Early warning system...PODay 145

It's too bad that my pneumothorax (collasped lung) was not discovered right away, before I was discharged from the hospital soon after my shoulder surgery. There were hints that I would now recognize, having experienced it. I mentioned before, every time the oximeter was used to check my O2 level the tech would tell me it was low and that I should breathe deeper. I would take a couple deep breaths and the number would come up. Also, my temperature was low and my pulse was fast. But no one put it all together and I didn't know.   As it was I went home, things got worse, I didn't complain and it was ten days post op before the problem was discovered.

St. Joseph Mercy Oakland Hospital in Michigan is working to create an early warning system to recognize problems before they escalate to become emergencies. They have created a patient early warning system. A monitor is worn on the patient's wrist to constantly track vital signs monitoring their blood pressure, respiration rate, pulse, oximetry and temperature. The data is linked to the patient's electronic health record. Monitors track the numbers and rank the patient from 0 to 5. Up to 2.9 is good, 3.0 or higher places one in the danger zone and alerts the nurses that the patient needs to be checked out.

The hospital's mortality rate has fallen 35% since the system was put in place four years ago.

It is too easy to overlook small indicators of a potential problem. An impartial system that rates the patient and alerts the nurse to some irregularities is a great idea and obviously works. Yes, people have the ability to recognize and report problems but their "good judgment" can get in the way. Who likes a problem patient! Sometimes an impartial computer program does turn out to be better. Until this idea catches on you are going to have to be your own advocat. Pay attention and speak up. I should have.

This is a great idea and all hospitals should implement it.





Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, Octobe

Hospital compare site...P O Day 130

CMS, the government administrative arm of Medicare, has created "the Hospital Compare" data base. This allows the Medicare patient to compare the rate of unplanned readmissions or deaths within 30 days of being in the hospital of their choice with the rate of those unfortunate events at other hospitals locally or nationwide. The purpose is to improve the quality of care with a measurement  that is easy for the consumer to understand. The goal for the hospital is to anticipate and prevent problems that lead to readmission or even death following hospitalization for certain conditions.

"Hospital Compare" records and reports instances when the patient is readmitted to the hospital within 30 days of discharge if they were initially treated for 1. heart attack, 2. heart failure, 3. pneumonia, 4. hip/knee replacement surgery, or 5. hospital-wide readmission to include internal medicine, surgery/gynecology, cardiorespiratory, cardiovascular and neurology services.

Also reported is the 30 day death rate from heart attack, heart failure or pneumonia.

They keep track of surgical complications such as: pneumothorax, blood clots, postoperative wound dehiscense, accidental puncture or laceration, pressure sores, venous catheter related infections, postoperative hip fracture due to a fall, and postoperative sepsis.

Ultimately this data serves two purposes: First, the patient can go to the Hospital Compare Home Page and compare the record of three hospitals of their choosing. This rate is also compared to national averages. Second, Hospital Compare is part of the Hospital Quality Initiative whose intent is to help improve hospitals' quality of care by distributing objective, easy to understand data on hospital performance. both for the benefit of the patient and the hospital.

This is a great way to be able to compare your local hospital with other nearby facilities and even nationwide statistics. To go to the Home Page of Hospital Compare by clicking on this link
http://www.medicare.gov/hospitalcompare/search.html:

I briefly mentioned this medicare site on P O Day 83 so if you have already checked it out thoroughly, forgive the repetition.

Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--

Doctors as employees...PO Day 126

I know I complained about collecting new doctors like a rock rolling downhill gathers moss. It's true. I already had one primary care doctor and two  specialists to answer to prior to my rTSA.  I added an orthopod,  a pulmonologist, a thoracic surgeon,  and two hospitalists to the list as a result of reverse total shoulder replacement surgery and pneumothorax.  Fortunately the hospitalists stayed with the hospital and were only my doctors while I was an inpatient. But now, instead of three doctors, I have six looking out for me.  Fortunately five of them have joined the increasing trend of becoming employees of the hospital rather than maintain private practices. If I did not have personal experience, I would presume these were less than Grade A+ doctors who were taking the easy way out. So not true!

Everyone of them has great credentials, excellent training at first rate hospitals. Their offices are well run.. organized, staffed with efficient people, responsive and located conveniently right in the hospital complex. Why would smart young doctors be willing to give up autonomy and become employees of a hospital system?

Meeting salaries, rent, operating costs, malpractice insurance, overhead and unexpected disasters are not young Dr. Kildare's responsibility.  If the roof leaks, the receptionist quits, or the electric bill doubles someone else will handle it.

Cash compensations for signing up with a hospital can  be significant and give a young physician a boost in starting his career. Salaries are often higher than a starting out physician might expect to earn in a private practice.

Benefit packages, like health care, are standardized and predictable. Doctors employed by the hospital usually have the same package as clerical staff. Someone else, someone with a Business degree, will deal with the morass of health care rules and regulations.

Physicians are often backed up by well trained ancillary staff like nurse practitioners who see the more routine  patient leaving the doctor time  to practice at the top of their skill level. Everyone feels more challenged in their role as health care provider. It's nice to be part of a team.

While specialists are already seeing high compensation for services, government health care programs are beginning to recognize the value of the primary care doctor and fees for service are being increased for doctors in this category.

Employed physicians are taking on greater roles in the administrative operations of the hospital. As doctors become more involved in the operation of the hospital they may see opportunities in administration that would not be there in a private practice.

Finally, wage negotiations may not be all about salaries. Educational packages, student loan pay outs, sabbatical breaks are all fair game. Work hours and vacation can be on the negotiating table.

So far it looks like it is turning into a winning arrangement that lets the doctor focus on the patient. Already 25% of physicians are now working as employees of hospital systems. And I am finding that it is very satisfactory to me, the patient. We'll see where it goes in the next few years.

http://youtu.be/rwv7FYqV2Wo


Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, Octobe

September Addendum...PO Day 107

Instead of rambling today, here is a wrap up of where I am at the end of September 2014, a little more than fourteen months after breaking my right shoulder and three and a half months post reverse total shoulder replacement arthropathy, rTSA.

Dr. Kai, orthopod, has cleared me to do most usual activity within reason. That doesn't mean I can actually do everything, but I can try.

I still need help with some household tasks: making a bed, vacuuming particularly. I'm getting better at ironing but don't do a very good job of it. Cooking is pretty much back to normal. I'm still avoiding really heavy cookware like Le Creuset cast iron pots and going with the lightweight stainless steel.

I continue physical therapy at home but don't have to go for formal PT.

My hair is still falling out. See July PODay 42 "Hair Today Gone Tomorrow" Telogen Effluviam. Good thing I had thick hair to start with! I do still look normal, hair wise, but there is always a hair falling on my ipad as I type or tickling down my bare arm, feeling like a bug is on me. The other day one of my hairs was in my salad! Yuck!

I feel like I am recovered from the pneumothorax (collapsed lung) See July Surgery plus 10 days. I don't even notice myself breathing through my mouth much any more.

I'll have some blood work for a different doctor this month and will find out if I am still anemic. I feel okay and imagine things are back to normal again. Hope so. Ditto: July Surgery plus 10 Days.

I still don't sleep well but that is probably only partially due to my arm. It's not really a problem as it is a great time to work on one's blog!

I'm better at dressing and undressing but it remains the one activity when I am most aware of my arm limitations. It's not harder than, say, driving but it's just that it is usually so automatic to pull up a pair of pants or zip up a dress. I hope it will become more second nature. But I still had to get help pulling my tee shirt off today.😞 (frownie face courrtesy of iOS 8.0 upgrade)

I did some work in the garden today. Weeding and raking. I'm considering the activity my physical therapy for the day. It's the first really physical work I've done in over three months. I must be feeling better!

All in all, I can't complain. Well, I can, I just shouldn't.

http://youtu.be/S9nSgMwtkK0

Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September