Hospitals may be providing us all with too many causes for high anxiety, with reports on increasing findings of “nightmare” bacteria stalking more health care facilities than had been known, more disclosures about how taxpayers may foot an even bigger bill to deal with a beleaguered public hospital in Washington, D.C., and a respected reform advocate’s detailing of just how traumatizing many hospital stays may be.
Let’s start with the new research by the federal Centers for Disease Control and Prevention, a study that tried to determine just how many cases there might already be of patients infected in hospitals, nursing homes, and other medical care facilities with so-called Superbugs, bacteria that resist treatment not only with most standard antibiotics but also drugs that are deemed therapies of last resort. These include three types of bacterial infections deemed especially urgent but difficult to control: Clostridium difficile (C. difficile), aka C-diff; carbapenem-resistant Enterobacteriaceae (CREs, as shown above); and Neisseria gonorrhoeae.
CDC officials weren’t sure how many of the Superbug cases — which leave doctors and hospitals little option but to provide only supportive care — they might detect by scrutinizing records from pathology labs nationwide.
The public health officials, the Associated Press reported, were distressed to find confirmation of some of their worst-case theories about the infections’ prevalence:
In the first nine months of [2017], more than 5,770 samples were tested for these ‘nightmare bacteria,’ as CDC calls them, and one quarter were found to have genes that make them hard to treat and easy to share their resistance tricks with other types of bacteria. Of these, 221 had unusual genes that conferred resistance. The cases were scattered throughout 27 states.
Dr. Anne Schuchat, principal deputy director of the U.S. Centers for Disease Control and Prevention, told the AP: “Essentially, we found nightmare bacteria in your backyard.”
About 2 million Americans get infections from antibiotic-resistant bacteria each year and 23,000 die, the CDC says. In 2011, the agency reported, more than 700,000 Americans suffered hospital acquired infections (HAIs) and this led to 75,000 deaths. These preventable sicknesses are part of the significant bane of medical errors, which claim the lives of roughly 685 Americans per day─ more people than die of respiratory disease, accidents, stroke and Alzheimer’s. Medical errors, experts say, may now be the third leading cause of death in the U.S., behind only heart disease and cancer.
In my practice, I see the huge harms that patients suffer while seeking medical services, especially in hospitals where they may end up in worse shape than they were admitted. We need to reduce overuse of antibiotics, which undercuts the effectiveness of these crucial infection-fighting drugs. And hospitals must step up their campaigns against HAIs. They insist they’re improving their care, often boasting about doing so with big, fancy facilities. But the toll these profit-raising pillars of their communities inflict continues to mount.
Taxpayers’ toll for replacement DC hospital
And for Washingtonians, poor and otherwise, that pain will persist and maybe even grow as the District of Columbia grapples with remedies for decades of neglect for the health needs of residents of its Southeast area.
District officials have brought in yet more pricey health care consultants to draft a plan to raze the area’s troubled United Medical Center and to replace it with a facility half its size, 106 beds in a new facility on the big campus now occupied by St. Elizabeth’s Hospital, which the Washington Post notes, was the site of a 19th century mental hospital and still houses a small mental facility.
The new hospital would replace UMC, which sits on the border between the District and Prince George’s County and has 234 beds.
Taxpayers would foot a guesstimated $248 million for this smaller facility, with the aim of getting a private operator in to run it and to try to get the District out as much as possible of the hospital business. The consultant told District officials the current UMC is too big, can’t justify its size based on the need and range of its services, and many more details of plans for a replacement need to be worked out still.
That would a gaping question for the DC council’s constituents and patients throughout a poor swath of the District and Maryland: Just what outsiders will eventually run the replacement UMC and what kind of care is planned?
These aren’t small questions, as lapses in the quality and safety of obstetrics care led to the latest crisis at UMC, causing closures of services and renewed regulator inquiries into the hospital’s operations. Poor and middle-class women in Southeast — an area already plagued by “infant mortality rates that are dramatically higher than those in whiter, more affluent parts of the nation’s capital” — have been forced to seek out alternatives to nearby UMC for pregnancy and maternity care.
It’s worth noting that as problems have mounted with UMC, district officials have relied on politically connected and expensive consultants, including to run the hospital. Are the politicians tapping the region’s extensive medical expertise, and are leaders stepping up to help deal with this bad situation, which will affect their hospitals, too? A reminder that Los Angeles experienced similar woes with a bad hospital built to serve — and placate — its poor, restive black community. That hospital’s collapse into nightmarish care was resolved with a community, not a consultant-driven response.
The UMC mess is something we’ll all need to watch, and likely will be asked to pay too much to resolve.
The trauma of hospitalization
Meantime, let’s give the DC health care consultants at least a little credit: They’ve recognized a huge problem with all hospitals, a factor that’s a detriment to the quality and safety of patient care nationwide. Hospitals have gotten too big, too costly, and too many have lost their focus on their most critical mission — healing the sick.
In fact, argues Harlan Krumholz, a doctor, Yale Medical school professor, and a researcher on and a leading reform advocate of these care-giving facilities, hospitals outright traumatize their patients just as they are sickest and most vulnerable. His entire interview on this issue, published by a government agency that studies ways to improve healthcare research and its quality, merits reading.
But here’s a slice, first about how he sees hospitals mistreating patients:
People come in the hospital with a condition. We immediately try to jump in to mitigate and to cure if possible. In the course of that care, we are causing a lot of collateral damage, which we’ve tended to discount as ‘they may be a little uncomfortable.’ They may have roomed with someone who was up all night. We maybe poked them at 4 a.m. But the big thing is that we are saving their lives—so we just push forward. We have a mentality that focuses on rushing in and addressing the primary illness, without regard to any harm that accrues. So, my conceptual model is that all of the stress, discomfort, inactivity, poor diet, missed meals, and inadequate rest and sleep has created a toxicity that incurs substantial collateral damage. At discharge, people are weakened and susceptible. Still, with all these things we do in terms of communication, collaboration, coordination… we can either ease their path, catch them gently, and help them make a successful transition. Or we can say you are punch-drunk from everything we have done to you, and now we’re going to set an obstacle course in front of you, wish you luck, and see how this stress test plays out for you in the next couple of weeks.
Krumholz, after describing “post-hospital syndrome,” sees how hospitals could be different:
We need to make sure that the patient gets adequate sleep, in an environment conducive to that. I would have patients in their own room. I would be sure people are well nourished. We would encourage, as preferred by the patient, social support, and visits. We would surround them by bright colors and sounds and odors designed to lift their mood (I have written that adult hospitals should follow the lead of pediatric hospitals in this way). We would avoid blood draws, Foley catheters, tests, and procedures except what is absolutely necessary. We would give people a schedule every day so they know what to expect and when, enabling them to have a sense of control and understanding. We would avoid a lot of the uncertainty. For example, on the consult service, we don’t tell people when we’re going to visit them. So, they are stuck in the room most of the day because they are afraid to miss us. It is as if we implement systems that give people anxiety, and we’re making it hard for them to be active in any way. This hospital of the future not only delivers outstanding care, efficiently and effectively, but delights the patient by every action, taking into account whether it is better positioning them for leaving the hospital. Even in the midst of acute illness we can think of rest, nutrition, strength, support, cognition, and a healing environment.
Yes, doctor, that sounds like a much better prescription for hospital care.
