Hospital Expansions Hinder Patient Safety in the Short Run
Research has shown that mergers, acquisitions and other medical facility expansions may increase the risk of patient harm in the short term and that improving safety is possible during these changes but will require a focused institution-wide effort. There have been more than 100 hospital or health system mergers and acquisitions each year since 2014.
In a recent study, more than seventy clinicians and their counterparts were interviewed to gain a better understanding regarding the possible safety risks associated with expansions. Many of them had interesting feedback.
One surgeon indicated she was once asked to assist in a code after a patient’s heart stopped beating. However, because of internal changes, she got lost trying to locate the room the patient was in. An anesthesiologist had a similar problem. After the hospital at which he was used to working merged with another, he had trouble finding the room in the radiology suite where a patient had stopped breathing and needed a breathing tube inserted immediately.
A pediatrician covering the emergency department in a hospital who was used to calculate medication doses based on a patient’s weight in kilograms accidentally gave a patient a double dose of anti-seizure medication. The emergency department didn’t have a system for converting pounds to kilograms, which led to the error.
Another physician who has assigned to cover a 24-hour urgent center immediately following a half-hour orientation found himself in a situation in which several ambulances were arriving at once with critically injured car crash victims. Care was delayed because he had not been briefed on how to call for back up. Another doctor wrote, “I know the medicine. I just don’t know how to get things done around here, and especially how to get them done fast.”
An article written for the Journal of the American Medical Association found the primary risks involved with mergers and acquisitions include different patient populations, unfamiliar infrastructure, and new settings for physicians. All of these factors lead to increased responsibilities and confusion, at least initially.
Tools need to be created and disseminated to support clinicians when they are asked to cover new areas, the studies have shown. There is a systemic assumption that a clinician who knows how to practice in one setting can do so in all. The difficulty in transferring patients between hospitals within a network when their condition changes also needs to be addressed. There are currently no guidelines for what should trigger a transfer and limited information on the protocol for doing so.
System expansions are likely to continue for the foreseeable future, so it is important to promptly and properly train and orient physicians to new circumstances and patient populations. Just because a doctor has worked in one area for a number of years doesn’t automatically mean he or she will feel comfortable jumping into another. Having an established plan in place is important but listening for feedback regarding the changes and revising whenever necessary is equally as vital. As these studies have shown, clinicians are willing to share their experiences. They just need to know someone is listening.