When hospitals choose higher margins/EBITDA/growth in earnings — whatever you want to call it— in exchange for bare-bones staffing that results in harm to patients, I have concerns. Patient care and safety should not be penalized because hospitals are willing to cut corners at any cost.
The following example is not hypothetical, or a story crafted from whole cloth to produce dramatic effect. It illustrates what happens in hospitals every day across the country. It was reported in the Modern Healthcare online edition story dated October 24. Not only were the facts shocking but it was the kind of event that invites greater regulation and union organizing efforts.
Here are the facts as reported in the article, that have ignited my frustration:
Last March, a nursing assistant noticed a large pressure ulcer on the backside of a patient needing intensive care at the Hazard (Ky.) ARH Regional Medical Center. It was about 10 days after the patient had been admitted for leg ulcers and complications related to diabetes and renal disease.
But on the day the sore was reported, the patient had been lying in one position on top of a bedpan for more than a day. The pressure from sitting too long in one position with limited blood flow had caused a large blister that covered the patient’s entire buttocks.
A federal investigation found the patient may not have been moved for “an extended period of time” because the hospital, part of the not-for-profit 10-hospital Appalachian Regional Healthcare system, was understaffed. Its policy required one RN for every six patients in this unit where most patients required intensive care. But that day, one registered nurse was caring for about a dozen patients, while the certified nursing assistant on duty had 14. Experts say it’s physically impossible for one nurse to attend to that many very sick patients.
In April, the CMS placed Hazard ARH in “immediate jeopardy” of losing Medicare funding due to failure to provide adequate staffing. That status was lifted in May. The hospital did not respond to requests for comment for this article.
Quality of care and patient safety are serious issues for our industry. Many thousands of patients die every year in hospitals as a result of preventable mistakes. Our industry has spent hundreds of millions of dollars trying to address quality and enhance safety without much success.
Hospital leaders have one of the toughest jobs in America today. Hospitals are complex business models but that does not mean that good service — which includes giving quality care in a safe environment — is such a complicated problem. You cannot say you have good service if your quality and safety numbers are low.
Patient care horror stories have become far too common and I fear that we have grown cold and indifferent to the sort of suffering and nonsense that only invites more regulation because the federal employees charged with overseeing this issue, the people we apparently love to hate, do not trust us to police ourselves. For patients to be placed in harm’s way for reasons that are purely financial is not acceptable. We should be outraged. Patients come to the hospital trusting us to take care of them to the best of our ability. Surely, putting the numbers first no matter what, is not worth breaking that trust.
© 2020 John Gregory Self