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Imagine that you are in the intensive care unit at the bedside of your loved one, and you think you see a medical error – a bad pill, a poorly washed hand. Do you speak? Even if you are afraid that it could annoy or alienate the medical team?
It's a tricky question, and a new study on Beth Israel's Deaconess Medical Center – the first study of the ICU of its kind – documents just how delicate. The researchers interviewed more than 100 family members at the USI and over 1,000 online to find out if they would feel comfortable expressing their concerns.
"One of the key messages to remember was that of patients and families. More than half of them expressed some reluctance to talk about common critical care concerns, including an error in care," explains Dr. Sigall Bell, lead author of the Beth Israel Deaconess Medical Center and Harvard Medical School. and the families cited, "I do not want to be labeled as a troublemaker" as a reason. Another third said: "The team is too busy." And yet another third chose, "I do not know how to raise my concern, or who to talk to."
About a fifth of respondents cited, "I'm afraid to seem to not understand the medical concepts," and another fifth chose, "I do not want to hurt my relationship with members of the # Medical team. "
Of course, it makes sense to think twice before interrupting a medical team in the middle of your loved one's health crisis. But the study comes in a broader context: medical errors are a huge problem at the national level and in recent years efforts have focused on empowering physicians to fight Errors.
This new study helps extend this focus to empowering family members and patients so that they can express themselves more.
Exactly how families can talk most usefully remains to study, says Bell, but it is clear that the relatives of a patient – often present at the bedside of the intensive care unit 24 hours a day , 7 days a week – can be a considerable asset.
"They know the patient best," she said. "They can detect these early signs when something is wrong, they are present during care transitions between different clinicians or different care teams, so they have a large amount of knowledge and experience that can contribute to the best care for the patient.
If you are at the bedside of a loved one and you see something that concerns you, advises Bell, let at least someone from the care team know it so you can decide if you want to continue it
. On the other hand, patients and families who do not talk when there is a potential problem often end up having a lot of guilt if something goes wrong, "said Bell. It is not uncommon to hear from family members that they knew something was wrong, or that they had this worry but did not speak. "
Mistakes occur more often in medicine than most people said Barbara Fain, executive director of the Betsy Lehman Center, the state agency that aims to improve the safety and quality of health care. [19659012] "When patients end up getting hurt, it's usually after a whole bunch of missed opportunity mistakes," she said. "It's exactly where patients and families can play a key role: very interesting studies show that patients and family members are often better than doctors and nurses in detecting errors; "
" On the other hand, patients and families who do not talk when there is a potential problem often end up having a lot of guilt if something goes wrong. "
Dr. Sigal Bell of the Beth Israel Deaconess Medical Center
Patients and their family members" should trust their instincts more than we know from all this research ", a- she added. "Speaking of a drug change, they are unaware of the fact that the doctor ordered them, or of a sudden unexpected change in mental state or level. patient discomfort, they can really make a difference. "
talk? What is the language?
Even though she works on patient safety, Fain even says that she may have trouble wrong to find the right words.
"Most people do better to ask their question as a question". "So, something like:" It seems to be a different dose or a different drug than the one that I've had. Can you check to make sure that's correct? "# 19659020" "That for would help you remember that you are entitled "
Research is needed on what is the most effective language, says Bell, but for now," I would say things like, "I'm really concerned about X ". or "I know this family member very well, and that's different from what I've seen before." Maybe even just a very direct help statement: "I need help to make sure the patient is on the right track." "
If your concerns are not addressed, said Fain, you should go beyond your care team: Most hospitals have staff whose job is to respond confidentially to patients or families." Or "customer service" – and, she said, that's what they are there for
Of course, speaking openly can only work if the medical staff is receptive. "Bell and Fain have said that it's really a hospital issue Although the study looks at what patients and families can do, it's actually up to hospital leaders to promote a culture where people are encouraged to express themselves.
Fain says one strategy would be to place posters in patients' rooms. Distribute pamphlets so families and patients know how to start conversations. their concerns and that they be encouraged. [196] 59023] Bell suggests patient education programs that would help patients and family members talk and assure them that they have unique knowledge – knowledge that the medical team wants to share
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