What patient wants to be hospitalized? Yes, hospitals have come a long way in making patients feel more comfortable. Shared rooms, increasingly, are becoming a thing of the past, the food has improved, free wireless internet access is widespread, and in-room entertainment options have expanded.
There are, however, some underlying issues that may make your patients’ hospital stays miserable. Some of them may be within your power to address.
The wait to be discharged
Your patient has recovered from their illness or procedure, they’re stable, and they can’t wait to go home. But wait they shall!
In many hospitals, the discharge process can creep, sinking patient satisfaction scores. For example, the consultancy SBTI recently posted about an Indiana hospital in which only 47.6% of discharged patients rated discharge timeliness as “very good.” The problem isn’t unique to the U.S. A 2021 Proceedings of Singapore Healthcare study found that among a study sample of 218 patients, 61.1% experienced discharge delays.
What’s slowing the process? Often, it’s timing. Many hospitals have experimented with discharging patients before noon. Of course, noon at most hospitals is prime time. Morning OR cases are making their way to patient floors, activity in the ED is increasing as people go about their days getting sick and injured, and other physicians are sending over patients for admission. Suddenly a noon discharge—which in many cases is planned on the prior afternoon—becomes 3 p.m., 4 p.m., 5 p.m. ...
Of course, patient discharge is a complex process of which the doctor plays only a small part. So, what can a doctor do to speed things up? An American Journal of Accountable Care study points to starting the process as early as possible. Researchers looked at discharge records for 1,707 patients who had undergone colorectal surgery. The researchers concluded that early-morning discharge orders increased the time it took to discharge patients and created a discharge backlog. Keeping these findings in mind, if a noon discharge is the target, a doctor could speed things up by submitting the order early the day prior to planned discharge (when possible, of course).
A 2020 American Journal of Managed Care study identified some interesting correlations between discharge before noon (DBN) and overall length of patient stay. The researchers found that among medical patients who received DBN, total length of hospital stay was above the median. Surgical patients who received DBN, on the other hand, had a length of stay below the median. The finding among medical patients suggests that some of the 78,826 patients involved in this study could have been safely discharged the evening prior. Taking these findings into account, doctors may be able to expedite discharge by asking themselves, if the patient can be discharged tomorrow at noon, could they potentially be discharged tonight?
Fear of infection
COVID-19 made many a bit more germaphobic. But what effect did it have on healthcare-associated infections (HAIs)? In a 2021 Clinical Infectious Disease study, researchers looked at 148 hospitals over 7 months to identify any associations between COVID-19 surges and HAIs. They found:
A 60% increase in central line-associated bloodstream infections
43% more catheter-associated urinary tract infections
44% more MRSA infections
A significant association between COVID-19 surges and hospital-onset bloodstream infections and multidrug resistant organisms
“COVID-19 surges adversely impact HAI rates and clusters of infections within hospitals, emphasizing the need for balancing COVID-related demands with routine hospital infection prevention,” the researchers concluded.
There are a couple of things doctors can do to put patients at ease and increase hand hygiene compliance. A 2017 Pediatric Quality & Safety study suggests that reminding your colleagues may help. The 4-year study involved more than 30,000 hand hygiene observations, 9% of which included attendings and 12% of which included residents. By simply having volunteers remind healthcare workers to wash their hands, compliance increased from 75% to more than 95%. A 2018 Journal of Infection Control study indicates that physicians are more likely than nurses and other healthcare providers to need external hand hygiene reminders.
Feeling misunderstood or discriminated against
Kaiser Health News recently published an eye-opening report that cataloged numerous instances of age bias in healthcare. It included the story of an 84-year-old pharmacy professor who was denied opioids while in agonizing pain from a urinary tract infection. A 63-year-old stroke and heart attack survivor summed up her nursing home experiences succinctly: “When I ask questions, they treat me like I’m old and stupid and they don’t answer.”
Sex and gender-based discrimination also persists. For example, so-called “bikini medicine,” or the idea that from a healthcare standpoint, men and women differ only in the anatomical aspects that would be covered by a bikini, remains rampant. Its shortcomings manifest in how cardiovascular disease, mental illness, and even COVID-19 are managed. Mounting evidence indicates that these conditions, among others, must be managed also through the lens of sex and gender.
Finally, implicit and explicit racial discrimination persists in U.S. hospitals and healthcare. A Kaiser Family Foundation report indicates that:
When compared with White people, people of color fare worse across numerous measures of health status, such as pregnancy-related deaths, infant mortality, overall physical and mental health, and rates of chronic conditions.
Black people live on average four years fewer than White people.
Black adults are more likely than White adults to say they had negative healthcare experiences, including a healthcare provider not taking them seriously and denying a test, treatment, or pain medication.
To combat implicit bias, the Joint Commission suggests using the following cognitive skills:
Perspective-taking: Strive to see things from the patient’s point of view.
Emotional regulation: According to the Joint Commission, clinicians who experience positive emotions while providing their services “may be less likely to view patients in terms of their individual attributes.”
Partnership-building: Thinking of patients as partners in the care continuum, rather than recipients of care.
Chances are, your hospitalized patients dislike and/or fear:
Waiting to be discharged. Studies indicate that discharge before noon is still a work in progress, and it helps to start the process as soon as possible.
Getting an infection. It seems COVID may have increased rates of hospital-acquired infections. Research indicates that doctors benefit from external hand hygiene reminders, so if you see your colleague slacking, maybe give them a nudge.
Feeling misunderstood or discriminated against. Ageism, sexism, and racism persist in healthcare. Doctors can strengthen meta-cognitive skills to become more aware of where they may be implicitly biased.
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