Wednesday, July 8, 2020

COVID-19 Requires Hospital to Rethink The Patient Experience

Keeping patients and health care workers safe is more than cleaning surfaces and having people tested for COVID-19 four days before they come from a procedure. It also means thinking about exposure, viral load, and ventilation. The time a patient spends in a hospital or health care facilities must be minimized for the health of the patient and all those who work in a health care setting. Procedures need to be recalibrated in real time to take into account the changing realities of COVID-19. It is not about having to wait; it is about the extra time spent possibly being exposed or exposing others.

For example, it is unconscionable that Georgetown University Hospital asks patients to check-in 2 hours before they are taken in to start the prep-op for a procedure. Good management practices would find it unacceptable that the process should take 2 hours. In the case that I witnessed the process actually took less than 20 minutes but the patient had to be there 2 hours before and then ended up waiting an additional hour because the other procedures were delayed. Of course there is paperwork that needs to be done, but much of that can be, and is often accomplished by phone or online.

I contacted the hospital by email about my concerns. The “Patient Advocate” responded in a way that made clear that they were an advocate for the hospital. I eventually called Dr. Michael Sachtleben, President, MedStar Georgetown University Hospital and Dr. Lisa Boyle, Vice President of Medical Affairs kindly returned the call. I emphasized that especially now, under the current circumstances, 2 hours should be unacceptable to all. For certain what is required is timely action and not the process of a committee to agree that 2 hours is too long. The goal must be to reduce time spent in the hospital as much as possible. No excuses. Following pre-COVID-19 standard operating procedures is dangerous to some and fatal to others.

I will see if there is any change as I will be taking my patient back for a repeat procedure. 

Thursday, February 6, 2020

The Evidence on Vitamin D is Clear

In August 2018 I wrote my first blog on Vitamin D and wondered how long it would take for clinical practice to change. Much more has been documented since then to move prescribers to rethink and change what they recommend.

Even with critically ill patients the benefits were not evident. The December 26, 2019 NEJM original article “Early High-Dose Vitamin Dfor Critically Ill, Vitamin D–Deficient Patients” from The National Heart, Lung, and Blood Institute PETAL Clinical Trials Network concluded “Early administration of high-dose enteral vitamin Ddid not provide an advantage over placebo with respect to 90-day mortality or other, nonfatal outcomes among critically ill, vitamin D–deficient patients."

When it comes to recommending Vitamin D the willingness to change current prescribing behavior is still missingThe lag between the bench and clinical practice is not just a matter of communication; prescribers also have to be willing to change.