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Basic Hospital Care Often Fails

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The treatment which has been proven over the past years for heart attack, pneumonia, and congestive heart failure is NOT being given to many patients in the United States.

The treatments are now standard. They have been agreed upon over decades as life saving procedures for patients suffering these serious ailments which are often (or, in the case of congestive heart failure, normally life-threatening). There is an article this week in the New England Journal of Medicine showing that are the norm in most medical practice and are not being used for the patients appropriate for them.

The Detroit News recently reported that:

” Reviewing data from the Centers for Medicare and Medicaid Services on 10 indicators for quality of care at 3,558 hospitals in the first half of 2004, researchers at Harvard School of Public Health found that simple, universally accepted treatments were not provided for:

• 11 percent of heart attack patients.

• 19 percent of those with congestive heart failure.

• 29 percent of pneumonia sufferers.”

There is a problem in modern medical practice (more than one, actually). While there are “evidence based guidelines” for these most serious afflictions and conditions, it is not always possible to get 100% of the practicing physicians to follow them.

Another member of the accreditation group was quoted as saying, “The studies illustrate a problem in modern medicine. While there’s a growing list of scientifically supported protocols for specific conditions called “evidence-based medicine,” physicians and hospitals don’t always follow them.

Making the shift requires creating evidence-based guidelines, getting hospitals and doctors to accept they’re the right thing to do, agreeing how to measure results, and finding processes to make sure they happen, Loeb said.

Those processes are likely to involve financial incentives, he said. “As much as we like to think of medicine as an altruistic profession, green seems to be the color of the (needed) elixir.”

Resource sites for people to check on specific hospitals are available at Hospitals. and at HospitalRatings according to the “Detroit News.

There are a number of factors, however, in the quality of hospital care. Each hospital tends to have specialties and is probably far better in, say, cardiology than traumatology. As a matter of fact there are only a limited number of real trauma centers rather than just emergency rooms. The Ryder Trauma Center in Miami is the regional trauma center and sees horrendous cases on a regular basis. The helicopters land on the roof and the fire department rescue/life support trucks line up on normal days.

There was also a study some years ago that found that cardiac units were best where the most surgery was regularly done. Your survival chances were higher where the cardiologists and thoracic surgeons did it most often. I have managed to survive CHF 11 years so far (they originally predicted 3-5 with luck) by going to the CardioVascular Institute of Baptist Hospital in Miami where the medical director of the unit plays in my arteries and Efrain Gonzalez, an electrophysiologist, installs and monitors a sophisticated computer he buried in my chest with wires (I suspect they were red and black and from Radio Shack) that snake into the chambers of the heart. Amazing things are being done in those places where things are done right.

The crux of the problem is usually that this is a choice you or someone else has to make during the stressful time of illness or accident. It is also the choice made for simple procedures that poor care and mistakes can turn into fatal errors. Andy Warhol went to one of the “best” hospitals in New York City for a simple gall bladder operation and came out on a slab. In Tampa some years ago a man who went in to the hospital for the amputation of a diseased foot. They did it well except they removed the good one. These “accidents” are not unusual. They are kept quiet in a profession that polices itself and protects its own.

So, when it is time to plan or hurriedly enter a hospital, how do you decide which hospital is best, safest and most effective for that which ails you? To find the Cardio Vascular Institute of Baptist Hospital in Miami from my home in Mexico when my cardiologist in Mexico had hugged me, cried and said, ” I hope to see you again”; I used the internet and guessed based on services, philosophy, pictures, an international services department and hope. That time I was right.

Here are links to some sites that may be able to help and there are Amazon links at the bottom of the article.

The best I could find is US News and World Report’s, “America’s Best Hospitals” at JCHA.

The Joint Commission on Hospital Accreditation has a site that is certainly interesting but complex and almost unusable at Joint Committee.

A site that helps rate hospitals and pick practiioners but is rather commercial at Health Grades might be of use.

The US Department of Health and Human Resources has a site that seems simple but is lengthy and complex compating treatments for pneumonia, heart attack and congestive heart failure at .

Then there is the necessity of treating urgent things at the nearest decent place and also discussing it with physicians, friends, heath care workers…

Make up an emergency plan before there is an emergency.

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About hfdratch

  • Yes, our hospitals fail us miserably at the most basic level…and it goes much deeper than not giving aspirin to heart patients 100% of the time. Our hospitals have deteriorated to become nothing more than inefficient and ineffective bureaucracies. I’m speaking from my 108-day experience during my husband’s hospitalization following a severe burn injury. He was admitted to was is reputed to be one of the best burn units in the country. Please visit the website, http://www.108days.com

  • Lisa. Thank you for the comment and sympathy and empathy for your pain and your husband’s injury.

    People should visit your site where you tell of your ordeal and the book you wrote about it.

    I recently reviewed a book on writing as a form of therapy and initially was not impressed but changed my mind. Also I have just been through 2 months of living in my wife’s hospital rooms (more to come) so it is too painful for me to read now. She has made me promise not to write of her ordeal.

    It is wonderful to see that you intuitively knew to write of the experience to help deal with it for yourself and speak to others.

    My post was “Writing as a Form of healing”:Review . At about the same time Dr. Pat wrote a post on blogging linked to my earlier article.

  • It should be noted that a large factor in the success of any treatment (of any condition) is patient compliance. While it’s easy to always blame hospitals and doctors, the patient factor is often overlooked.

    As a nurse who works with cardiac, diabetic, and transplant patients, I know from experience that all the best technology and science amounts to nothing if the patient and the family do not comply to the prescribed regimen.

    Are there doctors who err? Yes. But more frequently, the greatest complication in treating patients comes when the patients themselves do not adhere to their medication schedule, dietary changes that may be necessary due to disease processes, and the inconsistent pattern of follow up with their doctors.

  • Your comment on patient compliance with medical treatments goes so much without saying that I neglected to say it. Along with the necessity of magnet hospitals and honors for good nursing.

    My first trip to the coronary ICU broke my smoking habit, made me mostly vegetarian, a stickler for medications exactly as prescribed (when prescribed well) — everything but stree reduction. That is how I have survived 11 years (with some high tech help).

    However, there were stories of people sneaking off ICU to buy cigarettes. When my wife was in the hospital I met people walking and smoking pulling rolling IV units behind them.

    The importance of patient understanding of treatment and medication and the incredibly important role of nursing care is so important I regarded it as out of the scope of this article. Thank you for adding it.

  • Joanie:
    “It should be noted that a large factor in the success of any treatment (of any condition) is patient compliance. While it’s easy to always blame hospitals and doctors, the patient factor is often overlooked.”

    While this is certainly a factor, again, I am only speaking from my own experience, my husband was comatose, so he could do nothing but comply with treatment and therapy, however, the topic we’re addressing is healthcare failing us at a basic level. It would have been really nice if doctors, nurses, etc WOULD have prescribed appropirate therapy and treatment for my husband when he so desperatley needed it. My sister and I begged and screamed to get him the care he needed, to no avail most of the time. The blame, in our case, is placed right where it belongs, on the shoulders of the “healthcare professionals” who failed us at almost every opportunity. And it’s happening everywhere to thousands of people in hospitals across the country. There are catastrophic failures in our nations hospitals. They are very dangerous places to be when you’re sick or injured and at your most vulnerable, and that is not a result of patient non-compliance.