The recently-disclosed problems at Seattle Children’s Hospital with regard to infection from the aspergillus mold highlight some of the problems facing hospitals. Hospitals are not just buildings in which health care providers work and care for patients, but they are facilities that, under Washington law, are required to provide a safe patient environment. That includes physical facilities, as well as using appropriate practices and procedures. 

A recent article about the MD Anderson Cancer Center in Houston illustrates the challenges facing hospitals. MD Anderson is a leading national cancer care facility, and people come there from all over the world for treatment, often involving cutting-edge research and trials of various anti-cancer regimens. A key to having successful trials is communication to the treating physicians of changes in a patient’s condition. The “ground-level” players in this project are the nurses.

At MD Anderson, nurses had been given explicit orders to keep other providers, especially physicians, aware if the vital signs of a patient receiving chemotherapy hit specific thresholds. What the hospital found, however, was that the orders were frequently not followed, so the physicians could not react to the changes. After the troubling death of a patient, the Centers for Medicare & Medicaid Services (CMS) studied what happened and concluded that the death occurred “because it showed the toll exacted, not just at MD Anderson but around the nation, by an unexpected group: overwhelmed nurses.”

Procedures, protocols, and orders are important, but if a hospital does not have the human resources to follow the orders, they are just words on a piece of paper. The report by CMS concluded that “the clinicians most likely to be involved are nurses, who must straddle a thin line between doing no harm and doing the impossible.”

California has tried to alleviate this problem by requiring, by law, there be specific patient-to-nurse ratios, such as no more than two patients for every RN in intensive care units. Studies have shown that if all states had similar requirements, the in hospitals would have been reduced by up to 13%. To date, only California has such a law, although many individual hospitals have similar requirements.

“[The] CMS report shows how very fragile health-care safety remains,” said one of the CMS investigators. “If a flagship cancer center like MD Anderson is having these problems, imagine the issues other centers across the country that don’t have their resources are having.”

Read the Houston Chronicle article here: MD Anderson Safety Struggles Show Pressures on Nurses