tag:blogger.com,1999:blog-32053362.post4571587580627222431..comments2024-03-26T00:25:34.026-04:00Comments on Not Running a Hospital: GRACE: Will it be amazing?Paul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-32053362.post-18704546816006298582009-11-04T07:20:47.550-05:002009-11-04T07:20:47.550-05:00Thank you for raising this important issue. Some ...Thank you for raising this important issue. Some of the details of the initiative may not be conveyed in a blog post. One of the key components we have been training our staff to incorporate into the bedside GRACE component is determining from family, prior caregivers etc, the patient’s baseline level of cognitive and physical function. This clearly impacts the patient’s ability to comply with the check-list. There is an “opt-out” for the aspects for patients who are unable or in whom it would be medically unsafe for them to comply.<br /><br />And, your concerns about physicians in the hospital not being concerned about “the overall patient condition” may certainly be reflective of your experience with your aunt. It sounds like it was not a good one. Yet, physicians, and hospitalists in particular, are trained to care for the whole patient. This is something we strive for here at the BIDMC. If you have a poor experience with a physician or staff at a hospital, you should feel free to let Patient Relations know of your concerns so that they can be addressed.Melissa Mattison, MDnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-9984760675256126822009-11-03T17:28:30.568-05:002009-11-03T17:28:30.568-05:00I don't see any mention here of involving the ...I don't see any mention here of involving the family or the PCP in discussion of these issues. Taking a person's care away from the folks who deal with an elderly person on a routine basis is disturbing and disruptive for them. Hospitalists tend to treat for the admission trigger - not the overall patient condition. My aunt broke her hip and was sent to rehab having been constipated for 6 days - no one cared about anyting but the hip. The hospitalist did not listen to or work with the family when we raised concerns. This checklist would be one more set of tasks my elderly relative could not do and it would have added to her frustration and confusion. I can't see this protocol being at all helpful if the issues of caring for the person's condition overall and involving the PCP and family aren't addressed. Personal opinion....Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-11627594918075064812009-11-03T16:00:17.104-05:002009-11-03T16:00:17.104-05:00The falls issue is a complex one, as there is only...The falls issue is a complex one, as there is only so much you can do, and restraints are discouraged for obvious reasons. I am sympathetic to the dismay engendered by its inclusion in Medicare's "non-reimbursable complication" list. <br />However, recently my 87 year old mother was hospitalized to R/O stroke; her ultimate diagnosis was drug-induced delirium caused by over-prescription by her PCP for back pain. I told them up front, of course, that she was a high fall risk. But the problem was that the hospital appeared to deal with the fall risk by simply telling her she couldn't get up, and then not answering her bell when she needed to use the bath or was otherwise in need. They finally put an "elopement sitter" in with her, who was male and (?untrained), therefore couldn't/didn't help her with the bathroom issue. It was quite a scene, with which I was very unhappy - and I am familiar with hospitals' problems.<br />It seems like this is going to cause staffing issues and therefore induce more hospitals to simply leave the patient in bed, which of course raises their risk too. I don't know what a good answer is. I will be interested to see if GRACE is amazing, because it will be great if successful.<br /><br />nonlocalAnonymousnoreply@blogger.com