As a worry wart, the worst-case scenario easily enters my mind in most situations, particularly with health-related concerns. Pushing my overactive imagination aside, there really are legitimate hazards lurking in hospitals that increase your risk of complications. And many of the hazards are related to the use of technology in health care. What are the top health technology hazards for 2020?
This is the second post in a series of 3 covering ECRI’s recent report for 2020: Top 10 Health Technology Hazards. The goal of their report is to help health care facilities improve safety issues relating to medical devices and systems. But as a patient or family caregiver, you should learn about these hospital safety concerns for 2020 too!
4. Central venous catheters in at-home hemodialysis.
For some patients with end stage renal disease, getting hemodialysis at home provides many long-term benefits. However, for patients receiving home hemodialysis through a central venous catheter (CVC), the risks of home dialysis might outweigh the benefits.
What is a CVC and why is it potentially dangerous?
CVCs are usually placed through a large central vein, like the jugular vein, to provide a path from a point outside the patient’s body directly to the patient’s heart. Because of this direct pathway, issues such as infection, clotting, disconnection and air embolism can cause severe health consequences for patients.
Home use of CVC increases the risk of serious health problems.
Family members and other caregivers may lack the training and experience needed to manage the risks of CVCs and/or to respond to a CVC related problem. In contrast, in a healthcare setting, the clinical staff can provide proper CVC care and properly address any problems.
The increased use of home hemodialysis.
The US government wants to increase the use of home treatment for kidney disease patients. But at the same time, many hemodialysis patients use CVCs longer than recommended. Hence, the increased use of CVCs for home hemodialysis is quite possible, leading to increased risk for patients.
What can you do?
If you receive home hemodialysis through a CVC, ask your doctor about switching to another form of vascular access.
5. Unproven surgical robotic procedures.
Surgeons use robotic systems to help them perform a wide range of minimally invasive procedures. And, the list of procedures involving robots continually grows.
The benefits of surgical robots.
The benefits include motion scaling (when the surgeon’s large hand movements translate into smaller movements of the surgical instrument), improved dexterity and a reduction in hand tremors.
What’s the problem?
Although using surgical robots can improve and advance medical practice, there are downsides as well. According to the ECRI report, surgical robots can “lead to injury or unexpected complications and the potential for poorer long-term outcomes.” How? Robotic systems have limitations. For example, the robots may not provide tactile feedback regarding the forces placed on tissue, leading to potential harm. And in some cases, the complications from robotic procedures might take years to appear.
What can hospitals and surgeons do to reduce risk?
Healthcare facilities need to develop and follow stringent approval processes for the use of surgical robots in new procedures. Additionally, they must have comprehensive programs for the training, credentialing and privileging for surgeons and OR staff using surgical robots.
What can patients do?
First, don’t assume a robotic procedure is better, or worse, than a traditional minimally invasive procedure. Every surgical procedure has risks and benefits, so ask your doctor about the pros and cons of possible options. And get a 2nd, or even 3rd, opinion whenever possible.
For information on reducing your risk of surgical complications and harm, read my blog posts:
- Questions to Ask Before Surgery
- You Can Improve Your Surgical Outcome
- How to Recover Faster After Surgery
- What Kinds of Things Can Go Wrong During Surgery?
- Is Nighttime Surgery Safe?
- Is it Safe to Have Surgery in a Surgery Center?
6. Alarm, alert and notification overload.
In the past, the overwhelming number of alerts and alarms from bedside equipment caused staff to feel overwhelmed, causing alarms to be missed or overlooked. But now, there is an ever-increasing amount of information coming at clinicians in hospitals. More than ever, clinicians must balance providing patient care while responding to alerts from medical devices and IT systems.
How does this impact clinical staff and patients?
With the increasing number of devices emitting alerts, alarms and notifications, the risk of clinicians missing important information increases as well. How? The cognitive overload of all this information can distract clinicians or cause them to ignore alerts. And, to prevent the overload, some clinicians may change the notifications setting of devices to reduce the volume or frequency of alarms. As a result, clinicians can miss notifications and patients can be harmed.
Where’s all the information coming from?
Clinicians can easily be overwhelmed by the wide range of information regularly needing their attention. Bedside patient care devices and equipment use audio and visual alarms and indicators. Providers’ cell phones regular buzz with calls and texts. And, computers and tablets with electronic health records (EHRs) display alerts for clinical decision-support. And last, but definitely not least, patients’ bedside call systems beep and light up when patients need attention.
What can be done to address this problem?
The ECRI report recommends healthcare facilities should reduce the overall burden of so many notifications. Moreover, they should help staff develop the critical thinking skills needed to ease the cognitive overload.
What can you do about cognitive overload?
It’s important to realize that staff might be overloaded, leading them to miss critical pieces of information or make misguided decisions. Patients and families must be actively engaged in the process throughout a hospital stay. I recommend the following:
- First and foremost, speak up if something doesn’t seem right!
- Participate in bedside rounds whenever possible.
- Ask questions – jot down your questions as you think of them, so you won’t forget later.
- Take detailed notes of conversations with all staff. And keep track of test results, symptoms, side effects and other pertinent information. Keep all of this with the patient.
What can you do about the risk of missed bedside alarms?
Because the consequences of a missed bedside alarm can be severe, I recommend that a family member, or another trusted adult, stay with the patient whenever possible. This is particularly important when patients are too ill to speak up or call for a nurse themselves.
To minimize the risk of missed alarms, patients and families should learn:
- What monitors are in use and why.
- What the different alarms sound like for each piece of equipment.
- Which alarms are urgent and therefore demand immediate attention.
If an urgent alarm sounds and no clinician appears quickly, seek help by looking for a nurse in the hall or at the nurse’s station.
For more information:
- Being an Engaged Patient Can Help You Get the Best Medical Care Possible
- The Dangers of Missed Bedside Alarms
- The Benefits of Participating in Hospital Rounds