Home E-Weekly June 27, 2017

Did Short-Staffed Hospital Put Patients in Jeopardy?

Published: June 26, 2017

STRETCHED THIN A single OR team was reportedly asked to handle all emergent surgeries performed between 5 p.m. and 7 a.m.

Leadership at Tulare (Calif.) Regional Medical Center has promised to add resources to its surgical department after inadequate staffing levels reportedly contributed to 2 patient deaths.

The hospital routinely staffed 1 OR team consisting of a nurse, surgical tech and anesthesia provider to handle all emergency, lengthy and high-risk surgeries performed between 5 p.m. and 7 a.m., according to a report compiled by inspectors from the California Department of Public Health. The report cited specific examples of how the staffing model contributed to the patient deaths. In one instance, a backlog of emergency cases delayed surgery by 12 hours for a patient with bleeding in the lower bowel. In the second case, a patient who needed urgent surgery to remove a bowel blockage underwent surgery 9 hours later than expected.

The staffing issues did not go unnoticed among members of the surgical team. The hospital's operating room director told health inspectors she had expressed concerns about patient safety for 2 years and said the strain on OR resources was discussed repeatedly at weekly staff gatherings and monthly leadership meetings. One of the hospital's anesthesiologists and the former chair of its monthly steering committee claimed he asked administrators to address how resources were being allocated in the surgical department, but said nothing was done to address his concerns.

Tulare Regional submitted a corrective action plan. Among the process improvements outlined in the plan: a policy to define high-risk procedures and establish how quickly those procedures must be performed; surgical steering committee review of all surgeries performed after 5 p.m.; review of the daily surgical schedule by the director of surgery; and the hiring of backup surgeons, a CRNA, a physician assistant and a surgical tech to help the short-staffed surgical team.

In a statement, Tulare Regional and Healthcare Conglomerate Associates (HCCA), which owns the hospital, say they do not agree with the state's survey report. According to the statement, the hospital offered a plan of correction, which it says is "hardly" an admission of wrongdoing, because it is always seeking to improve its procedures and practices. The statement also says it is "ridiculous" to suggest that the hospital's administration would ever delay implementation of a safety or quality measure, especially if there was any concern by any staff member.

"State inspectors have found the hospital to be fully compliant with all [of the plan's] requirements and the matter is closed," says Kathleen Johnson, vice president of marketing for HCCA.

Daniel Cook

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