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Who knows us best?

Providers and Patients

Why concerned family members matter.

We talk a lot about patient and family engagement at HealthInsight. I'm sure it is on the mind of most health care professionals at some level. But building this into our day-to-day muscle memory of how we respond in situations is still pretty rare. I would like to tell a story of a dear friend of mine who recently dealt with the lack of patient and family engagement and all it is intended to prevent.

This is a 75-year-old man, overweight, not in horrible shape but who has long suffered from breathing problems (frequent bronchitis, sleep apnea, etc.). He has desperately needed a knee replacement for as long as I've known him but was very reluctant to take such a drastic step. Finally, he knew he didn't have any choice and made the decision to proceed. He researched local surgeons and settled on one with full confidence that he had picked the best in the area.

The surgery went without a hitch, and he was coming out of recovery nicely. However, his wife noted a considerable difference in the hospital's nursing staff responsiveness from one shift to the next. On the second day after the surgery, during one of those shifts when she wasn't too pleased with the attention to detail by the nursing staff, the hospital was preparing for his discharge. His wife noted that he was shivering and generally didn't look very good. The nurse apparently dismissed her observation with a quick, "He's just excited about going home." Despite their reservations, he was discharged to home. In the middle of the night, he woke his wife up because of blood in his urine and not feeling well. His wife called the ambulance for immediate transport to the hospital. After a couple of hours, the emergency room physicians identified him as septic – his kidneys were shutting down.

The story ends well with him recovering completely and happy about having his knee replaced.

According to the National Center for Health Statistics, severe sepsis strikes more than a million Americans every year. It's been estimated that between 28 and 50 percent of these people die – far more than the number of U.S. deaths from prostate cancer, breast cancer and AIDS combined. One would hope for protocols to be in place to monitor high-risk patients for sepsis in just about every health care situation. At a minimum, nursing staff that deal with a high volume of seniors receiving joint replacements should be highly sensitized to the possibility of sepsis. More important with that population, health care professionals should naturally listen to the caregivers who know the patient better than anyone.

My friend's wife knew the look in her husband's face when he wasn't doing well and was vocal enough to bring his shivering to the attention of a busy nursing staff member. Because of her quick action in the middle of the night getting him back to the hospital, he is alive today – not because the health care system was watching out for him. On a positive note, the surgeon apparently had quite a bit to say to the hospital about allowing this situation to get so dangerous. Hopefully his influence on the hospital is a lasting one that includes listening to his patients when he turns them over to the hospital staff and taking the cautions from concerned family members seriously.

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