her room, it was so soothing. It was very quiet. You could hear a pin drop. No one just entered the room; they always knocked first, and asked, Would it be all right to come in? The lab techs would ask, Is this a good time to come in? It wasn’t intrusive. They’d ask, Is there anything else I can do for you? My Mom might say, Yeah, I’d like some more ice water. The lab tech or whoever would get her what she needed. As a Care Partner, we could do that too.
Hospital CEO Susan Stone adds:
We have a program, Lights Out Lavender. We’ll do a back massage for the patient, and ask if they’re ready for bed. Our staff round every hour.
We worked hard to make it quiet at night. For example, we have reminders to make sure the environment is quiet. We did an assessment and realized that the Housekeeping carts were too squeaky. The doors for the patient laundry used to click shut really loudly, so we’ve changed those. Also, we use soothing sound machines if patients like them, to create white noise, which can sound like rain, or the ocean.
Ken’s comment: The healing environment creates tangible results. Patients have high satisfaction, as do physicians and other staff. The environment seems to quicken healing, as patients’ length of stay is significantly shorter than in a comparison unit, according to “A Retrospective Evaluation of the Impact of the Planetree Patient-Centered Model of Care on Inpatient Quality Outcomes," abstracted here. Even so, the hospital has been profitable since 2010, perhaps because so many have heard about the spa-like hospital.
Thanks to Dr. Susan Stone and Debi Janway for sharing their story.
Thursday, May 26, 2016
Wednesday, May 25, 2016
Thursday, May 12, 2016
Two years ago I had a knee replacement. They had a two-hour class for ten of us having a joint replacement. They required it as preparation for surgery. They gave us an overview, and then also tools, for instance a calendar. They led us through an exercise: Put your surgery date on the calendar, then go ten days back and write down a note to stop your Motrin or other anti-inflammatory meds; and then lay out the future, with your post-op appointment ten days out. They told us what kind of healing you should see within two weeks. It was really comprehensive.