Surviving Your Hospital Stay

SEPTEMBER 26, 2015
Arlen Meyers, MD, MBA
hazard signHospitals are not good for your health. Every year, 400,000 people die in them due to preventable errors. One in 25 people admitted to the hospital will develop hospital acquired infections, some antibiotic resistant with the resultant 23,000 a year who die. Handoff errors are rampant and account for 80% of medical errors. Most of these problems have to do with people. Now, according to a new report, we have to worry about dangers of medical technologies used in hospitals. They include:

1) Alarm Hazards: Inadequate Alarm Configuration Policies and Practices: Hospital rooms are typically filled with patient-monitoring devices that emit alarms when pre-set conditions occur. Frequently, this can make for such an ever-present cacophony of beeps and buzzes that healthcare workers stop paying attention to them. “Alarm fatigue” will persist unless the facility creates and follows a policy where each piece of equipment is calibrated to sound an alarm only in clinically significant conditions that require a staff response.

2) Data Integrity: Incorrect or Missing Data in EHRs and Other Health IT Systems: Part of the purpose of electronic health records (EHRs) is to reduce medical errors caused by missing, conflicting, or incorrect information about a patient and their treatment. But even the most up-to-date technology for centralizing that data is subject to errors by the person entering the information, delays in transmission, or problems as mundane as two computers or pieces of equipment with conflicting date or time readings.

3) Mix-Up of IV Lines Leading to Misadministration of Drugs and Solutions: It’s common for one patient to be connected to multiple IVs. A tangle of tubes can result in one or more line being connected to a wrong fluid container, dripping at the wrong rate, or administering medication at the wrong site. Most errors of this type can be prevented with proper labeling and by physically checking each line from source to destination.

4) Inadequate Reprocessing of Endoscopes and Surgical Instruments: The Ebola crisis has highlighted the need to carefully disinfect and sterilize any and all objects that have a chance of being contaminated through contact with a patient. The incidence of problems is low, but the results can be severe. Endoscopes present a particular challenge because of their narrow, hard-to-clean channels. Education, rigorous protocols, and adequate time and room for reprocessing are the keys to preventing these errors.

5) Ventilator Disconnections Not Caught Because of Miss-set or Missed Alarms: The aforementioned risks from misconfiguring medical equipment alarms are particularly dangerous in the context of catching ventilators that are experiencing partial or complete disconnection along the breathing circuit. This can lead to brain injury or death. Protocols must be enforced to ensure alarms are set to actionable levels, are clearly audible to staff, and are backed up with ancillary notification systems.

6) Patient-Handling Device Use Errors and Device Failures: Patient-handling refers to healthcare workers lifting, moving, or transferring patients. A report by the Occupational Safety and Health Administration (OSHA) estimates that in a national survey covering approximately 1,000 hospitals, patient-handling injuries accounted for 25% of all Workers’ Compensation claims for the healthcare industry in 2011. A wide variety of devices, such as lifts, sliding boards, and specially designed chairs, toilets, mattresses, and stretchers can reduce the strain on workers. But these devices carry their own risks in cases of improper use or mechanical failure. Regular maintenance of the equipment, training in its proper use, and paying attention to weight-bearing limits are among the best solutions here.

7) “Dose Creep”: Unnoticed Variations in Diagnostic Radiation Exposures: Patients may be exposed to increased radiation levels by clinicians attempting to improve image quality in diagnostic radiology. Standard practice requires that the technician obtain the diagnostic image with a dose that is “as low as reasonably achievable (ALARA).” Manufacturers are increasingly adopting the standardized exposure index (EI), established by the International Electrotechnical Commission (IEC). Procurement of new equipment that adheres to this standard can eliminate this problem, but only with accompanying software upgrades, device calibration, staff training, and integration of EI checks into existing workflows.

8) Robotic Surgery: Complications Due to Insufficient Training: The differences between traditional surgery performed with human hands and robotic surgery performed with machines require training for the entire surgical staff. This can prevent errors in positioning team members (relative to the size of the robot), lapses in safety precautions and team communication, or a lack of proficiency in the surgeon’s ability to use the equipment optimally. Training should be reinforced by frequent experience using the robotic equipment, as well as rigorous credentialing.

9) Cybersecurity: Insufficient Protections for Medical Devices and Systems: Electronic medical equipment is increasingly interconnected and networked. That means it is vulnerable to malicious hacks, malware, or invasions of privacy. These risks should be formally assessed on an ongoing basis, and mitigated through the implementation of IT best practices such as network firewalls, strong passwords, and software patches.

10) Overwhelmed Recall and Safety-Alert Management Programs: The exponential growth of healthcare technology corresponds to an increasing flow of manufacturer recalls and safety alerts from government agencies and non-profit organizations. Missed recall or safety announcements aren’t mere administrative errors – they can lead to dangerous malfunctions that endanger patients’ health and lives. A management system is needed to receive these critical pieces of information, distribute them to the correct personnel, respond to them, and document that response.

Patients – even the most vigilant – can do little or nothing about most of these risks. Doctors and hospital administrators and staff can only do so much. With so many moving parts during any given patient admission, technologists, safety engineers, and medical device manufacturers need to do a much better job of building safety and redundancy into their products. They need to pay more attention to the development and application of methods for the enhancement of the safety and reliability of complex technological systems.

To survive your hospital stay or help someone else to do so, you have to be a medical quarterback and know the playbook cold. Most patients can't. Just understanding the lingo takes Google Medical Translate or a knowledgeable advocate or intermediary. HINT: Business opportunity.

Americans have achieved incredibly complex technological accomplishments – the Atom Bomb, the space program, the Human Genome Project, and the Hubble Telescope – to name a few. Several medical products, like electronic health records, don't work for harried, busy, practitioners or are so complex they require a long learning curve, like robotic surgical devices. “Safety first” should be more than just a motto. Just because the Food and Drug Administration clears something does not guarantee that it's safe.



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