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
Showing posts with label shoulder. Show all posts
Showing posts with label shoulder. Show all posts
Friday, November 7, 2014
Thursday, November 6, 2014
Patient hand washing 101..PODay 144
So, after tattling on hospital staff who don't wash their hands as often as they should, here comes a study by a Canadian group published in Infection Control and Hospital Epidemiology that looks at patients who are in the hospital. The team tracked 279 adults who were patients in an organ transplant ward. They found only about 30% washed their hands during bathroom visits, 40% at mealtime, 3% while using patient kitchen facilities, 3% on entering their hospital rooms but amazingly, 7% washed their hands when exiting their rooms.
Women were more likely to wash their hands and more likely to use soap than men. For some strange reason all patients were more likely to wash their hands later in the day than in the morning.
It looks like we patients are doing a much poorer job than the hospital staff. But we are the ones paying the price. The U.S. CDC ( Centers for Disease Control and Prevention) reports that one in twenty-five hospital patients will contract at least one hospital related infection and in 2011 there were 722,000 cases of hospital acquired infection, some serious or life threatening.
Hand washing is very effective in preventing transfer of infections and it is a simple, inexpensive thing to do. We all know we should do it, are we just lazy? Are we rebelling against our mother's voice in our head? Are we in too big a hurry? Whatever the psychological explanation, the physical effects of not washing hands is real and risky. Not only do we need to nag the hospital staff, our guests and even our doctors, we need to look at ourselves as a source of contamination and change our habits! Since infection is a lifelong risk to the total shoulder replacement surgery patient, we need to be especially attentive to the little things like unwashed hands that put us at risk as well as the big things like a purulent wound on a cut foot.
Women were more likely to wash their hands and more likely to use soap than men. For some strange reason all patients were more likely to wash their hands later in the day than in the morning.
It looks like we patients are doing a much poorer job than the hospital staff. But we are the ones paying the price. The U.S. CDC ( Centers for Disease Control and Prevention) reports that one in twenty-five hospital patients will contract at least one hospital related infection and in 2011 there were 722,000 cases of hospital acquired infection, some serious or life threatening.
Hand washing is very effective in preventing transfer of infections and it is a simple, inexpensive thing to do. We all know we should do it, are we just lazy? Are we rebelling against our mother's voice in our head? Are we in too big a hurry? Whatever the psychological explanation, the physical effects of not washing hands is real and risky. Not only do we need to nag the hospital staff, our guests and even our doctors, we need to look at ourselves as a source of contamination and change our habits! Since infection is a lifelong risk to the total shoulder replacement surgery patient, we need to be especially attentive to the little things like unwashed hands that put us at risk as well as the big things like a purulent wound on a cut foot.
Sunday, October 26, 2014
Penalties for readmission.PO Day 133
So I told you about the Hospital Compare site in Post 130. It sounded so benign and like the whole purpose was to be supportive of hospital and patient alike. It turns out the government gives and the government takes away.
Compiling all those statistics about readmissions to the hospital and educating patients and hospital staff to recognize little problems before they turn into big ones to prevent those readmissions has a more punitive outcome. Since 2010 data has been being compiled about readmittance rates for patients who were in hospital for heart attack, heart failure and pneumonia. Hospitals are fined for patients who are readmitted within 30 days of discharge. Now hip and knee replacement surgery patients have been added to the list.
Hospitals can be penalized as much as 3% of their medicare charges. 2610 hospitals across 29 states will be penalized these year. More hospitals are being fined this year because of the addition of the joint replacement surgeries even though they have reduced the readmission rates for other conditions. Hospitals are in a "catch 22" situation as the financial gain of readmission outpaces the fines for too high a rate of readmissison. What to do?
I suppose eventually shoulder replacement surgery will be added to the list of conditions for which hospitals can be fined. I am so glad that has not happened yet or I would be one of those patients who are part of the problem! In some weird way I do feel like a "bad" patient for developing complications that put me back in the hospital. I am just glad that at this stage I don't count.
Compiling all those statistics about readmissions to the hospital and educating patients and hospital staff to recognize little problems before they turn into big ones to prevent those readmissions has a more punitive outcome. Since 2010 data has been being compiled about readmittance rates for patients who were in hospital for heart attack, heart failure and pneumonia. Hospitals are fined for patients who are readmitted within 30 days of discharge. Now hip and knee replacement surgery patients have been added to the list.
Hospitals can be penalized as much as 3% of their medicare charges. 2610 hospitals across 29 states will be penalized these year. More hospitals are being fined this year because of the addition of the joint replacement surgeries even though they have reduced the readmission rates for other conditions. Hospitals are in a "catch 22" situation as the financial gain of readmission outpaces the fines for too high a rate of readmissison. What to do?
I suppose eventually shoulder replacement surgery will be added to the list of conditions for which hospitals can be fined. I am so glad that has not happened yet or I would be one of those patients who are part of the problem! In some weird way I do feel like a "bad" patient for developing complications that put me back in the hospital. I am just glad that at this stage I don't count.
Saturday, October 25, 2014
MY Simple Shoulder Test..PO Day 132
Here is my version of the SST, the Simple Shoulder Test, modified to fit my lifestyle:
Can I ride my bicycle now?
Am I able to use garden two handed loppers to trim an unruly vine?
Am I able to reach under the pull out bottom freezer drawer to clean up all the ice cubes that fall down there?
Can I reach behind my back to hook a bra or zip a dress?
Am I able to put on a necklace with a small hook by myself again?
Can I move the heavy couches in the living room to clean under and behind them?
Have I stopped looking down when I walk, worrying that I will stumble and fall?
Am I able to sleep on my right side again? And sleep the night through?
Can I dip ice cream from a carton from the freezer?
Am I able to lift down that really heavy Staub cast iron pot from the top shelf?
Am I able to use those two new kayaks I bought the week I fell and broke my arm?
Have I run out of things to say or write about reverse Total Shoulder Replacement Surgery?
Now, that seems relevant!
http://youtu.be/AlGvRwalchQ
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically.
Sunday, October 12, 2014
Go home or go rehab? PO Day 119
It is definitely more common to have a friend who has had knee or hip replacement than total shoulder replacement surgery, reverse or not. We might even have visited the knee or hip patient in the rehabilitation facility where many of them went when they left the hospital. While we all would rather be home in our own surroundings under these circumstances, sometimes a nursing home, Rehabilitation facility, can be the best choice. If we live in a multistory home, if we don't have someone at home to help us immediately post op, or if we have concurrent health issues that make our recovery more complicated...we might be better off taking advantage of our medicare allotment for inpatient nursing care. Even in spite of my hospital orthopedic coordinator's admonition that one's risk of contracting post surgery infection is greater in a nursing facility than at home!
But, we shoulder surgery patients insured by medicare do NOT qualify for this coverage! Unlike the knee or hip patient, we are considered perfectly ambulatory. Our shoulders might hurt, it might be hard to dress, we might be sleeping in a recliner for a while, we might even feel a bit wobbly for the first few days. But we can walk and that makes all the difference. So clear a path from the bed to the bathroom, remove those hazardous items from the stair steps, and pick up that throw rug that everyone trips over.
As a matter of fact, your recovery will be faster and easier the more you walk around. Just be careful.
http://youtu.be/RGQmvPSjrpk
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--
But, we shoulder surgery patients insured by medicare do NOT qualify for this coverage! Unlike the knee or hip patient, we are considered perfectly ambulatory. Our shoulders might hurt, it might be hard to dress, we might be sleeping in a recliner for a while, we might even feel a bit wobbly for the first few days. But we can walk and that makes all the difference. So clear a path from the bed to the bathroom, remove those hazardous items from the stair steps, and pick up that throw rug that everyone trips over.
As a matter of fact, your recovery will be faster and easier the more you walk around. Just be careful.
http://youtu.be/RGQmvPSjrpk
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--
Wednesday, October 8, 2014
Sales reps in the OR..PO Day 115
We've all seen them; smartly dressed young professional types pulling a rolling suitcase, standing aside at the reception desk in our doctor's office. They look like they are waiting for an audience with the Queen. Suddenly the door to the inner sanctum opens and the doctor's assistant nods for them to follow and they disappear.
Generally you have just seen a pharmaceutical representative making a "call" on a physician. Their job is simple and straightforward; they educate the doctor about their products, provide samples, leave coupons to be shared with patients starting on the new drug, share a couple fresh jokes with usually a medical derivation, and occasionally arrange a free lunch for doctor and/or staff, although such monetary compensation is frowned upon these days.
What we, the patients, usually don't see takes place in the operating room. In addition to the surgeon, the OR fills up with ancillary people there to support the surgeon and the patient. You might recognize the anesthesiologist, the scrub nurse who assists the doctor with sterile procedures and instruments, a circulating nurse who is responsible for the non-sterile jobs on the periphery of the scene, a holding room nurse who brought the patient in and the recovery nurse who takes the patient out. Off to one side is a professional looking salesman type, most likely dressed in operating room scrubs but not quite dressed as if to "scrub in." He is a Medical Devices Sales Representative.
He has developed a friendly rapport with the surgeon who has come to respect the agent's knowledge about the artificial devices used in so many surgeries today. Not only is he there to deliver the artificial knee, hip or shoulder that will be used today, he has very likely been in on the decision of what to use, what size is required and what "issues" might show up in this patient. He is now in the operating room to offer support to the nurses in arranging instruments according to when and howthey will be needed and "provide guidance during unexpected events and equipment failures." Wow, he sounds like someone you really want to be there!
The problem is that he is "expensive." He is usually well compensated by the devise manufacturer both in salary and sales commissions. Yes, he is a salesman. He is not there to encourage the surgeon to comparison shop or try the equivalent of Consumer Reports "Best Buy"prosthesis. He is there to promote his product. And in this day when hospitals are having to reduce overhead, he is being looked at as a way to reduce costs. In many joint replacement procedures the device is the most expensive item on the list of charges in the bill. The one big advantage third-world-reduced-cost-surgical-destinations have is that the prosthetic device they utilize will often cost one tenth of the US manufactured joint.
Hospitals are beginning to see the merit in creating a regular staff position, a liaison between the surgeon and the device manufacturers. This person would be responsible for inventorying the equipment needed, assuring its sterility, shopping around to get the best prices, all the while being well versed in the vagaries of the equipment and how to use it. Even knowing hospitals are thinking about it has caused manufacturers to reduce their sales staffs.
I don't know how to think about this potential change. It's kind of like when Allen Shepard realized his space ship was built by the lowest bidders on government contracts. If you remove the profit incentive will you have the same dedication and work ethic? Will the manufacturers have the same desire to educate and inform? Will the surgeon have the same expertise available to him? I hope so.
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically.
Generally you have just seen a pharmaceutical representative making a "call" on a physician. Their job is simple and straightforward; they educate the doctor about their products, provide samples, leave coupons to be shared with patients starting on the new drug, share a couple fresh jokes with usually a medical derivation, and occasionally arrange a free lunch for doctor and/or staff, although such monetary compensation is frowned upon these days.
What we, the patients, usually don't see takes place in the operating room. In addition to the surgeon, the OR fills up with ancillary people there to support the surgeon and the patient. You might recognize the anesthesiologist, the scrub nurse who assists the doctor with sterile procedures and instruments, a circulating nurse who is responsible for the non-sterile jobs on the periphery of the scene, a holding room nurse who brought the patient in and the recovery nurse who takes the patient out. Off to one side is a professional looking salesman type, most likely dressed in operating room scrubs but not quite dressed as if to "scrub in." He is a Medical Devices Sales Representative.
He has developed a friendly rapport with the surgeon who has come to respect the agent's knowledge about the artificial devices used in so many surgeries today. Not only is he there to deliver the artificial knee, hip or shoulder that will be used today, he has very likely been in on the decision of what to use, what size is required and what "issues" might show up in this patient. He is now in the operating room to offer support to the nurses in arranging instruments according to when and howthey will be needed and "provide guidance during unexpected events and equipment failures." Wow, he sounds like someone you really want to be there!
The problem is that he is "expensive." He is usually well compensated by the devise manufacturer both in salary and sales commissions. Yes, he is a salesman. He is not there to encourage the surgeon to comparison shop or try the equivalent of Consumer Reports "Best Buy"prosthesis. He is there to promote his product. And in this day when hospitals are having to reduce overhead, he is being looked at as a way to reduce costs. In many joint replacement procedures the device is the most expensive item on the list of charges in the bill. The one big advantage third-world-reduced-cost-surgical-destinations have is that the prosthetic device they utilize will often cost one tenth of the US manufactured joint.
Hospitals are beginning to see the merit in creating a regular staff position, a liaison between the surgeon and the device manufacturers. This person would be responsible for inventorying the equipment needed, assuring its sterility, shopping around to get the best prices, all the while being well versed in the vagaries of the equipment and how to use it. Even knowing hospitals are thinking about it has caused manufacturers to reduce their sales staffs.
I don't know how to think about this potential change. It's kind of like when Allen Shepard realized his space ship was built by the lowest bidders on government contracts. If you remove the profit incentive will you have the same dedication and work ethic? Will the manufacturers have the same desire to educate and inform? Will the surgeon have the same expertise available to him? I hope so.
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically.
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