Welcome to the debut issue of On Call — your guide to the rapidly shifting world of hospitals and health care.
Introducing On Call
We were eating in a pizza parlor when I noticed something strange happening to my 2-year-old son. The right side of his face was rapidly swelling, his lip the size of a Magic Marker.
My wife and I rushed to an Akron Children’s urgent care. The doctor checked my son’s vitals and found everything was normal, other than a slight fever, fatigue, and the swelling. A nurse gave him Benadryl and a lime popsicle; exhausted but relieved, we drove home, wondering whether it was an allergic reaction (the salami, maybe?) or a passing virus.
The episode unfolded at the end of my second day as STAT’s national hospitals writer. It reminded me, yet again, of the importance of the world I’ll cover in this newsletter.
My goal for On Call is to bring you compelling news about hospitals and the delivery of care across the United States. You’ll read about innovators (in a feature I’m calling “Zag of the Day”), hear from top execs, and meet the caregivers who make it all happen. I’ll take you inside controversies, explore the push and pull of regulation, and unpack the financial forces shaping health care. I also aim to capture the drama, humor, and humanity that you all see every day.
A little about me: I’m a veteran business and health care journalist now living outside Cleveland, where I’ve been trying my hand at farming in my spare time. (Here’s my full bio.) I’ll be traveling the country to report; I’ll also be drawing on my STAT colleagues in Boston, D.C., New York, San Francisco, and Los Angeles.
I’m eager for your feedback.
Quick poll: How to fix caregiver burnout
We hear all the time that doctors and nurses are burned out.
How burned out?
We asked. Or rather, we asked our partner Figure 1, which gives medical professionals an online forum for consulting with their peers, to pose that question to its members. They got more than 1,800 responses, and the results were revealing:
Nearly half the US nurses and doctors who responded said they were at 4 or 5 — with 5 being extremely burned out — on a 1-to-5 scale. Asked what their employers could do to make things better, they weren’t shy:
“Stop pushing patient satisfaction to the Nth degree,” wrote one physician.
A nurse wrote: “Show even a little gratitude or appreciation. The only time time I hear from supervisors/admin is when I’m being told what I/we did wrong.”
Another nurse was even more blunt: “Stop the assembly line style of patient care…There is blatant disrespect for the providers from unlicensed, under-educated management.”
How could your workplace improve morale? Email me your thoughts and we may feature them in a future On Call.
She wants to start a revolution
As one of my first stops on this new beat, I headed west to Salt Lake City to talk with a woman who’s become known as a major force for change: Dr. Vivian Lee.
Since she took the helm of the University of Utah Health Care system five years ago, Lee has ruffled a lot of feathers — and inspired plenty of hospitals execs to follow her lead.
She was the first to dare to post unedited patient reviews of doctors on her hospital website. And the first to insist on tracking the cost of every single service the hospital provides. (The resulting database contains 200 million rows of info, each as wide as a football field.)
Lee’s next big idea: Asking patients how they’d define successful care. And making sure every one delivering that care is driving toward that goal.
Read more about Lee and the radical changes she’s unleashing.
New this morning: Mental health crisis in the ER
The shortage of emergency psychiatric care is dire.
That’s the message coming out this morning from the American College of Emergency Physicians’ annual confab in Las Vegas. Half of the 1,700 ER docs polled by the group say the mental health system in their communities has frayed in the past year. And the ER is often left to cope.
Among the findings sparking dismay (and discussion) today:
- Only 17 percent of ER docs surveyed reported having a psychiatrist on call to respond to mental health emergencies.
- About half said psychiatric patients are routinely “boarded” in the emergency department as they wait for an inpatient bed.
- Nearly one in four psychiatric patients (compared to 10 percent of medical patients) stayed in the emergency department more than six hours.
- Patients with bipolar disorder, depression, and psychosis were especially likely to face waits of more than 24 hours.
“We are looking at a potential crisis of unmet psychiatric need,” said Dr. Suzanne Catherine Lippert of Stanford University.
Zag of the day: Urgent care for opioid addiction
Boston Medical Center today unveils a new approach to treating opioid addiction, dubbed Faster Paths. I got an exclusive sneak peek from Dr. Edward Bernstein, who directs the program.
Faster Paths is basically an urgent care center specifically designed for opioid addicts. Patients can get medication treatment. They’re given naloxone rescue kits. And counselors hook them up with primary care and community services. They even make sure their clients have transportation to get the help they need.
The goal: To make sure opioid addicts aren’t just jolted back to life in the emergency room, but receive follow-up care to treat the underlying substance abuse disorder.
As I saw during my recent reporting on the opioid epidemic in Ohio, ERs too often become revolving doors: Overdosed patients are repeatedly brought back to life, only to show up again the next day, or the day after that. Faster Paths, funded by a $2.9 million state grant, aims to break that cycle for BMC’s patients, many of whom are impoverished.
“The idea is to develop a delivery system that’s coordinated and a welcoming home for people with addiction,” Bernstein told me. “People will feel respected, and the staff that works there wants to be there.”
‘Why do I have to keep explaining I’m a doctor?’
Everyone ought to read Jennifer Adaeze Okwerekwu’s essay about being a young, black, female doctor in a world that often refuses to recognize her status.
“Fish or chicken?” she was asked by another hospital employee recently while trying to perform a neurological exam. The employee had mistaken her for a relative of a black patient and asked her for a food order. Okwerekwu had to show her hospital ID to make clear that she was a doctor.
“Why do I need to keep explaining who I am in a space I have earned, and where I know I belong?” she asks.
What else to read today
- Tuberculosis is far from a disease of the past. (NPR)
- Hospitals struggle to address ICU delirium (STAT)
- Affordable Care Act defections hitting North Carolina hard. (Washington Post)
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