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Health August 2012

Financial Fortitude

Hospital Checklists Can Be Literal Life Savers

By Karen Telleen-Lawton

Researchers from Rush University Medical Center in Chicago found that elderly patients who are hospitalized are at a higher risk of developing cognitive problems afterward. The cause isn’t certain, but surely the complex and disjointed nature of hospitals increases the likelihood of confusion at all levels.

I have to admit I was tepid about reading The Patient's Checklist: 10 Simple Hospital Checklists to Keep you Safe, Sane & Organized. Planning out your next hospital stay is not as exciting as plotting your next vacation. But if you read the preface you’ll be hard pressed not to finish this book – or at least keep it for future reference.

Some list books make interesting bathroom reading, where you learn some fascinating or humorous tidbit and emerge with a whole new conversation starter. This is not one of them. Instead, as author Elizabeth Bailey describes, it gives you the tools to act as your own or your loved one’s “patient’s advocate.” Bailey offers enticements throughout: reasons you want to be an informed patient and not just a bystander to your care. A few that left me aghast:

  • 98,000 preventable deaths a year are caused by medical errors in hospitals.
  • Medication errors are responsible for 28% of all hospital admissions.
  • Each hospital patient is subject to an average of one medication error per day.
  • Every six minutes a U.S. hospital patient dies from a hospital-acquired infection.
  • Each year 2 million American hospital patients acquire an infection during their stay.
  • 52% of doctors do not wash their hands between patients.
  • Half of all adverse drug reactions are the result of medical error.

These shocking teaser statistics are the bad news that ushers in the good: the checklists, which could greatly reduce the chances of this happening to anyone who implements them. Bailey’s intention is to guard against simple human error and to encourage simple human kindness, so that the patient is not only “cured” but “healed.”

She breaks down the arcane health care delivery system to patient tasks focused on three goals: understanding why each action is being done to you or your loved one; agreeing that each action is necessary and the appropriate treatment at the time; and being sure that every single action – routine or uniquely complex - is meant for this patient, performed under sanitary conditions, and using the best practices.

The ten lists are disarmingly simple:

  1. Before you go: how to be a more informed, prepared, and proactive patient.
  2. What to bring: practical and personal, like ear plugs, eye masks, and extra socks.
  3. During your stay: suggestions for increasing comfort.
  4. Master Medication List: an easy to understand consolidation.
  5. Daily Medication log: right drug, right dose, right schedule, right method, meant for you.
  6. Daily journal.
  7. Discharge plan: home care guide, to break down what is often exceedingly complex.
  8. Insurance: suggestions to help organize and follow through.
  9. Doctor Contacts.
  10. Family and Friends Contact List.

Bailey was an avid list-maker before she and her sister were forced to navigate a series of medical errors that nearly killed their healthy senior father. The cascading disasters permanently cost him his health. Afterwards Bailey changed careers from film producer to patient advocate. She designed the checklists as an efficient and effective way for patients and their loved ones to manage the myriad details of patient care in a busy hospital setting.

Bailey’s father’s situation is far from unique. Researchers from Rush University Medical Center in Chicago found that elderly patients who are hospitalized are at a higher risk of developing cognitive problems afterward. The cause isn’t certain, but surely the complex and disjointed nature of hospitals increases the likelihood of confusion at all levels.

Patient care is fragmented among personnel shift changes and doctor specializations. Governmental and insurance requirements add layers of protocol. Some hospitals have staff who are supposed to be paying attention to the whole, but their caseloads may preclude their ability to know the situation for each individual patient.

Other than childbirth, I haven’t had occasion for being in hospitals except as a visitor, and I don’t relish being a patient. List-making would definitely help me hack overwhelming tasks and procedures into bite-sized pieces. It will take some courage and fortitude to request and gather the information required to keep these lists. Nevertheless, if these statistics hold true, you will see the payback during your stay. The lists make the system comprehensible and, in bringing the patient (or advocate) back into the decision-making loop, improve the chances for better outcomes.

The best news is, I believe medical care not only can improve but be less expensive (or grow more slowly) if patient-centered care is implemented. The Patient's Checklist is a small but vital step towards that goal.

 

Karen Telleen-Lawton, CFP®, is the principal of Decisive Path Fee-Only Financial Advisory
(www.DecisivePath.com) as well as an environmental and economics author and writer (www.CanyonVoices.com). She can be reached at: This email address is being protected from spambots. You need JavaScript enabled to view it.

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