On nosocomial infections: How hospitals can cause infections

The hospital, inasmuch as it is a place meant for recovery from illnesses, can be a source of disease all the same. In fact, if healthcare providers fail to adhere to principles of asepsis, patients under their care may just acquire nosocomial infections during the course of their hospital stay.

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Nosocomial infections, also known as hospital-acquired infections (HAIs), are infections which patients contract while they are inside the hospital facility for medical treatment. As many as 1 out of 20 hospitalized patients contract nosocomial infections, thus resulting to complications that lead to unwanted protraction of hospital stay.

Nosocomial infections are most commonly found in three forms:

• Catheter-related bloodstream infection. Most commonly found in intensive care units, these are infections caused by different types of bacteria that found their way into the bloodstream through peripheral and central lines.

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• Hospital-acquired pneumonia (HAP). As opposed to “community-acquired pneumonia (CAP)” which occurs before or a short time after admission, HAP is a lung infection that occurs 48 hours or longer after admission to a healthcare facility. This type of pneumonia tends to be more serious, as the patients’ immune systems are often compromised, making it harder for them to fight back the infection.

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• Surgical site infection (SSI). It is a post-surgical infection that occurs in the body part where the surgery was performed. It is usually caused by opportunistic transient flora (bacteria that colonize the host in certain areas but not cause disease) that manages to enter the surgical wounds. While some of these infections are only skin-deep, some manage to seep deeper, reaching deeper tissues such as visceral organs, bones, and even implanted material such as hip replacements.

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The faces of risks in surgical patient management

Patient safety is considered a serious public health issue worldwide. In fact, the World Health Organization shows that 1 out of 10 patients is harmed under hospital care even in developed countries. This shows that risks are inevitable, specifically during surgical procedures. Thus, the assessment of risks is crucial so that physicians can perform their duties effectively and make consensual decisions for whatever surgical procedures they perform.

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In this light, tests are used in calculating or stratifying risks for patients undergoing surgery, especially in myocardial problems. This is summarized as follows:

1. General preoperative risk stratification

2. Preoperative risk stratification for myocardial events

3. Postoperative risk stratification

The purpose of this scoring system is to identify potential high-risk patients and focus on generating a multi-level risk-and-benefit discussion among hospital practitioners.

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Risk is a term that comes in many forms, depending on the expectation and experience of varying patient groups. In understanding and identifying these risks, there are methods to utilize. In integrating these methods concurrently with proper implementation, risk management could improve significantly. As a result, medical practitioners and healthcare executives, like Dan Bucsko and Kurt Weinmeister, can perform their duties well in improving the quality of care for all patients, and risks, such as prescription error, injurious fall, improper documentation, adverse anesthesia effects, and even death, could ultimately be avoidable.

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"He's the captain of the ship": A surgeon's intraoperative responsibilities

When the entire pre-op sequence is said and done, the surgeon now gears up for the main event: the intraoperative phase.

 In the entire perioperative stage, it is in the intraoperative phase that the surgeon takes complete charge. The surgeon is personally responsible for the client’s welfare during the operation, and is required to be in the operating room or within close vicinity for the entire surgical procedure.

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Modern surgical procedures are often viewed as a team effort; as such, surgeons, being the head of the surgical team, can assign roles to each member of the staff. Surgeons may delegate associates or residents to perform a small portion of the operation under direct supervision. It is important to note, however, that delegation does not denote a transfer of personal liability. If the resident or surgical assistant commits a litigable error, the surgeon takes full responsibility.

The surgeon is allowed to leave the operating room so long as the reason is procedure-related. These may include review of related pathology and diagnostic imaging, and a short dialogue with the patient’s family. However, the absence should be brief, and a qualified substitute must be assigned to stay with the patient during the entire duration of the surgeon’s absence.

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In some cases, surgeons must leave the operation prior to its completion due to unanticipated circumstances. If the absence is deemed to be protracted, qualified substitutes must be identified and should be present in the operating room before the surgeon leaves. Subsequently, the patient should be informed of the incident postoperatively.

If surgeons leave the operation for reasons which are deemed to be non-legitimate and unacceptable, healthcare executives such as Dan Bucsko and Kurt Weinmeister should be immediately informed to ensure patient safety and to profile a case in point in ensuing peer reviews.

As a captain takes charge of his crew to veer the ship toward reaching its destination, so must a surgeon lead the entire team—everyone from the assisting nurses to the anesthesiologist—toward surgical success and patient recovery. 

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REPOST: Patient satisfaction’s impact on physician livelihood

This American Medical News article discusses patient satisfaction and its effects on doctors' livelihood as well as their own sense of satisfaction, professionally speaking.

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Leaving a patient satisfied can be critical to a physician’s job evaluation and pay. But what does patient satisfaction mean, and how can a doctor make sure it happens even as he or she makes treatment decisions that might not make a patient happy?

American Medical News has reported on what makes a patient satisfied enough to rate a physician highly — and how to balance giving the best care with what a patient might expect or demand. Patient satisfaction: When a doctor’s judgment risks a poor rating

Some doctors see an ethical conundrum in using patient satisfaction as a factor in rating their effectiveness as physicians — and as a factor in their pay. The problem comes when patients, unhappy that they’ve been denied a treatment they don’t need, take their anger out on physicians when assessing their services.

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Satisfaction scores seen as crucial to physician success

Price is the primary factor for consumers when they choose a product — except in health care, where personal experience reigns supreme. For that reason, consultants are advising physicians to win over patients with convenient, personalized and warm service. They recommend that physicians deliver the best, most appropriate care while giving each patient a satisfying experience.

Shift to medical home may not increase patient satisfaction

Researchers hypothesized that practices with more medical-home elements would have happier patients. But the data they gathered showed that didn’t always happen. The problem, they theorize, is that things that the make the office run more efficiently, and can help improve care, can be seen by patients as impersonal and factory-like.

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Physician rating website reveals formula for good reviews

What makes a patient happy? It’s not the physician’s expertise, or the perceived quality of care. It’s a short time in the waiting room and a longer time in the exam room. That’s the formula for patient satisfaction one organization came up with after it read 36,000 online reviews of physicians.

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