One of my friends recently told me that a family member had developed a severe pneumonia and been hospitalized for almost a month. I told him that, without knowing which hospital the patient was in or who his doctor was, I already knew that deconditioning was going to be a problem…and more reconditioning that would have seen ten years ago. The reason is hospital administrators and their insistence on something they call “continuous quality improvement”. In administrative terms this does not mean taking care of patients, it means taking care of numbers. And thanks to our federal third-party payers, one of the most rewarding is the hospital’s patient satisfaction rating.
The patient wants more morphine? Overlook her risk of aspiration or hypotension and give her another shot. He wants to stop the enemas before the effluent is clear? Hey, so what if an early colon cancer is missed due to inadequate cleanout–at least the patient will say nice things on his questionnaire. This has to be balanced against other numbers, like average length of stay compared with some office bureaucrat’s estimate of how long that sickle crisis or pneumonia ought to last. But a nurse or doctor who refuses a patient request, however dangerous or unreasonable, is likely to be called in to explain why not to alienate patients or families.
My friend’s relative is getting out of bed more and walking whenever somebody can be found to prop him up–usually a visitor since the hospital is keeping patient-to-nurse ratios as high as it can get away with. We can only hope he complains about not being asked to do anything uncomfortable.