Medical-Legal Topics

Johns Hopkins in Baltimore

My husband’s Medicare card permits him to get medical care anywhere in the country. (For those of you younger than 65, remember the days of free choice when you could select any doctor and see any specialist you wished without a referral? If you live long enough to get Medicare, you’ll get that choice again.) Given that he could have a triple bypass operation anywhere in the country, we choose Johns Hopkins in Baltimore for his surgery on September 23. Johns Hopkins has been identified as the number one hospital for the 19th consecutive time.

This is what I observed from my patient safety/standard of care seat/spouse sea:

Communication
We received clear explanations from Johns Hopkins staff of what to expect during the preoperative, intraoperative, and postoperative period. I received an hourly call from either the surgical waiting room receptionist or the operating room nurse while Raj underwent his 4 hour long surgery. The calls gave me an update on what part of the surgery was being done at that time. (The cardiac surgeon had previously assured me –without me asking- that he would perform the operation, not his residents or interns.) After the surgery, the cardiac surgeon found me to discuss the triple bypass and to tell me where to position myself so I could see my husband as he was wheeled out of the OR and into the ICU. I knew what to expect- a brief visit in the ICU after they settled him in, and removal of the ventilator by 8 PM that night.

Attentive communication was available electronically as well. Both before and after surgery, he has had ready access to his doctors who promptly responded to his emails.

Integration of best practices
My husband received two packages of Chlorhexidine soaked washcloths to use to clean his skin the night before and the morning of the surgery. (From having researched IV catheter related infections for programs I teach to clinical staff and risk managers, I knew Chlorhexidine reduces the risk of infection when used prior to insertion of an IV, as well as for daily care of an IV site.) Each package had a sticker which we peeled off and applied to a paper that we handed to the OR staff the morning of surgery. They used this system to verify the patient followed the instruction.

Many facilities struggle with the issue of getting people to wash their hands before and after patient contact. JH was clearly aware of this issue and reinforced the hand washing message. The OR nurse handed me a sheet explaining my need to wash hands when I visited my husband. The hallways of the hospitals were filled with posters about hand washing. Skin cleaning solutions were dispended from canisters outside of each unit to remind people to clean their hands before entering the unit. (I compared this with another hospital’s emergency room I visited in 2008 which had only one sink to serve 30 bays.)

Technology
The staff used computers to document at the bedside. After surgery Raj had a drain in his leg where his vein had been removed, two chest tubes, pacemaker wires in his heart, cardiac monitor leads, a jugular intravenous line in his neck, an arterial line in his wrist, and a Foley catheter in his bladder. He got out of bed the next day and did well. His chest incision was glued together, which meant that he did not have to undergo the painful removal of sutures. After he got home Raj’s local cardiologist admired his incision.

Efficiency and customer service
From the moment of the first encounters with the hospital staff, we knew what to expect and events moved according to schedule. Yet, there was not an impersonal feel to the care. Efficiency and organization prevailed. I’ve noticed this on other visits to the hospital. The walls in the outpatient areas are painted different colors, so it is easy for the staff to give directions such as “Go to the desk by the green wall.” There is a desk next to the elevator on each floor containing outpatient departments. A person is specifically assigned to help a person find the right department. The hospital staff clearly understands customer service.

Some examples:
The day before Raj went home after surgery, I heated up water in the microwave for his tea. I lost my grip on the Styrofoam cup as I removed it from a microwave that was over my head. The scalding water spilled over my hands and left second degree burns on my right hand. (I now know what it means when I read medical records that quote patients having a “burning pain”.) The intense pain lasted for hours. The staff supplied me with ice packs and ice and offered to take me to the emergency department, which I declined.The stoic traits took over.

After Raj got home and his pain medication was getting low, the staff Fed Exed him a prescription so he could get his medication renewed.

Perhaps the most touching example of customer service occurred when we went back for a postoperative check. Raj needed a chest x-ray. I sat on a low hard bench in the radiology department using my laptop computer while he had a chest x-ray. An employee of the radiology department came over to me and said, “You look uncomfortable. There is a soft chair with a good light and an outlet around the corner. Would you like me to help you move your things?”

Johns Hopkins does it right.

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