How to survive your hospital stay

Hospitals are not good for your health. Every year 400,000 people die in them due to preventable errors. One in 25 people admitted to the hospital will develop hospital acquired infections, some antibiotic resistant with the resultant 23,000 a year who die. Hand off errors are rampant and account for 80% of medical errors. Most of these problems have to do with people. Now, according to a new report,we have to worry about dangers of medical technologies used in hospitals.They include:

1) Alarm Hazards: Inadequate Alarm Configuration Policies and Practices: Hospital rooms are typically filled with patient-monitoring devices that emit alarms when pre-set conditions occur. Frequently, this can make for such an ever-present cacophony of beeps and buzzes that healthcare workers stop paying attention to them. “Alarm fatigue” will persist unless the facility creates and follows a policy where each piece of equipment is calibrated to sound an alarm only in clinically significant conditions that require a staff response.

2) Data Integrity: Incorrect or Missing Data in EHRs and Other Health IT Systems: Part of the purpose of electronic health records (EHRs) is to reduce medical errors caused by missing, conflicting, or incorrect information about a patient and their treatment. But even the most up-to-date technology for centralizing that data is subject to errors by the person entering the information, delays in transmission, or problems as mundane as two computers or pieces of equipment with conflicting date or time readings.

3) Mix-Up of IV Lines Leading to Misadministration of Drugs and Solutions: It’s common for one patient to be connected to multiple IVs. A tangle of tubes can result in one or more line being connected to a wrong fluid container, dripping at the wrong rate, or administering medication at the wrong site. Most errors of this type can be prevented with proper labeling and by physically checking each line from source to destination.

4) Inadequate Reprocessing of Endoscopes and Surgical Instruments: The Ebola crisis has highlighted the need to carefully disinfect and sterilize any and all objects that have a chance of being contaminated through contact with a patient. The incidence of problems is low, but the results can be severe. Endoscopes present a particular challenge because of their narrow, hard-to-clean channels. Education, rigorous protocols, and adequate time and room for reprocessing are the keys to preventing these errors.

5) Ventilator Disconnections Not Caught because of Miss-set or Missed Alarms: The aforementioned risks from misconfiguring medical equipment alarms are particularly dangerous in the context of catching ventilators that are experiencing partial or complete disconnection along the breathing circuit. This can lead to brain injury or death. Protocols must be enforced to ensure alarms are set to actionable levels, are clearly audible to staff, and are backed up with ancillary notification systems.

6) Patient-Handling Device Use Errors and Device Failures: Patient-handling refers to healthcare workers lifting, moving, or transferring patients. A report by the Occupational Safety and Health Administration (OSHA) estimates that in a national survey covering approximately 1,000 hospitals, patient-handling injuries accounted for 25% of all Workers’ Compensation claims for the healthcare industry in 2011. A wide variety of devices, such as lifts, sliding boards, and specially designed chairs, toilets, mattresses, and stretchers can reduce the strain on workers. But these devices carry their own risks in cases of improper use or mechanical failure. Regular maintenance of the equipment, training in its proper use, and paying attention to weight-bearing limits are among the best solutions here.

7) “Dose Creep”: Unnoticed Variations in Diagnostic Radiation Exposures: Patients may be exposed to increased radiation levels by clinicians attempting to improve image quality in diagnostic radiology. Standard practice requires that the technician obtain the diagnostic image with a dose that is “as low as reasonably achievable (ALARA).” Manufacturers are increasingly adopting the standardized exposure index (EI), established by the International Electrotechnical Commission (IEC). Procurement of new equipment that adheres to this standard can eliminate this problem, but only with accompanying software upgrades, device calibration, staff training, and integration of EI checks into existing workflows.

8) Robotic Surgery: Complications Due to Insufficient Training: The differences between traditional surgery performed with human hands and robotic surgery performed with machines require training for the entire surgical staff. This can prevent errors in positioning team members (relative to the size of the robot), lapses in safety precautions and team communication, or a lack of proficiency in the surgeon’s ability to use the equipment optimally. Training should be reinforced by frequent experience using the robotic equipment, as well as rigorous credentialing.

9) Cybersecurity: Insufficient Protections for Medical Devices and Systems: Electronic medical equipment is increasingly interconnected and networked. That means it is vulnerable to malicious hacks, malware, or invasions of privacy. These risks should be formally assessed on an ongoing basis, and mitigated through the implementation of IT best practices such as network firewalls, strong passwords, and software patches.

10) Overwhelmed Recall and Safety-Alert Management Programs: The exponential growth of healthcare technology corresponds to an increasing flow of manufacturer recalls and safety alerts from government agencies and non-profit organizations. Missed recall or safety announcements aren’t mere administrative errors – they can lead to dangerous malfunctions that endanger patients’ health and lives. A management system is needed to receive these critical pieces of information, distribute them to the correct personnel, respond to them, and document that response.

Researchers found that hospitalized patients who died or were transferred to the ICU during their stay experienced a diagnostic error nearly a quarter of the time — and in most cases the error caused harm, according to a new study that's prompting calls to rethink how health systems keep patients safe.

The growing youth mental health crisis is the top patient safety concern this year, according to the?latest report?from ECRI.

Here's the full list of concerns for 2023:

1. Pediatric mental health issues
2. Verbal and physical abuse against healthcare workers
3. Challenges facing clinicians amid an uncertain time for maternal and infant health
4. The effects on clinicians who are working outside of their scope of practice or competencies
5. Delayed identification and treatment of sepsis
6. Consequences from poorly coordinated care for patients with complex conditions
7. Risks associated with failing to look past the "five rights" for medication safety
8. Inaccurate patient medication lists that cause?medication errors
9. Administering neuromuscular blocking to patients by accident
10. Preventable harm?caused by missed care or treatment

Here is the 2024 list:

1. Challenges transitioning newly trained clinicians from education into practice ?
2. Workarounds with barcode medication administration systems ?
3. Barriers to access maternal and perinatal care ?
4. Unintended consequences of technology adoption ?
5. Decline in physical and emotional well-being of healthcare workers ?
6. Complexity of preventing diagnostic error ?
7. Providing equitable care for people with physical and intellectual disabilities ?
8. Delay in care resulting from drug, supply and equipment shortages ?
9. Misuse of parenteral syringes to administer oral liquid medications ?
10. ?Ongoing challenges with preventing patient falls

Now you can start worrying about AI.

Clinicians have little idea how AI algorithms at their disposal were trained.

The lack often includes the makeup of the patient data—demographics, relative health status and so on—that went into creating these tools.

As a result, there can be no telling how capable any given algorithm is of diagnosing any patient in any given clinician’s care.

For these reasons, healthcare institutions “need to establish a robust AI governance program that addresses all phases of technology adoption and use.”

The observation and advice are from ECRI, which has named “insufficient governance of AI in medical technologies” No. 5 among its top 10 tech health-tech hazards of 2024.

According to the WSJ, more than two decades after the launch of a national patient-safety movement to tackle the alarming toll of medical mistakes, preventing those errors has proved much harder than expected.?Despite research?that shows some improvement over time, hospitalized patients are still at substantial risk of medication mishaps, hospital infections, breakdowns in nursing care, and complications from surgery and other procedures.

The most persistent problems, which add billions to healthcare costs, were apparent even before the Covid pandemic threw hospitals into chaos, reversing or erasing prior safety gains. According to?a study?of 2018 data from 11?Harvard Medical School-affiliated Massachusetts hospitals, so-called adverse events—which cause serious harm, prolong hospital stays and contribute to death—affected nearly one in four patients admitted to hospital. Approximately a quarter of those adverse events were preventable with well-known checklists and other safety measures. Technology might help.

Patients , even the most vigilant, can do little or nothing about most of these risks. Doctors and hospital administrators and staff can only do so much. With so many moving parts during any given patient admission, technologists, safety engineers and medical device manufacturers need to do a much better job of building safety and redundancy into their products. They need to pay more attention to the development and application of methods for the enhancement of the safety and reliability of complex technological systems.

To survive your hospital stay or help someone too, you have to be a medical quarterback and know the playbook cold. Most patients can't. Just understanding?the lingo takes Google Medical Translate or a knowledgable advocate or intermediary. HINT: Business opportunity.

Many have pushed for sick care to embrace the aviation industry to improve safety.

Major U.S. passenger airlines have forged a phenomenal safety record by relying on pilots, controllers, and mechanics to voluntarily report incipient hazards. Analyzing such incident data and then disseminating lessons from it has meant more than a decade without a fatal crash.

Over the same period, the country’s healthcare system has tried to mimic some of these air-safety principles, but it has made scant progress in eliminating deadly treatment errors. Mistakes in hospitals are estimated to cause at least 250,000 unnecessary patient deaths annually in the U.S., making it the fourth leading cause of medical fatalities after cancer, heart disease and Covid-19.

The plan would prod doctors and hospitals to embrace self-reporting of their potentially deadly ‘near misses,’ the way that pilots do.

Determined to do better, healthcare leaders are now doubling down on aviation’s lead.

The field of healthcare AI continues to nurse two conspicuous Achilles heels—racial bias in initial algorithm iterations and uneven input data as algorithms age. For inspiration to persevere against these and other cure-resistant sore spots, the healthcare sector might look to the aviation industry.

The suggestion comes from technology scholars representing numerous institutions of higher learning. The group expounds on its proposition in a paper recently presented to an academic conference and posted online by the Association for Computing Machinery. ?

Pointing out that aviation is a field that “went from highly dangerous to largely safe,” computer scientist and engineer Elizabeth Bondi-Kelly, PhD, of the University of Michigan and colleagues name three broad actions that have improved aviation safety and could do similar wonders for healthcare AI

The President’s Council of Advisors on Science and Technology (PCAST) is pushing the White House to address the “alarmingly high rates of medical errors and patient injuries” occurring regularly across the U.S. healthcare system.

One in 4 Medicare patients experience an adverse event during hospitalization, and over 40% of those are due to errors that could be prevented, the advisory committee wrote in a Thursday letter and advisory report?(PDF) to President Joe Biden.

Americans have achieved incredibly complex technological accomplishments-the Atom Bomb, the space program, the Human Genone Project and the Hubble Telescope - to name a few. Several medical products, like electronic medical records, don't work for harried, busy practitioners or are so complex they require a long learning curve, like robotic surgical devices. Safety first should be more than just a motto. Just because the FDA clears something does not guarantee that it's safe.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Substack and Editor at Digital Health Entrepreneurship