Many healthcare providers don’t use the healthcare system often. In fact, I’m sure many of us have heard doctors say, “I don’t need to go to the DOCTOR!”
For that reason, sometimes I think we have a limited sense of what it’s like to be a patient.
As a patient in the hospital, we turn our days and nights over to a system that intends to get us to a certain level of recovery and intends to keep us alive. The hospital, per se of course, isn’t always structured to support overall wellness or healing — that’s the job of others in the healthcare system, and of the patients themselves.
But sometimes information will confront us about just how hard a hospital stay can be on the health of a patient -- and we're forced to reconsider our approach.
One common complaint in hospitals is that you can't sleep because of all of the interruptions throughout the night -- vital checks, light, noise, early rounds, blood draws, etc. For many of us, this may sound like a tiny price to play for the crucial monitoring that happens through those hours. And perhaps it is.
But a recent article in the New York Times reconsiders whether the price truly is small. We all acknowledge the profound value of sleep in our basic functioning and healing: "Short sleep durations are associated with reduced immune function, delirium, hypertension and mood disorders. Hospital conditions, including sleep disruptions, may contribute to 'post-hospital syndrome' — the period of vulnerability to a host of health problems after hospitalization that are not related to the reason for that hospitalization."
There are so many demands in medicine that we’re forced to do things that may not make sense in terms of healing, but are the only way to proceed, working within the structure of the medical system. As the New York Times says, the hospital is "an environment that, all too often, seems set up for everyone else’s convenience but the patient’s.”
As providers who want to truly care for our patients, and in this time of value-based care, these are concerning truths. So what are we to do?
First, I believe that the sooner we can get people home, the better. This is a combination of the efficacy of care within the hospital PLUS an expectation of a high level of support once the patient leaves the hospital. The more we can depend on sophisticated monitoring and care from the home environment, the sooner the patient can get home. Many times, that means we need to be enabling healthcare collaboration across the continuum of care. That way, aides and wound care nurses can tend to patients from where they're most comfortable, but have a moment's access to other providers, as needed.
Second, the more humane, the more holistic, we can make our healing environments, the better. A clinical study showed that even small changes to disruptions to sleep in hospitals cut patients’ sedative use by half. Yes, hospitals are places where we achieve a bare minimum of functioning. But thinking more comprehensively about whether they're also supporting health may be a wise investment for us to make.
Finally, it's crucial that we let providers make commonsense decisions. Our checklist culture has sometimes reduced errors, but it may have also reduced the commonsense nature of what many of us do. Any nurse has an impeccable gut sense of how she might combine vital checks and blood draws so that no monitoring sensitivity is lost, but the patient is disrupted less frequently. But if she's told she MUST do these things on a set schedule, she begins to override her own sense of what's best for the patient.
Metrics like Length of Stay can seem challenging or even excessively profit-motivated to consider. But when you think about the patient's experience in the hospital and the intersection of Length of Stay and the patient's quality of healing, it gets clearer how the "right" thing to do is also the "smart" thing to do.
To learn more about how telemedicine can support shorter Length of Stay and improve outcomes, download our Quick Guide:
