Going into hospital these days is like embarking on a voyage: the doctor provides the ticket, the nurse conducts us to our bed and from then on we hurtle through the hospital corridors from one stop to the next anxiously watching for signs to our anticipated destination.
What used to be termed a hospital stay has evolved into a hospital journey. But the timetable with its scheduled stops is where the similarities end. Today’s reality is that a transit through hospital is subject to much variability and therefore inherently unsafe. Evidence is increasingly showing the difficulties in determining how long a hospital trip will take and if the patient’s passage will include adverse events. In short it is not easy to predict the length of journey or the patient outcome.
An unpredictable environment is hard to control and even harder to keep safe especially when one of the most common outcomes of hospitalization is death.
In surgical circumstances, where there are defined roadmaps and where the overall objective is the discharge of a live patient from hospital, the outcomes are more predictable and safety much easier to ensure. For example, in the case of hip fracture the timing of a hospital journey is precise. In a Swedish study conducted over 10 years data confirmed that if the time in hospital is too short, i.e. less than 10 days, the patient will die.
But when the procedure is not straightforward or as with the bulk of medical conditions, if survival is not the only outcome, the journey is often inconstant. In the delicate life/death balance that is intensive care it is well known that an extended sojourn is deadly.
An unpredictable environment is hard to control and even harder to keep safe especially when one of the most common and foreseeable outcomes of hospitalization is death. What is becoming increasingly clear is that preventing hospital death may look good in the league tables but may not be the safest outcome for some patients.
We have paid a lot of attention to establishing practices for protecting patient safety in hospitals to ensure the compassionate prolongation of life, so should we be setting parameters for safe hospital deaths?
Perhaps the real question for health care thinkers and planners is: how safe is it really to ensure a hospital journey free of adverse events only to send the patient home to die at the last stop?