About 25 years ago I had gallbladder surgery. That was before they started using a laproscopic procedure, so I spent a couple of nights in the hospital. That was my last hospitalization until my thoracoscopy in late May. Some things have changed and some have stayed the same.
For the Better
I think hospital admission procedures are easier now. Part of that may be that I receive all of my healthcare from a single organization—Scott and White Healthcare—that uses electronic medical records. The hospital already had all of the information needed for admission, so I simply had to show up at a scheduled time at the hospital and sign a few papers. Very convenient.
I think the hospital is more compulsive about ensuring that the patient is the one they are supposed to be doing something to. The nurses and others would hardly speak to me without asking me my name and birth date, and before the thoracoscopy, the surgeon came in to initial my right shoulder to ensure that everyone agreed that it was my right chest they were going to look at. In the past they would look at my hospital ID bracelet before doing anything, but I guess it is more accurate to have me give them my name and DOB.
My room seemed to be smaller than the one I had 25 years ago; however, it was not too small. It seemed to be just the right size. It had a very comfortable hospital bed, a small recliner, and an interesting small sofa that expanded lengthwise so a visitor could stretch out to sleep. I think that was the best innovation in the room. There was also a small wardrobe with a flat screen TV above it.
Pain management also seems better than 25 years ago. While I never suffered much the first time, I had virtually no pain this time because my epidural drip that shut down pain in the chest area. The painkillers were in a secure, electrically powered box hanging from my IV stand. When the medicine ran out, an alarm would sound, and I’d push the call button and alert the nurses. Then someone from pain management would come around to add new medicine to the machine. Actually, my regular IV also sounded an alarm when it ran out. That seems much more efficient than depending on a nurse or aide’s having to visually check the IV.
There were other new electronic aspects to my stay. Whenever the nurse came around to give me my medications, the cart had a built in laptop with a scanner that read my hospital ID to record who was receiving the dosage.
The final improvement was the use of wound adhesive to close all of my external incisions. With this surgical super glue, there are no more stitches to remove. The glue just flakes off after the incision has healed.
About the Same
At the time of my gallbladder surgery, I had been working long hours, and in some ways the surgery was a kind of a vacation. I really liked the fact that I could watch TV in the middle of the night without worrying about having to get up in the morning and without disturbing Jana or the girls. I also enjoyed rolling my IV stand down the hall to the kitchen and getting juice or ice cream at any time of the day or night. This time, my hospitalization was not a vacation, but it was not a bad experience either because I still had unhindered access to a refrigerator with yogurt, ice cream, and juices.
Worse
The hospital participates in a federal program in which patients rate their stay on several common items, and the results are used to compare hospitals. Items over which nurses and auxiliary staff have some control are provided in the box below.
· Nurses were courteous and respectful, listened carefully, and explained things clearly.
· Patients got help from the staff as quickly as they felt they needed it.
· Patients' rooms and bathrooms were kept clean.
· Whether patients would recommend the hospital to friends and family.
· It was quiet at night around patients' rooms.
· When patients were ready to leave, the staff discussed the help they would need and gave them written information about their recovery.
All of these items are important, but except for the last one, they have little to do with the quality of the medical treatment provided to the patient. The halls were filled with posters about providing “5-star” service on floor 4D, and the nurses, aides, and other staff were with one exception friendly, solicitous, and helpful. The problem is that rankings on these broad items divert attention from more crucial aspects of one's treatment.
The idea that schools, colleges, hospitals, and other institutions can be ranked in terms of quality is appealing on the surface, but the ranking processes are too simplistic to really be useful. Questionnaires are easy to create and analyze, and people think the ratings provide accountability, but it is all so superficial. These items are not sufficient to evaluate the quality of nursing at the hospital. Patients’ reactions are much less important than the ways medical procedures are carried out and the quality of the staff’s responses to nonroutine medical events. The name checking procedures and the use of a computerized system to check medications mentioned above attests to the fact that attention is being paid to important processes, but the fact that I was given different deep-breathing instructions by different personnel, and the fact that my glaucoma drops were somehow misplaced suggest that ratings of patient satisfaction might not be the best data on which to evaluate a hospital. Lets hope that there are leaders in all of these institutions who focus on improving significant institutional procedures and practices in addition to the PR window dressing that the rankings represent.
Oh, did I mention that patients can go down to the floor’s kitchen and get ice cream, juices, yogurt, and other snacks whenever they want?
David
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