Blog, theater

Taking risks in Recovery

Something patients don't know about...

Medical treatments can vary widely across different hospitals, even when they are in the same city.

Different procedures might reflect individual surgeons preferences. 

Different nurse to patient ratios might reflect the hospitals funding structure, ie is it public or private?

The ‘nuts and bolts’ of many elements of patient care is not standardised.

These differences are referred to among patient advocate groups as ‘unacceptable variations in care’.

Patients don’t know these differences exists.

They believe that they will automatically receive the same treatment, no matter where they go.

They also expect that if they go to private hospitals, they will receive better treatment, in return for the extra money they are paying out.

That is not necessarily the case.

There is no information about different hospital protocoles or staffing ratios available to patients. 

This leaves them in the dark about how to find the best care, or how to compare their hospital visit against other patients experiences.

The only public information available in Australia is in the form of ‘personal stories’ from private organisations like Patient Opinion.

In other countries like the USA and UK, information is made public about different hospitals performance.

In Australia this information is collected by bureaucrates, but it is kept secret from the public.

Inadequate nursing staff working in a private hospital

This story is about a clash over nurse to patient ratios between an agency nurse who was used to working in public hospitals, and a bed manager in charge of a private hospital.

An agency nurse was contracted to work a late shift (1pm to 9.30pm) in a small private hospital.

A number of patients were being taken into theatre for surgery in the afternoon (on the pm list). However many of the nursing staff had been sent home after 5pm.

Hours outside 9am to 5pm attract penalty rates.

A patient was due to come out into recovery at 7pm after surgery for a fractured hip. By this time the agency nurse was the only staff member working in the recovery unit. There was no backup if the patient experienced a problem like a blocked airway.

The nearest doctors and nurses out of sight, in another area of the hospital.

Concerned about patient safety, the agency nurse refused to accept the patient into recovery until at least one other nurse was brought into recovery.

The agency nurses rational that if the patient deteriorated and had an airway blockage, she could not care for him safely.

The doctors and nurses in theatre were extremely frustrated and the bed manage was called in.

“Nothing had ever gone wrong in the past”, she assured the agency nurse. “It is perfectly safe to have only one nurse in recovery”.

The bed managers overwhelming concern was controlling the hospital budget and keeping the private surgeons happy.

Delayed surgery meant unhappy private surgeons and the extra cost of hiring more than one nurse to work in recovery. 

Nothing changes, patients are unaware

The agency nurse dug her heels in, and still refused to take the patient into recovery. She was subsequently sent home.

She was never reemployed by this hospital again. The private surgical patient had no idea that he would have had a higher ratio of nursing staff to care for him, if he was treated in a public hospital.

There are many stories like this shared among Doctors and nurses.

Patients don’t get to hear about them.

The media doesn’t report on them.

Politicians and bureaucrates gloss them over.

Creating safe hospitals is like building a solid house. It requires a lot of elements to work together.

These elements include up to date equipment, adequate staffing levels and ongoing education.

Wikihospitals 2015.

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