Despite the wake-up call given 18 years ago by the Institute of Medicine’s report “To Err is Human,” medical errors still occur at alarming rates. The landmark publication estimated that up to 98,000 Americans die each year from medical errors, and one out of every twenty-five hospitalized patients is harmed by a medical mistake. There is, however, cause for guarded optimism. Many organizations, agencies and legislatures have stepped forward and created solutions and educational programs targeted at reducing medical errors.
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Surgical Site infections (SSIs) occur in 2% to 5% of surgery patients. This category of infection comprises approximately 22% of all healthcare-associated infections and has a 3% mortality. Patients with SSIs require significant care and average 7 to 10 days of increased length of hospital stay. The cost of providing care for a single SSI ranges from $3,000 to $29,000. The total cost of care for SSIs is estimated at $10 billion dollars per year. There are of course additional expenditures for outpatient care, readmissions, and care of long-term disabilities.
Catheter-associated urinary tract infections are the fourth most common HAI. They comprise over 12% of all acquired infections in acute care hospitals. 93,300 of these UTIs are estimated to be acquired in hospitals each year, with an estimated death toll of 13,000 patients.
The CDC defines a Central Line-Associated Bloodstream Infection as: “A laboratory-confirmed bloodstream infection (LCBI) where central line (CL) or umbilical catheter (UC) was in place for more than 2 calendar days on the date of event, with day of device placement being Day 1 and the line was in place on the date of event or the day before.” In other words, the patient must have had the device in place for at least 2 days and the diagnosis must be made while the device is still indwelling or was indwelling on the day before.
The Centers for Disease Control and Prevention defines healthcare-associated infections (HAIs) as: “Infections that patients acquire during the course of receiving healthcare treatment for other conditions.”
Healthcare-associated infections are very common, and the cost associated with them is enormous. It is estimated that 1 out of every 25 hospitalized patients is treated for an HAI, with costs ranging between $28 billion and $33 billion per year.
Any discussion of communication in healthcare must include the process of transferring patients and their vital medical information from one provider to another and/or from one healthcare setting to another. Such transfers are known as healthcare handoffs; examples include when a patient is transferred from an ambulance to an ED or when a surgical patient is moved from the recovery room to a surgical floor.
Physicians, nurses and other “healers” have had special relationships with patients for centuries. This unique bond between those who provide medical treatment and those who receive their care is currently being endangered by a massive and impersonal healthcare delivery system that is becoming more dependent on automation and technology with each passing year. The good news is that patient attitudes, impressions, and subsequent compliance with treatment plans can be positively influenced when healthcare professionals improve their communication skills with their patients.
According to the most recent survey on hospital culture by the Agency for Healthcare Research and Quality (AHRQ), provider perception of a positive hospital safety culture was the lowest for questions concerning the presence of non-punitive response to errors, effective handoffs and transitions, and adequate staffing. These results are detailed by the AHRQ in the “Hospital Survey on Patient Safety Culture 2016 User Comparative Database Report.”
“It’s all about communication!” The world of medicine has changed by leaps and bounds over recent decades. Computers are part of our daily lives, and technological advances have significantly improved our ability to diagnose and treat diseases that were once thought incurable. Despite this incredible progress, healthcare providers continue to commit far too many medical errors. And unfortunately, many of these mistakes are simply caused by “poor communication.”
Current strides in improving patient safety in hospitals and medical facilities provide clear evidence that the healthcare industry has the capacity for meaningful change. However, providers continue to face significant obstacles; perhaps the biggest obstacle of all revolves around developing and expanding a vigorous “safety culture.” Indeed, much of the focus has been on technology and incremental process improvement, but building a “culture” is the foundational contributor to ensuring patient safety.