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22 July 2016

United States: New Federal Report Says Rehab Hospitals are Dangerous Places

[Our comment:  Several times, my mother was sent to rehab after falling in her assisted living residence.  They are not nice places.  My 91-year-old uncle is now in one, and we worry about him. Back here in Switzerland, where some of these places can be quite posh, we heard of someone, sent to a rehab after knee replacement surgery, falling out of her wheelchair.  Two days later she was sent urgently to hospital where she remained in ICU for weeks.  It might be a serious infection, similar to the personal story related in this article.  She  is now in another not-so-posh "convalescent" facility, suffering from "burning" around the operated knee and internally.  The doctors won't tell us what is wrong (do they really know?) but friends have to wear sterile gowns when visiting her.  She will probably never be able to return home again but will eventually be sent to a nursing home.]

Are Rehab Hospitals Hazardous to Your Health?
by Joe Graedon, People's Pharmacy, 21 July 21 2016

A new study found that rehab hospitals are dangerous places where mistakes are common. Anyone entering such a facility needs vigilance and help from family.

If you suffer a serious injury in an automobile accident, get a knee or hip replaced or suffer a stroke, there is a very good chance you will end up in a rehabilitation hospital. These facilities are supposed to get you back up on your feet and functioning again, especially if you need more assistance than family members can provide.

Regular hospitals like to move people out as quickly as possible after surgery or some other trauma because their reimbursements are tied to the condition being treated. Rehab hospitals are less expensive and bills are usually tied to Medicare reimbursement.

New Federal Report Says Rehab Hospitals are Dangerous Places:

The Department of Health and Human Services Office of the Inspector General has just released a report (July, 2016) about adverse events in rehabilitation hospitals. The findings are scary:

“An estimated 29 percent of Medicare beneficiaries experienced adverse or temporary harm events during their rehab hospital stays, resulting in temporary harm; prolonged stays or transfers to other hospitals; permanent harm; life-sustaining interventions; or death. This harm rate is in line with what we found in hospitals (27 percent) and in SNFs [skilled nursing facilities] (33 percent). Physician reviewers determined that 46 percent of these adverse and temporary harm events were clearly or likely preventable. Physicians attributed much of the preventable harm to substandard treatment, inadequate patient monitoring, and failure to provided needed treatment.”

What This Means for You:

If you or someone you love has to go into a rehab facility there is roughly a one in three chance there will be harm caused by the care that is administered. Anticipate medication errors, bedsores, falls or infections. Much of this health care harm could be prevented but do not assume you will be protected.

A Personal Story:

Several years ago a good friend (we’ll call her Gail) needed knee replacement surgery. She was in great health and was anticipating a family trip to Europe. She wanted to be able to walk without pain and arranged for the knee surgery well in advance of the trip.

The surgery went well and she was discharged to a rehab hospital where it was anticipated that she would get good care and physical therapy. Within a relatively short period of time, though, her knee swelled and she began a rapid decline. It was determined that she had developed a serious infection. She was readmitted to the hospital where the surgery was done and treated aggressively and then sent back to the rehab facility. In her debilitated state she developed life-threatening diarrhea due to C. diff (Clostridium difficile) and within several days was dead.

Her son was distraught. Gail had gone into the hospital in very good health for what everyone thought was routine surgery. Within a few weeks she was dead from a hospital-acquired infection.

Health Care Harm is a Huge Problem:

Reports like the one issued by the Office of the Inspector General quickly disappear without a trace. It is known that over one fourth of hospitalized patients and a third of those admitted to skilled nursing facilities will suffer health care harm.

Doctors have a fancy, hard-to-pronounce name for this: iatrogenesis.Merriam-Webster defines it as:

“inadvertent and preventable induction of disease or complications by the medical treatment or procedures of a physician or surgeon.”

Not surprising to us, the new report found that almost half of the problems in rehab hospitals were due to medication errors. Patients are at the mercy of the staff. If someone gives a patient the wrong dose or the wrong medicine or the wrong combination, no one may be alert to catch the mistake.
Medical Mistakes Claim Way Too Many Lives:

A study from John Hopkins University titled “Medical Error-The Third Leading Cause of Death in the US” has generated tremendous controversy within the medical profession. The authors suggest that over 250,000 deaths result from medical mistakes (BMJ, May 3, 2016). Not surprisingly, a great many doctors have denied the data or complained that the analysis was flawed. They have called upon the BMJ to retract the article. Shooting the messenger is a lot easier than fixing the problem.

We actually think that health care harm is responsible for even more deaths than 250,000. According to our calculations, medical mistakes are actually theleading cause of death in America, ahead of cancer and heart disease. If you would like to see our statistics and our reasoning, here is a link to the article:

Will Medical Mistakes Kill You or Someone You Love?

It doesn’t have to be this way. If the medical profession would make preventing health care harm a priority, something might change. But in the 40 years we have been tracking this problem we have not seen much progress. That is why we wrote Top Screwups Doctors Make and How to Avoid them

We created aSafe Patient Checklist:
  • Take a prioritized list of your top health concerns/symptoms.
  • Ask the doctor for a recap to make sure you have been heard.
  • Take notes or record the conversation: you won’t remember everything you have heard.
  • Take a friend or family member to be your advocate and record-keeper.
  • Get a list of all your medications and supplements so that interactions can be prevented.
  • Find out about the most common and serious side effects your medications may cause.
  • Ask the doctor how confident he or she is about your diagnosis. Find out what else could cause your symptoms.
  • When in doubt, seek a second opinion.
  • Always ask your providers to wash their hands before they examine you.
  • Get your medical records and test results.
  • Keep track of your progress: maintain a diary of relevant measurements such as weight, blood pressure or blood sugar readings.
  • Be especially vigilant when moving from one health care setting to another. Mistakes and oversights are especially common during transitions.
  • Ask how to get in touch with your providers. Get phone numbers or email addresses and learn when to report problems.
  • Inquire about resources to learn more about your diagnosis or treatment.

In Top Screwups we have tips and question lists:
  • “Top 10 Tips to Stopping Screwups in Hospitals (page 22)”
  • “Top 10 Diagnostic Screwups (page 44)”
  • “Top 10 Reasons Why Doctors Screw up Diagnoses (page 46)”
  • “Top 10 Questions to Ask to Reduce Diagnostic Disasters (page 69)”
  • “Top 10 Screwups Doctors Make When Prescribing (page 78)”
  • “Top 10 Questions to Ask Your Doctor When You Get a Prescription (page 95)”
  • “Top 11 Tips for Preventing Dangerous Drug Interactions (page 108)”
  • “Top 10 Screwups Pharmacists Make (page 111)”
  • “Top 10 Tips for Taking Generic Drugs (page 139)”
  • “Top 10 Tips to Surviving Old Age (page 167)”
  • “Questions to Ask Your Doctor Before Agreeing to Surgery (page 177)”
  • “Top 10 Tips to Promote Good Communication (page 188)”

The latest report from the Office of the Inspector General reminds us that when we are in a health care facility, whether it be a hospital or a rehab center, we need to be proactive. That is why we wrote Top Screwups. We hope it will provide you the information you need to keep yourself or someone you love safe from health care harm.

http://www.peoplespharmacy.com/2016/07/21/are-rehab-hospitals-hazardous-to-your-health/

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