ust a few decades ago, hospital candy stripers sold cigarettes to patients in bed. Today, culture has changed so much that at many of the same hospitals, you can’t smoke anywhere on the entire campus.
“It’s absolutely absurd to think there was a time when we actually smoked at the nurses station, sold cigarettes to patients, or bummed a smoke off of patients,” said Dana Siegal, a former nurse who is now director of patient safety for CRICO Strategies, which analyzes medical errors and malpractice risk.
What other practices will we look back on in 30 years and say, “Can you believe we used to … ?”
Siegal posed that question at a recent conference sponsored by the National Patient Safety Foundation. Here are five responses the audience came up with.
Advise doctors not to say sorry?
As recently as 10 years ago, doctors who hurt patients would almost never say, “I’m sorry,” for fear that those words would be used against them in court, Siegal told STAT after the conference. “We used to never acknowledge our mistakes to patients and families.”
Now that thinking is evolving, she said. Many hospitals have trained staff on how to disclose mistakes and apologize for them, a practice that can actually reduce malpractice suits.
While some hospitals are still advising their staff not to apologize, the legal landscape is changing: 36 states and D.C. have passed laws allowing medical staff to apologize to patients without fear of legal reprisal, and seven more states are considering similar legislation, according to the National Conference of State Legislatures.
Leave what a drug treats off prescription labels?
Patients get confused about medicine all the time, said Dr. Gordon Schiff of Brigham and Women’s Hospital in Boston. One of his patients recently told him she had stopped taking her medicine for depression. “She happened to have her bottles with her,” he said. “It turns out the medicine she actually stopped was for diabetes” — which sent her blood sugar out of control.
Schiff, a primary care doctor and patient safety researcher, said it’s crazy that we don’t put labels on medicine bottles saying what the drug is for. That’s really confusing for patients — especially elderly patients who are juggling lots of prescriptions.
So why doesn’t the label say what the drug is for? Schiff said it is possible for doctors to write the information into electronic records, but it’s not easy, and the pharmacy may not print it on the label. He’s now leading a project that attempts to change that.
Watch people wash their hands?
To curb the dangerous spread of hospital-acquired infections, many hospitals have observers watch staff wash their hands. But when people know someone is watching over their shoulder, they change their behavior.
Klaus Nether, director of solutions development at the Joint Commission Center for Transforming Healthcare, found that hospitals overestimate how much people wash their hands: When handwashing was overtly monitored by infection control staff, eight hospitals self-reported 80 to 90 percent compliance. But when they switched to more sly observation — by insiders like chaplains and security guards — compliance rates measured much lower, at an average of 48 percent.
Why weren’t people washing their hands? Nether’s group identified 41 causes. Some people had their hands full. Others were distracted. Sometimes dispensers and sinks were too far away. The team came up with a tool that helps hospitals identify obstacles to handwashing and gives ideas to solve those problems — such as moving dispensers to a more convenient spot. One hospital system in Houston boosted handwashing rates from 58 to 96 percent, and saw infection rates drop accordingly. The tool is catching on, he said: So far, over 600 health care organizations have used it for over 4,500 handwashing projects.
Spend more time on paperwork than on patient care?
The precise figure is disputed, but many say the bottom line is clear: The burden of documentation is “too much,” said Dr. John Halamka, chief information officer at Beth Israel Deaconess Medical Center.
“We’ve turned clinicians into automatons” who are constantly typing from morning to night, he said. “If you have 15 minutes to see the patient, make eye contact, not commit malpractice, be empathetic, and enter all of these required data elements, it’s just not possible.” Halamka said he has counted 300,000 pages of new regulations since he began his job 20 years ago. But he’s hopeful that burden will ease up.
Andy Slavitt, the man in charge of the Centers for Medicare and Medicaid Services, has vowed to win back “the hearts and minds of physicians” by lightening the burden of documentation that clinicians face. In a recent interview, he told STAT that his office has already “taken a very significant beginning” to simplifying reporting requirements. “But I don’t think people will feel it until it’s really been in place for a while,” he said.
Make it hard to get medical records quickly?
Historically, hospitals have argued that medical records belong to the health care provider, not the patient, Siegal said. They were hesitant to share the records for fear of malpractice, and to protect patients from bad news, but that’s changing as medical culture embraces more transparency and patient engagement, she said. Most electronic health records now have patient portals where patients can peer in and see lab results and other information.
But patients can’t download their whole medical record in an electronic file, and not all of the information — such as physician’s notes — appears in the portal, said Dr. David Blumenthal, president of The Commonwealth Fund and former US national coordinator for health information technology.
“It is still more common than not for patients who want to see their medical records to be referred to the medical record room, where records are xeroxed and people pay by page,” he said. Complaints about access to medical records are among the top five issues investigated by the Office for Civil Rights at the Department of Health and Human Services.
Blumenthal envisions a day when patients can use third-party apps, or “data butlers,” to view and manage all of their health records online. The federal government wants to make that possible, but the private companies that make electronic health records are resisting because they don’t want to share their “secret sauce” for data management, he said.
“There is a kind of a standoff right now,” Blumenthal said.
Correction: An earlier version of this story misstated what happened to a patient who had stopped taking her diabetes medication.