When does your surgery end?

The answer seems pretty obvious: when the incision is closed and you are transferred from the operating room to a hospital recovery ward, where doctors and nurses are trained to treat your condition and help you to heal.

This, however, didn’t happen to?Lewis Blackman.

At 15 years old, Lewis already demonstrated great talent and potential: he was a high achiever statewide in honors math, English and science, a talented musician, actor and athlete and was very attentive to others’ needs. His future looked bright with limitless possibilities. But he never had the chance to attend college, marry or have children.

On Thursday, November 2nd, 2000, his future narrowed to a single path – the corridor to an operating room, where he underwent thoracic surgery. His surgeon said Lewis’s thoracic surgery was successful.

Following the operation, instead of being transferred to a surgical recovery unit, Lewis was transferred to a pediatric oncology unit. Why? Initially, the surgery had been scheduled for that Monday, but was rescheduled to Thursday, so that Lewis and his sister could celebrate Halloween with their friends.?Typically, on Thursdays (unlike Mondays, for example,) hospital beds are full and hospitals cannot always provide the appropriate clinical beds for patients.?The staff of Lewis’s oncology unit were unfamiliar with the specialized pain regimes for his thoracic surgery. On Saturday and Sunday (typical for some hospitals), only the weekend staff cared for Lewis. That team included a general surgery resident physician still in training, and nurses, many of whom were “floating” in from other departments. Because they were unfamiliar with Lewis’s symptoms, they missed a key sign of his deteriorating condition: severe internal bleeding.? These circumstances, in addition to the fatigue of the overworked staff, contributed to Lewis Blackman’s death, despite a successful surgery.

This tragedy tore the hearts of his friends and family members, who lost a devoted son, brother, and loyal pal. Our society lost a potentially great achiever. But even if Lewis had none of his talents, he was a young boy who had not yet experienced many landmark events in life. No child, no family deserves this?AVOIDABLE?tragedy.

How was it avoidable?

Was this heartbreaking calamity preventable? Why had Lewis not been transferred to the preferred surgical ward? Why were no beds available in that surgical unit even though his surgery was planned and scheduled weeks beforehand? The answer is well-known in the hospital industry, but largely unknown to most patients.

The unfortunate explanation is that hospitals schedule many more surgeries at the beginning of the week compared to Thursday and Friday. Most patients are intentionally discharged before the weekend (sometimes prematurely), a management habit that is omnipresent throughout the healthcare industry.

This practice creates artificial peaks in demand for beds and other hospital resources. By Thursday, these peaks spike hospital occupancy, thereby piling nurses with excessive workloads. Stretched thin to care for more patients, hospitals see corresponding increases in patient mortality, higher rates of infections, errors, and readmissions. These perils have been documented in multiple studies.

Many years ago, hospitals enjoyed ample financial resources and could afford to staff their units around the clock, even when at full occupancy. It was possible to schedule as many planned surgeries as requested by a surgeon, thereby creating artificial peaks in surgical volume.

Today, healthcare costs have skyrocketed to the extent that hospitals can no longer afford staffing as before. This, combined with manmade peaks in demand, places immense stress on hospital resources.

Once a patient is misplaced due to this artificial lack of preferred beds, they are more likely to experience care from inadequately trained clinicians.

Under these circumstances, surgical outcomes are not determined by the clinical quality of a surgery alone. Patients’ health outcomes are equally vulnerable to the care that patients receive after surgery.

The book “Hospital, Heal Thyself: One Brilliant Mathematician's Proven Plan for Saving Hospitals, Many Lives, and Billions of Dollars” describes the damaging effect of these artificial peaks in surgical volume on the rates of mortality, readmissions, hospital-acquired infections, nursing burnout and shortage as well as on inflated number medical errors and deaths.

Lewis Blackman became the victim of mismanaged hospital operations. It is due to the commendable efforts of his mother, Helen Haskell that Lewis’s story became widely known and has likely saved lives. However, the mismanaged events that led to Lewis’s death still persist today (and have likely became more severe due to the skyrocketing healthcare cost and increased demand from baby boomers), meaning that many deaths and injuries can be avoided. It is scary and frustrating that we do not know just how prevalent such tragedies due to mismanaged operations are today.

While the status quo in hospital surgical scheduling continues, how can you limit the risk for yourself or your loved ones?

When you come to a hospital for surgery, first, don’t schedule it on Thursday or Friday and ask the following:

·?????? Will you be placed in the preferred unit post-surgery?

·?????? What is the maximum number of patients your nurse will care for at that unit during your stay? ?(Research demonstrated?that the safe number should not exceed four.)

·?????? If your stay extends into the weekend, will your surgeon or an attending surgeon (rather than a resident physician) be available?

As mentioned in the endorsement by leading Emergency Physician, Dr. Peter Viccellio for the aforementioned book, “your life may depend on it”.

These questions would not be necessary if the number of patients admitted to the preferred units could be streamlined (spread out by hospitals over the course of the week). Until that happens, patients need to ask their care team these questions. If the answers are satisfactory, only then will your surgery end when you leave operating room.

Hospitals that have streamlined their weekly surgical volume experienced not only reduced mortality, readmissions, hospital acquired infections and ED overcrowding, but also significantly improved margins as well as patient and clinician satisfaction. For example,?Cincinnati Children’s Hospital avoided $100 million in capital costs while improving its margin by over $100 million annually.? According to research published in the Journal of the American Medical Association, if all U.S. hospitals adopted these practices, they could save many lives and?reduce overall U.S. health care costs by 4-5% (or $180 to $200 billion)?annually.

This intervention is of a particular importance during the COVID-19 Pandemic and resulted in many lives and millions of dollars saved at every hospital that implemented it.

A successful surgery should end with a healthier patient going home safely from the hospital, not in an unplanned funeral.?

Similar questions should be asked in the Emergency Department (ED).

When you or your loved ones plan to have a surgery or come to an ED, look for hospitals, where the leadership is committed (vs. giving lip service) to patient- and clinician-centeredness. Fortunately, there are such - https://lnkd.in/efK4WJvb.