Hospital Errors

 

Hospital errors incidence

     250000 Americans die every year from hospital mistakes. That is one person in every ten minutes. 1 in ten people are treated in a hospital every year. Hospital mistakes are the fifth leading cause of death in U.S.  Dont assume doctors, nurses, aides or surgeons know best.
 One in seven hospital patients suffers at least one hospital mistake that prolongs his or her stay causes permanent damage, requires life sustaining treatment or results in death.

Hospital acquired infections

     In USA infections acquired after being admitted to a hospital kill more than 30000 patients every year. This is a death toll similar to breast cancer in USA   Any hospital with high infection rates should be avoided. If you are in hospital do not touch toilet handles, bathroom fixtures, door handles or public surfaces. Even doctors working in hospitals carry a lot of germs in their ties and necklaces.

Hospital acquired infections

     http://www.nysenate.gov/files/pdfs/DirtyTieFINAL_1.pdf
 One out of four hospital doctors stethoscopes have harmful staph bacteria.
 http://www.ncbi.nlm.nih.gov/pubmed/19145528
 Dont pick up a hospital pen to write.
 Sixty percent of hospital buttons are colonized with bacteria more than even toilet surfaces.
 http://www.ctvnews.ca/health/hospital-elevator-buttons-coated-with-more-bacteria-than-toilet-stall-surfaces-1.1903812

Air Conditioning

    Cooler room tempratures inhibit growth of bateria.  Avoid hospitals which are not air conditioned.  Hospital floor should be cleaned between patients.  That we do regularly. I have never seen any Sri Lankan hospitals I have visited or been as a patient doing that.

Medication errors

    Medication related fatalities occur due to incorrect prescription or administration of medication. How many doctors in Sri Lanka type their prescriptions.  You know how bad doctors handwriting is.  I type all my prescriptions when they take it to a pharmacy.

Anaphylaxis

     Always tell your doctor about vitamins, herbs and your intake of alcohol or smoking.
 Always tell about all the medicines you take and the right dosage in milligrams when you go to the hospital so you would not get the wrong dosage. Always tell hospital doctor about your allergies.  77 percent of deaths due to anaphylactic shock (serious allergy happens inside hospitals in USA )
 http://www.ncbi.nlm.nih.gov/pubmed/24332862

Advise to the patient

     Make sure the hospital charts your weight properly. They may put your weight in pounds and you might get double the dosage. This has happened to many people.
 From the doctor or pharmacist get a full explanation as to how to take your medicine, what times any interactions, if safe to drive after taking it.
 Any doubts can be cleared by this website where you can check if you got the right drug.  http://www.drugs.com/imprints.php

Avoid errors

     If you suffer from a disease always learn about it yourself. If a treatment doesn't seem right you don't have to take it.  Always remember to thank your providers and hospital workers so that you would be treated as a person. During shift changes chances of medical mishaps skyrocket. Have your hospital staff check your identity to prevent mishaps.

Further Advise

    If you have catheters, IVs they may need to be changed to prevent infections. Dont forget to ask your nurses. When IV fluids run out let them know. If you cannot move you have to be moved every four hours to prevent bed sores.

Experience of the doctor

    If you are going to do the procedure find out how many of the same procedure they have performed before. Skill and experience of the hospital and the doctors matter a lot to your safety. Doctors and hospitals keeping electronic records have 86 percent fewer communication errors.

Computerized Records

    Hosptial using computer systems kill 20% fewer people because computers can pick up allergies and drug interactions. It is best to keep your own records. Avoid weekends for hospital surgeries when medical errors are more common with lighter staffing.

Surgery

    Mix up of patients commonly happen because the patient cannot communicate once anesthetized.  Patient must communicate with all concerned prior to the surgery to make sure everybody knows about his condition. Have the surgeon initial the surgical site prior to surgery. Longer you are in hospital greater the risk of a hospital error.

Beware of side effects

    Remember that all tests and treatments have side effects. Sometimes less is more.  A lot of hospital deaths occur with blood clots. Venous thromboembolism affects a million people in USA annually killing about 100000 of them. 

General Anesthesia kills

    Obviously more common with any surgery under general anesthesia or prolonged surgery.  Avoid falls in the hospital. Mostly occur while going to the bathroom. 30% hospital falls result in seriuos  injury. Most american beds have bed railings. 

Risks of General Anesthesia

     Risk of death in General Anesthesia alone is 1 in 10000

     Risk of Liposuction with General Anesthesia is 1/5000

     2% of all ICU admissions are due to complications of GA

Complications of GA

      Pain

      Nausea and Vomiting in 30%

      Damage to teeth 1/4500

      Sore Throat and Laryngeal Damage

      Anaphylaxis

      Cardiovascular collapse

      Respiratory Depression

     Aspiration pneumonia

     Hypothermia

     Hypoxic brain damage

     Nerve Injury

     Awareness during

     Embolism, air, thrombus,

     venous or arterial

      Backache

      Headache

      Idiosyncratic Reaction , eg malignant hyperpyrexia with suxamethonium, Succinyl-choline

      Iotrogenic problems, pneumothorax

      Death

Aspiration Pneumonitis   

      Due to lack of gag refelx

      Can occur with high spinal anesthesia.

      Cricoid pressure during induction helps

      Ranitidine or PP inhibitors help. Use of metoclorpramide help.

Peripheral  Nerve Damage   

     Results from nerve compression

     Commonly ulnar nerve and common peroneal nerve

     Rarely Brachial plexus damage

Damage to teeth

    The most common claim made against  Anesthetist.

    Upper left incisor is commonly damaged.

Embolism

      Rare but can be fatal.

      Air Embolism common with pelvic operations.

      Venous thromboembolism should be prevented with TEDS and Low Molecular Weight  Heparin

Safety of tumescent local anesthesia

     Doctors in Sri Lanka have very little experience in Tumescent Anesthesia and saftey of that technique. This anesthesia was developed by Dr Jeffrey Klein from California who is a dermatologist and a founding member of the American Academy of Cosmetic Surgery.

Safety of tumescent Anesthesia in out patient setting

     Tumescent anesthesia is the safest technique for liposuction and can be done in an outpatient setting.  By overregulating it unsafe techniques using general anesthesia and sedation will continue to be practiced harming people with serious side effects including death.

     Coldiron B1, Fisher AH, Adelman E, Yelverton CB, Balkrishnan R, Feldman MA, Feldman SR.

     Safety of tumescent liposuction in 15,336 patients. National survey results.


Safety of tumescent liposuction in 15,336 patients. National survey results.

 

    Office-based tumescent liposuction performed by dermatologic surgeons is safe, with a lower complication rate than hospital-based procedures. Future legislation should recognize the proven safety of this procedure as performed by dermatologic surgeons in their offices.

The safety of liposuction: results of a national survey

    Housman TS1, Lawrence N, Mellen BG, George MN, Filippo JS, Cerveny KA, DeMarco M, Feldman SR, Fleischer AB.

    Safety of liposuction using exclusively tumescent local anesthesia in 3,240 consecutive cases.

 


Safety of liposuction using exclusively tumescent local anesthesia in 3,240 consecutive cases

 

 

     The same surgeon performed liposuction using exclusively TLA in 3,240 procedures.

     In a series of 3,240 procedures, no deaths occurred, and no complications requiring hospitalization were experienced

     Liposuction using exclusively TLA is a proven safe procedure provided that the existing guidelines are meticulously followed.

Dr Jeffrey Klein

 

 

 This is Dr Jeff Klein who discovered tumescent anesthesia speaking at the 2nd Annual World Academy of Cosmetic Surgery in Vienna  on Semptember 4th 2011 posing for a picture with me. I am holding in my hand special cannula made by Dr Jeffrey Klein for liposuctions. He is a Dermatologist.