Medical Economics – Week 3 Assignment
A Day on Hospital Wards
The use of technology on hospital wards should provide physicians, nurses, and other health care providers with a system that supports patient safety and satisfaction as well as efficiency.
“Patient Sign Out Sheets” include pertinent patient information including the reason for hospitalization, past medical history, code status, current medications, allergies, daily labs, and even VTE prophylaxis. This automated print out provides a basis for organizing physician thought processesand plans. This is a great example of how technology can simplify and improve patient care.
Despite this useful organizational tool, there are many other issues hospitalized patients face that require attention and are commonly left to the physician’s “mental checklist.” On a busy day on wards, items on this “mental checklist” can easily be overlooked. Common issues includecardiac monitoring, foley placement, line placement, ambulation status/physical therapy recommendations, diet, and as needed pain medications. The above issues commonly affect patient safety and satisfaction, and if they are not carefully monitored, gross inefficiencies in the discharge process can occur..
For example, the following is a common discussion on morning rounds. The attending asks “How was Mr. Ramirez’ night?” The intern replies, “ He is really frustrated because he could not get any sleep. He says the machine above his head was beeping all night.” On further discussion, it is determined that Mr. Ramirez was placed on cardiac monitoring on admission when his diagnosis was unclear and that his “ chest pain” was determined to be a peptic ulcer. The team discusses that there is no indication that the cardiac monitoring is required and it should have been discontinued in time to allow Mr. Ramirez to obtain a restful night’s sleep. Having left Mr. Ramirez on cardiac monitoring with no indication of cardiac issues incurs cost to the hospital and patient, may lead to unnecessary tests, and certainly decreases patient satisfaction by keeping the patient awake all night.
Another example of this issueinvolves Ms. Green who had a foleycatheter placed on admission due to an oliguric AKI. Though part of our “mental checklist” should include assessing foley as well as line necessity every day, this can be forgotten on a busy service and has the potential to adversely affect patient safety. The plan is for Ms. Green to be discharged to her home , but the intern reports that she is complaining of suprapubic pain and has a low grade fever. Ms. Green developed a CAUTI because her foleywas not removed days ago. The hospital will not be reimbursed for this and we have caused the patient harm.
I propose the creation of an additional automated patient status sheet that includes the pertinent patient issues that are commonly left to a “ mental checklist.” It should be documented in power chart if a patient is on cardiac monitoring or has a foley or line placement. Their diet, ambulation status, and record ofreceiving prn pain medications in the last 24 hours should also be documented. This data should auto-populate every morning on a patient status sheet. While it remains the physician’s responsibility to ensure that the auto-populated information on this sheet is accurate every day, at least there will be a mechanism to remind the physician of these issues. This could be an effective “ safety net.” In addition to patient safety and satisfaction, this will improve utilization of hospital resources and improve the discharge process.