South Carolina physician Dr. Val Jones recently spent eight long days in the hospital, sitting at the bedside of a loved one. She learned that the only upside of such a vigil was being “reminded of what it feels like to be a hospital patient – or at least the family member of one”.
Personally, I have to admit that I get a bit light-headed whenever a doctor writes about becoming a hospital patient – or, as in Dr. Val’s case, the bedside companion of somebody they care about who becomes one.
Welcome to our world, doctors!
Most docs experience a profound Eureka! insight when they actually see first hand what it’s like being on the other end of the stethoscope, as if finally appreciating a reality they may have under-appreciated until now.
The good news, wrote Dr. Val, was that the hospital staff were (by and large) excellent, and no major medical errors occurred. The bad news: the experience was “fairly horrific, mostly because of preventable design and process flaws.” And that’s why she decided to come up with her “Top 10 List of Annoying Hospital Design Flaws”.*
Of particular interest to me is the fact that nothing on Dr. Val’s list is news to your average patient. In fact, we’ve been talking for years about these “design and process flaws” to anybody who will listen – yes, including to our doctors.
My fondest hope now is that her physician colleagues and hospital administrators will pay attention to Dr. Val’s list – because they sure aren’t paying attention to ours so far.
Because she’d worked in a number of hospitals over the years, Dr. Val recognized that these flaws were in fact commonplace. Her Top 10 List was created, she said, in hopes that someone somewhere will make their hospital a friendlier place because of it – particularly when it comes to design and process flaws that prevent the patient from sleeping (or, as Dr. Val calls it, “hospital policy”). For example:
1: False Alarms. “Every piece of hospital equipment seems to be designed to beep for a complex list of reasons, many of which are either irrelevant or unhelpful. I snapped a photo of a particularly amusing (to me anyway) alarm. This was a bed alert, signaling the “patient exit” of an intubated and sedated gentleman in the ICU. Not only was the location of the alert sign curious (if you could get close enough to the alert screen to read the text, you would surely already have noticed that the patient was AWOL) but it was triggered by mattress pressure changes that occurred when the patient was repositioned every two hours (as per ICU pressure ulcer prevention protocol).
“The I.V. drip machines are probably one of the worst noise pollution offenders, beeping aggressively when an I.V. *might* need to be changed or when the patient coughs (this triggers the backflow pressure alarm, leading it to believe that a tube is blocked). Of course, I also thoroughly enjoyed the vitals monitor that beeped every time my loved one registered atrial fibrillation on the EKG strip – a rhythm he has been in and out of for years of his life.
2: Intercom Systems. “Apparently, some hospital intercom systems are wired into every patient room and permanently set at “full volume.” This way, every resting patient can enjoy the bleating cries for housekeeping, tray pickup, incoming nurse phone calls, physician pages, and transport requests for the entire floor full of individuals undergoing the sleep deprivation protocol.”
3: The Same Questions Ad Nauseum. “Over-specialization is never more apparent than in the inpatient setting. There is a different team of doctors, nurses, PAs, and techs for every organ system – and sometimes one organ can have four teams of specialists. Take the heart for example – its electrical system has the cardiac electrophysiology team, the plumbing has the cardiothoracic surgery team, the cardiologists are the “minimally invasive” plumbers, and the intensivists take care of the heart in the ICU. Not only is a patient assigned all these individual micro-managing teams, but they work in groups – where they rotate vacations and on-call coverage with one another. This virtually ensures that the sleep-deprived patient will be asked the same questions relentlessly by people who are seeing him for the very first time at 20 minute intervals throughout the day.”
4: Inopportune Intrusions. “There are certain bodily functions that benefit from privacy. I was beginning to suspect that the plastic urinal was attached to the staff call bell after the fifth time that someone summarily entered my loved one’s room mid-stream. Enough said.”
5: Poorly Designed Tubing. “Oxygen-carrying nasal cannulas seem to be designed to maintain a slight diagonal force on the face at all times. This results in the slow slide of the prongs from the nostrils towards the eye. Since the human eye is less efficient at absorbing oxygen than the lungs, one can guess what might happen to oxygen saturation levels to the average, sleep-deprived patient, and the resulting flurry of nursing disturbance that occurs at regular intervals throughout the night (and day). My loved one particularly enjoyed the flow of air pointed directly into his left eye as he attempted to rest.”
6: The Upside Down Call Bell. “In an age of wireless technology, where almost every American has a cell phone and/or a flat screen television, it is odd that the light, TV, and nurse call bell control system must be tethered to a short cord positioned just outside of the patient’s reach. The controller is also designed so that the cord comes out of the box’s farthest point, causing it to remain upside down in the hands of anyone lucky enough to reach it from a chair or bed.”
7: Excessive Hospital Bands. “In addition to multiple rotating IV access points, my loved one’s wrists and ankles were tagged with not one but four hospital band identifiers, including one neon yellow band sporting the ominous warning: “Fall risk.” If that little band is the only way that a staff member can ascertain a patient’s risk for falling down unassisted, then one is left to wonder about their powers of perception. In a moment of rare good humor, my loved one looked down at his assorted IV tubes and three plastic wrist bands and concluded: “I’m one stripe away from Admiral.”
8: The Blank White Board. “Sleep-deprivation-induced delirium can be rather disorienting. To help patients keep track of their core care team names, most hospital rooms have been outfitted with white boards. Ideally they are to be filled out each shift change so that the patient knows which activities are scheduled and the names of the staff who will be performing them. Filling out these boards is tiresome for staff members (not to mention that the dry erase markers are usually missing) and so they remain blank most of the time. This has an anxiety-producing effect on patients, as the boards boldly proclaim that no nurse is taking care of them, and no activities are scheduled. I also noted that the size of the board lettering was a fraction smaller than a person with 20/20 vision could make out from the distance of the bed.”
9: The Slightly-Too-Tight Pulse Oximeter. “Because being tethered to a bed with IV tubing, telemetry cords, and a nasal cannula is not quite irritating enough, hospital staff have devised a way to keep one unhappy finger in a constant, mild vice grip. This device monitors oxygenation status and helps to trigger alarms when nasal cannulas achieve their usual peri-ocular destination every 30 minutes or so.”
10: The Ticking And Creaking IV Drip. “During the few rare moments of quiet, we did not enjoy any sort of blissful silence, but rather the incessant ticking of the I.V. drip machine. My loved one remarked that he felt as if he were trapped in an endless recording loop of the first five seconds of the TV show Sixty Minutes. And so if the alarms, tethering, interruptions, PA announcements, tubing, or white boards didn’t drive you mad, the auditory reinforcement of a ticking time bomb next to your head could bring you close to tears.
“And so, because of all these nuisances (not to mention the ill-fitting hospital gowns, inedible food, and floors covered with various forms of “seepage” that penetrated patient socks on hallway ambulation attempts), we had one of the most unpleasant experiences in recent memory.”
* © 2012 Dr. Val Jones Get Better Health
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Q: What other hospital design flaws would you add to Dr. Val’s list?