Late one night in April 2018, my good friend and work associate finds it so difficult to breathe she wakes her husband to drive her to Emergency. One day she’s on her feet at work, the next she’s in the ICU, diagnosed with Streptococcus Pneumonia, on oxygen, intravenous antibiotics and pain medication.
This takes all of us by surprise. She is not a frail woman, but vibrant and active. Only a few months before she hiked in and out of the Grand Canyon twice in two days. She’s the kind of person who wakes at dawn to exercise, counts her steps, rarely drinks soda, and eats celery and hummus for lunch. Yet there she is, in intensive care, in full-on sepsis, white blood cell counts climbing. One hospital day becomes five, then over a week.
Coincidentally, during this same time, I’m digging deep into healthcare associated infections (HAIs) and hospital-acquired conditions (HACs) and 3M’s methodology for potentially preventable conditions (PPCs). Everything I learn heightens my anxiety about the peril of my friend’s extended hospital stay. HAIs are so prevalent that in 2018 an estimated 32 percent of large U.S. hospitals will be penalized for hospital-acquired conditions. Though it may be far from perfect, the intent of the Medicare Hospital-Acquired Condition Reduction Program is to incentivize hospitals to reduce the likelihood of infection. And penalties are stiff. An average Medicare HAC penalty for a large U.S. hospital—those with 500 to 1,000 beds—could be well over $1 million a year. Hospitals must outperform the bottom quartile each year to avoid the HAC penalty.
Meanwhile, my friend is well into her second week in ICU. They insert a needle to drain fluid from her lungs. I worry about the possibility of accidental puncture or laceration during the procedure. The veins in her arms begin to collapse from ongoing IVs and nurses want to put in a Picc line for easier access. I worry about central-line bloodstream infections. Nurses also want to insert a catheter. I think of potential urinary tract infections and antibiotic-resistant staph infections (MRSA). Fortunately, my friend’s husband, a healthcare worker himself, stands watch at the foot of her bed and refuses both procedures. He knows full well his wife’s risk of infection rises with each invasive procedure and the risks keep stacking up. He only allows what is essential.
As her hospital stay drags on, we console ourselves at the office by hatching an imaginary plan to break her out of the hospital. Working in health care, we know a little more than most people about the risks she faces. When we visit her, her frailty is unmistakable—her labored breathing, drifting in and out of sleep. It’s alarming. Reading news criticizing Medicare HACs program takes on more weight.
My friend’s hospital stay finally ends after 17 days, with most of that time being in the ICU. But at last her infection subsides, she’s out of danger and returns home. But having a friend in peril brings all the talk about HACs into clear focus. This is not just a debate over clinical terms, statistics and reimbursement dollars; real lives are at stake.