In today’s world of improved technology, educational opportunities, and breakthroughs in medical knowledge, it is ironic that one of the major failings of the modern medical field is its inability to protect patients from preventable errors that occur in virtually all hospitals, nursing homes, outpatient clinics, and physician offices. Sadly, the very group that is designed to protect and improve patient health is far too often the one that does just the opposite. Because of the prevalence of, and the astronomical costs arising from, these mistakes, there is a national initiative to improve patient safety. However, it is not nearly enough.
From a financial perspective, the costs of mistakes in the medical field are huge, and add to the already explosive health care expenditures in today’s economy. The costs of medical errors, however, often exact a much more human price that cannot always be easily measured. Unnecessary deaths, loss of functionality, increased pain, chronic suffering, mental anguish, prolonged hospital stays…these are but a few of the non-monetary costs that patients experience daily as a result of their visits to a health care facility. Irreversible errors have disrupted not only the lives and health of many patients themselves, but have often ruined the lives of their families and friends.
After working in the health care field for over thirty years, I have come to find that better technology and availability of improved medical literature have not resulted in overall improved patient safety. Looking at almost any patient chart, numerous errors can often be found, not by simply one department or person, but often there seems to be a snowballing effect. In fact, it is almost a joke in hospitals nowadays that errors, many of them serious, tend to follow a particular patient throughout his or her stay. For example, a patient may be registered under another patient’s record due to carelessness by the admissions clerk, then the patient must wait for hours in a narrow hallway for someone to come to get him to take him to his room because someone forgot to come down to get him, nursing staff is too busy on the floor when he arrives to properly assess him so the medication ordered by his physician does not get to him for another couple of hours. In the meantime, the ER physician wrote the wrong dosage and the pharmacist failed to catch the mistake. The ward clerk picks up the wrong chart and orders lab-work and radiology testing on the wrong patient. If the patient is febrile, he may have blood cultures ordered stat to rule out sepsis and these should be drawn prior to administration of antibiotics; however, the one medication the patient receives on “time” is the antibiotic, and due to the fact that the clerk failed to order labs on the correct patient, our patient receives the medication prior to his cultures being drawn. Consider, as well, the fact that, when testing is ordered on the wrong patient, not only does the correct patient not get his testing drawn, but the incorrect patient is drawn unnecessarily. If the error is ever discovered by the physician (who astonishingly, actually may never even notice!), testing is at best delayed and may even be suboptimal (as in the example above for the blood cultures). I have seen serious errors occur and, but for the grace of “God”, some are caught just in time to prevent death or serious harm. Many are never caught and, no doubt no one ever knows why poor Aunt Jane went into the hospital for a simple surgical procedure, but left on a gurney to the local funeral home the same morning.
What are some of the causes of medical errors? There are a lot of reasons, many of which hospital administrators do not want to admit. In today’s health care environment, medicine is a business, and profitability is measured in terms of the “bottom line”.
One major cause is the lack of properly educated personnel, in particular nursing staff. In the quest for a solution to the nursing “shortage”, two-year associate RN programs are cranking out nurses into the market at an alarming rate. Under-educated to start with, they then do not receive the requisite on-the-job training; part of this is due to the lack of adequate staffing to perform such orientation. Why the lack of staffing? Hospital administrators and large corporate health care groups (the norm for survival in todays competitive health care business) force department managers in all clinical areas of most hospitals to staff on a shoestring in order to save money. Staffing is cut close to the bone by enforced “flexing” (sending personnel home without pay if patient volumes will not justify more people, no matter the “level” of illness of the patients and not accounting for higher patient arrivals later in the same shift). In other words, it is easier to send personnel home than to reach them to come in to work if needed. This is not a situation unique to nursing- all clinical departments are in this situation: overworked and overstressed. Often billing and insurance departments are the only departments with adequate staffing.
Also, there seems to be a consensus that anyone can do certain job functions in a hospital. For the past few years, in order to try to compensate for the shortage of qualified medical laboratory personnel, hospitals have forced nursing staff to draw blood and perform “waived” laboratory tests. Since many factors can affect laboratory testing, including equipment problems and specimen integrity issues, substandard results (often dangerously incorrect) can be reported by personnel not trained in the intricacies of such testing. This has also been an issue in physician offices, where doctors want to get reimbursed for laboratory and radiology tests and think that such testing involves only “pushing a few buttons”, but lack the proper training as to how to accurately perform them. I have seen nursing performing testing on incorrect samples and clotted specimens when the specimen was not supposed to be clotted. Hospital laboratories are tightly regulated by law. However, few patients realize that the same regulations do not always apply to physician offices, who are often not familiar with quality control requirements and how to handle quality control failures in order to ensure accurate patient test results.
In a work environment such as this, where medicine is perceived to be a business like any other, the attitude often rubs off on the employees. Health care has become merely a job to many health care workers nowadays. (I do not mean to imply that this is the case with all workers- there are still dedicated nurses, cardiopulmonary techs, radiology techs, physicians, laboratory technologists and technicians, etc., but they are getting fewer in number, older in age, and often quit out of despair.) Gone are the days when medicine was an esteemed and noble profession. Even doctors, in today’s workforce, are generally hired by hospitals and no longer have their own practices to be concerned about. Therefore, there is no initiative to “own” the patient’s health. Many doctors will refuse to answer their phones or beepers if they are “not on call”. And the physicians in a large practice who rotate call coverage? They are often not familiar with a colleague’s patient whom they may never have even seen. Specialists, although obviously important for specific disease- or organ- related treatment, simply do not have the time to get to know their patients well enough to treat the “whole” patient. Gone is the day of the family physician who hung out his shingle and knew all family members by name.
Also, the very fact that there is so much more knowledge out there adds a certain amount of risk. With all this information, one has to be able to sort it out. If there is not an efficient way to do this, it is easy to focus on the wrong treatment or miss the correct one. Although new technology to accomplish this is often available, remember that it costs money and many hospitals are not willing to spend it. Realistically, many cannot afford to in today’s world of decreased reimbursement by insurance and government agencies. An example is improved computer software and an electronic patient record. These do not come cheaply.
Probably one of the biggest causes of medical errors is lack of communication overall. Although there are initiatives to try to address communication issues, we are still behind the curve in actually putting these into use.
These are only a few of the reasons for risks to patient safety when visiting a hospital. There is a nationwide focus on improvement of patient safety. One of the best ways to improve patient safety is to empower patients to ask questions, to be observant, to learn about their conditions and to make sure that they question anything that doesn’t look or feel right about their care. Patients should get the facts from their physicians and make sure that they feel comfortable that they are not being overlooked. Speak up and speak out. Be knowledgeable enough to be able to converse intelligently about your health. If you do not feel comfortable doing so, take someone with you who is able to watch out for you. If you are hospitalized, if you have someone to stay with you, do so. Do not be afraid to question.