is Deputy Editor at CMAJ, and Editor of CMAJ Open
While wandering past the many posters at the Society of Hospital Medicine 2015 conference, I noticed that many of the research projects focused on very practical aspects of our care of patients in hospital — in particular, on not making them sicker. This seems obvious. After all, we admit patients to make them better, don't we? Yet many of the things we and other health professionals do, the way hospitals are built, the hospital routine, may actually make our patients sicker.
Here are 10 practical pointers that I gleaned from the poster session. Most will seem like common sense, but in the hustle and bustle of hospital life, some things can get missed.
- Don't take blood unless you have to. Be sure that the results of any blood work you order will change management. If not, don't order the tests.
- Don't routinely transfuse if your patient has anemia. In some conditions, transfusions aren't helpful.
- Don't routinely order blood cultures in suspected infection if the patient is not septic. If there is pus to culture (e.g., in the urine), why not culture that instead? This is of particular importance in children who, let's face it, are often not that stoical about needle sticks and don't have that much blood to spare.
- Let your patients sleep. Why have them woken up in the middle of the night to check vitals, unless their condition requires close monitoring? You need sleep to stay well — so do your sick patients.
- Feed your patients. Patients are often kept NPO unnecessarily. Starving them will not improve their healing.
- Make sure your patients know who you are. Communication with patients and families is enhanced when they know who to talk to. Photos may help.
- You are not the only one caring for your patients. How about rounding with other members of the health care team?
- When transferring care to another physician or team at the end of a shift, share important details about each patient, preferably through the EMR. Ignorance is not bliss.
- When your patients are ready to go home, let them go. Plan for discharge early in admission, and don't delay it while things get organized.
- Finally, don't forget to talk to your patients. Computers, tablets and smart phones can help patient care, but they can also get in the way of direct patient contact.