All of Us

Overnight in a Hospital

by Mike Critelli

On June 14, I had an overnight post-surgery stay at the Physicians Regional Health System hospital in Naples, FL. Naples is 94% white, and has an average annual family income over $105K. My experience in this affluent part of our country was remarkably substandard. Through my many conversations, I learned that many others in all types of communities experience what I did, or worse.

In 2020, America suffered lockdowns and other extreme measures implemented to prevent inundating our hospitals with COVID-19 patients. Federal and state governments had no plans for the surges in capacity when we were hit with COVID-19. Though some states were far better than others in responding to the crisis, we all lacked enough beds, ventilators, personal protective equipment, and staff.

Now, whether in response to COVID-19 or not, existing hospital capacity issues still need to be addressed.

Hospitals build and staff for the capacity they believe they will need. Typically, overall hospital beds are 70% utilized, with an estimated 20% set aside for surge capacity.

Existing capacity is often poorly managed. In the case of my stay at Physicians Regional, capacity issues were not the fault of:

  • The uniformly high-quality professionals who cared deeply for me
  • The top-notch surgeon who admitted me
  • The surgeon’s partner, who issued the discharge order
  • My deeply committed and highly competent Patient Advocate

However, broken processes, equipment, supplies and communications lengthened my stay and also delayed someone else getting into my hospital bed.

Physicians Regional wasn't fully prepared for a patient surge.

Like other patients, I assumed that June 14 was “off season” in Naples, and that demand would be much lower than May 14. The peak Naples hospital season starts at Thanksgiving and ends after April 30.  

I was wrong because Naples’ population is growing fast. The “seasonal” residents are staying into mid-June and post-pandemic “medical tourists” are coming for earlier access.

The discharge process adds hours to someone’s stay. But errors will lead to preventable readmissions and gobble scarce capacity.

Three items precede the patient's discharge:

  • Detecting any stay-extending medical conditions
  • Assembling supplies and instructions needed for post-discharge recovery processes.
  • Ordering patient prescriptions for any recovery medications.

Patient discharge controls are often complex. I assumed that either my surgeon or his partner would issue the discharge order and would be empowered to get it done. But, in many hospitals, hospitalists—physicians employed by the hospital—often must approve all discharges.

My admitting physician’s partner attempted to issue discharge orders three different times over a two-hour period on Tuesday, June 15. Some staff thought the hospital's approval was required. Wrong!

The discharge kit missed items ordered from Central Supply. The nursing staff lacked the skills or knowledge to fix this.

A senior nurse arrived. She knew the right Central Supply staff to call. Without her savvy, I might have been having lunch and dinner at the hospital.

At 1:30am Tuesday, I pressed the red service button on my wired remote device to summon a nurse. I pressed the button 6 times at 10-minute intervals, over 60 minutes before a nurse appeared. He told me that the desk dispatcher failed to inform him of my call. He gave me his direct hospital phone number.

The technician responsible for “checking my vital signs” initially had a flawed oxygen monitoring device. She needed a replacement to get the correct reading.

This was not the first piece of malfunctioning equipment on my stay.

At 3am Tuesday, the alarm on the saline pump to which I was attached via an IV, blared out. My nurse informed me that an air pocket in the saline line was detected. If this isn't properly monitored, it can lead to a potentially fatal air embolism.  

The medication list on the discharge instructions didn't match what the admitting physician told me. The admitting physician didn't answer our call, and I left the hospital with an incomplete medication prescription list.

On Friday June 18, I had troubling post-discharge symptoms. The physicians’ assistant at the surgeon’s office gave me a list of foods and beverages to avoid. The hospital should have given this to me.  

I wasn’t readmitted, because I knew enough to contact the surgeon’s office first. But without that knowledge, I could easily have returned to the Emergency Department and clogged up the patient service area.

My experience is all too common in American hospitals today. We need to do a far better job using the hospital and outpatient care capacity we have.

Hospital processes need to be better designed. This can expand usable capacity. Examples include:

  • Discharge packets and medication instructions should be standardized and pre-prepared. Central Supply could have had the supplies prepared for delivery to me the day before, when my physician decided to have me stay overnight. The medication list could have been secured as well before my physician left the hospital after the surgery.
  • The use of a front desk dispatcher for patient-nurse communication adds unnecessary time and complexity. The nurse and I both had cell phones. I could have used SMS or text messaging to summon him. If he were with another patient or otherwise unavailable, he could have pressed a single key that would have so informed me.

Pandemics and other surge-producing events magnify existing process, communication and leadership deficiencies. They also lead to more healthcare worker burnout, since the staff interacting with me had to work harder, while achieving less satisfactory results.  

Hospitals and other healthcare organizations need a fundamental makeover.