This is A case study.. Please help as much as you can. Thanks A 53-year-old man

Question

This is A case study.. Please help as much as you can. Thanks

A 53-year-old man with long-standing history of rectal prolapse presented for elective sigmoid resection with rectopexy. The patient underwent a pre-operative surgical office consultation weeks prior to surgery and was apprised of the surgical risks, including bleeding, infection, injury to organs, anastomotic leak, need for temporary (or permanent) ostomy, pain or injury to nerves affecting urinary or sexual function. There was no documented discussion of potential use of an experimental device or the associated risks of such mechanical devices to be utilized during the surgery. A day before the surgery, the patient was admitted for bowel prep. The morning of the surgery, the surgeon again reviewed how the procedure would be performed and described the associated risks. Meanwhile, two representatives of a stapling device vendor requested access to the OR to oversee the trial of a new stapler. The hospital’s policy for vendor access to the OR required approval by the Materials Department for use of trial devices, after which the representatives could be provided ID badges for access to the OR suite. In this case, the attending surgeon informed the vendors that they must obtain an ID badge to gain access to the OR without clearly articulating the steps for approval of trial devices. When the vendors returned to the OR with ID badges, the surgeon granted them access to the OR. As the surgeon applied the trial stapler in performing the anastomosis, it closed around the distal sigmoid colon and rectum, but would not re-open. After 45 minutes of trouble-shooting with the vendor representatives—including replacing batteries—the surgical team elected to re-open the sigmoid colon and resect the rectum to remove the stapler. During this process, part of the rectum was torn and multiple staples were lost in the operative space. These complications required that the patient undergo a diverted loop colostomy, requiring surgical reversal. The surgeon disclosed this event to the patient, who underwent an uncomplicated recovery and surgical reversal seven months later.

Case Study Assignment: Create a risk management strategy (focusing on communication) to try to prevent this type of adverse event in the future and to mitigate any adverse impact of future occurrences similar to this. Your strategy should clearly delineate the creation of processes intended to:

1. Prevent future similar occurrences and;

2. To mitigate/prevent litigation in the case of an adverse event that occurs in spite of the prevention methods. Relate each of your proposals/changes in procedure to the topics on communications strategies to reduce risk and explain how your proposal of policy will mitigate/alleviate risk in future adverse occurrences.

You may want to use

a. Respect and Civility

b. Cultural Sensitivity

c. Patient Empowerment

d. Health Literacy

e. Patient Consent

f. Disclosures and apologies g. Patient Satisfaction

Explanation / Answer

The very nature of Healthcare organisations which provide care to all and at times to critical patients, and overall operate in a segment where sensitivity to patient needs and excellence in service, in the terms of identifying and providing optimal care to a patient, become the basis for success and survival of the organization. Competition has similar implications for every industry and segment within an economy. The more the competition the better the quality of goods and services offered to lure the consumers, and to lower the pricing, by cutting costs wherever possible, to ensure maximum value at minimum cost. Considering the sensitive nature of the Healthcare industry as it provides services to save lives as well as protect quality of life available to the population at large, quality care and optimal services are the required asset and not competitiveness or maximization of profitability. Due to surgical procedures and even non invasive treatment carrying extensive risks due to critical nature of the outcome being as extreme as loss of life or significant impact on quality of life of the patient, it is the ethical responsibility of every involved specialist to have extreme sensitivity and accountability towards the patient through inclusive management and needs based decision making.

Risk management strategy for any surgical procedure first and foremost means to ensure implementation of all necessary legal and statutory requirements, stipulated and post by law besides those which are part of rules and regulations procedure to be adopted by individual organisation and finally the rights of patients that arise due to essential existence of ethics in the practice of medicine and fundamental human rights.

1) firstly, effective communication is the most crucial factor in mitigation of risk in health care. The rules and regulations to be followed during any surgery need to be clearly communicated in a list which is present with every surgeon, all operating room staff and all other staff related in any way with the surgery and the patient. Inclusive management becomes extremely important within industries such as the Healthcare due to the critical nature of the work involved and the repercussions of negative outcomes, for the society as well as the organisation. Facilitation of free and effective flow of communication with all information being distributed and shared through an efficient data and information management system which has adequate provision for feedback to ensure the information is received and reviewed by the individual it is intended for. Serious lapses can result due to inadequate sharing of information or lack of feedback. This risk can be mitigated by implementation of an efficient document management and sharing system over the internet which maintains all required security quick and easy flow of communication with fast and constant accessibility. All staff need to be extensively trained on use of the system and understand the importance of effective communication in healthcare.

2) All legal and statutory requirements need to be implemented within the policy framework of the organisation to mitigate risk from legal action. It is essential that effective monitoring and control system exist to ensure that all specified policies with respect to procedures are communicated and followed by every employee. The health insurance portability and accountability act, list the basic rights granted in in besides those which result from ethical practice of medicine and fundamental human rights. These are:

Right to be treated with respect and without discrimination regardless of social status or health condition.

Right to obtain absolute information about the medical condition along with all related records and documents including all test results and doctors notes. This is another reason for having an excellent database management system to ensure no patient records are misplaced.

The right to make a choice of the treatment with complete information of all available options for the concerned medical condition through complete involvement. This right is closely associated with the right to informed consent.

The right to informed consent requires the signature of the patient or Guardian on a phone signifying player consent for all tests treatments of procedures a patient undergoes. This is to ensure that the patient has clearly understood all related risks and benefits prior to participation and any treatment plan or surgical procedure.

The right to refuse treatment allows the patient to refuse any treatment provided the patient is of sound mind and capable of making sound rational decisions through written expression. There are certain exceptions to the case which also needs to be understood.

The right to make decisions about end of Life Care including all life preserving measures such as medical equipment which helps provide life support services like ventilators or feeding tubes.

3) the Healthcare industry is based upon work which requires compassion and empathy within all individuals related to the field to provide the humane angle to all care and treatment provided. Research clearly indicates that empathetic and compassionate care as a massive impact on positive outcomes and improved quality of life, especially pain management and ability to manage the situation in a more positive manner. Ethics within medical care comprises of clearly understanding the needs and requirements of the patient through clear and effective communication and implementing this knowledge within the treatment options to provide optimal service to the patient which leads to satisfaction for the patient along with understanding of the procedures. Any utilisation of drugs or equipment which is not the optimal solution for the given condition and patient but provides benefit in some form to the practitioner or organisation is highly unethical. This is a clear breach of the trust and respect every individual and society as a whole places within the profession and all individuals related to it. The medical fraternity is not supposed to be self centred and is expected to put the interests of the patient above all others by providing selfless service, perfectly matching patient needs and requirements. This requires recruitment policy to be followed by the organisation where the ethical values are clearly presented in the vision and Mission statement of the organisation while being supplemented by the tone at the top which tends to make it easier to implement throughout the organisation by emulation, and the same values identified within the candidates to be employed. The screening process needs to ensure this. They should be an adequate system for grievance registration and redressal which has a quick response team. Another internal complaints management system should be implemented for information on bypassing of any required procedures by any of this staff.

4)The National Institutes of health committee has recommended various steps to be taken to ensure improvement of Patient Safety through establishing specific programs in that Patient Safety with well defined responsibility and accountability at the executive level. The committee also has insisted that all the safety programs should provide strong clear invisible attention to safety through implementation of ecfective systems for monitoring as well as immediate reporting and analysing of errors within Healthcare facilities. It has also as for implementation of established safety principles which require all equipment to be of specified standards as well as utilisation of approved processes and supplies. To improve team management through introduction of interdisciplinary training programs for all the involved teams, providing more flexible and knowledgeable staff. It is also insisted that the top level management of all Healthcare organisations understand the importance of safety measures as being an essential component of the industry. No safety measure can be seriously implemented without commitment from the management, as well as, absolute involvement at all levels of the organisation.

5) Healthcare organisations need to implement proven safety practices as also focus on reduction of errors in the recording as well as medication process which are the most sensitive areas. The Hospital can mitigate risk by adopting latest available Technologies such as RFID for implementation with an existing systems to ensure minimum errors with maximum care and safety. The entire Healthcare industry is utilising Technology for massive improvement in safety for example snomed CT which is absolutely fabulous for an important tasks such as recording Healthcare data capture and storage with widespread use for taking right decisions for doctors. This data helps a number of clinical specialists to adopt successful and innovative cure with better patient outcomes. It also provides ready to use case studies for serious and rare diseases thereby, avoiding errors. Insurance providers need to focus on quality by cutting all unnecessary cause with push up the cost of Healthcare without any addition of value for the patient. Research data has indicated that if Medicare operated at a level similar to top 10% performaners in healthcare, it could improve the quality of care provided and lower cost by 20%. The major obstacle is the measurement of value through clinical outcomes data of which is not adequate presently. Many doctors as well as Healthcare providers have taken the initiatives to transform the sector by implementing adequate quality safety and cost cutting measures, thereby providing efficient care while maintaining safety and optimising clinical outcomes. Many of the Healthcare providers have realise the importance of data management within the industry and utilising the process analysis tools to identify problem areas and closely monitored them through immediate action and reaction on these focus areas.

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