Continuing with my dad’s saga in the healthcare system…

After 9 days in the hospital precipitated by pain and discomfort extending from his chest to his abdomen (which led to a visit to the ED, hospitalization and a score of tests which all came up negative), they discovered during his stay that his atrial fib was not being properly regulated by the drug he was on. The pacemaker they installed just a few weeks previously was doing its job to keep his heart beat around 70, but he was getting abnormal spikes in rate sometimes up to 130 just walking down the hall. Increased dosages of the drug didn’t work, nor did increased frequency. So he sat and waited for the past few days for his clinicians to come up with a solution.

Even though he’s soon turning 97, his mind is still as sharp as a tack, as are his observational skills. Nothing escapes him, and the litany of mistakes and dis-satisfiers he noticed became a daily occurrence. The other night in my daily call to him he gave me his report. I believe they are instructive, but perhaps a bigger question is whether or not his observations and insights will ever make their way back to the hospital’s leadership, much less his care team so they can improve their performance.

Because of his age they are rightly concerned he might fall. He had firm instructions that he wasn’t to leave the bed without assistance, and they had him monitored to alert the staff if he attempted to make an escape from bed without them. Needing to use the bathroom, he called the desk. His tech answered. She said she had just two tasks and she’d be right there in five minutes. Forty five minutes later she still hadn’t shown so he got up and took himself to the bathroom. Apparently the alarm never went off because she showed up a few minutes later wanting to know if he was ready for the bathroom.

Another night, he asked for assistance to help him into the bathroom so he could brush his teeth and use three other tools the dentist recommended—a half hour ritual. So, his tech got him a seat so he didn’t have to stand. When he stood, his socks with the non-skid ridges stuck to the floor. My dad used to be in the janitorial business and he has watched as his room has been cleaned (and on some days not). They now use a device similar to the Swiffers that we can all buy in the grocery store. In the old days, his crews would have first cleaned the floor and then mopped with clean water to clean up the residue. Whatever the residue that is left on the floor by this new cleaning method may, for all I know, leave an antimicrobial barrier. But as far as he is concerned, since his socks were sticking to the floor … it wasn’t clean. This is a reminder that when it comes to patient satisfaction, perception equals reality.

Getting to his age, he’s got lots of meds in addition to those that are supposed to regulate his heart. Some need to be taken a half hour before eating, others an hour after breakfast. Consistently nurses or techs have either brought him all of the capsules at one time—usually the wrong time for many of the drugs. Or, as was the case yesterday, a nurse woke him at 5:30 AM for his drug that’s supposed to be taken a half-hour before breakfast. He asked her why she woke him up so early since breakfast had never arrived earlier than 8:30 during his many stays there. Why couldn’t she just come in at 7:30 and let him sleep? Her response: doctor’s orders. He was dubious. And now exhausted. The truth was more likely nurse’s convenience. He wondered why his care was so unpredictable from day to day?

I asked him if he had ever filled out a satisfaction survey after his many hospitalizations that began this past summer. Yes he had—sounded like it wasn’t HCAHPS given the length of the survey he described. Did he give the hospital poor marks? No, he wanted to be generous.

Then the other day someone from the hospital appeared at his bedside wanting to interview him about his experience there. All he could think is that if he told the truth, word would get back to his care team, and he wondered whether it would change their attitude toward him—for the worse. His response: everything’s been fine.

I went on to check out this facility’s HCAHPS scores. Consistently they scored below the Florida average, and well below the national average.

I wonder if anyone there is genuinely seeking the truth, and if they do find it, what are they doing to help their teams learn and improve?