PART 4 (Click Here for Part 1)
Remember I said that the hospital seemingly runs on protocols for everything? Much of our care is directed by standards that are well researched, examined and thought out. The decisions are tailored to give patients the best possible outcome. Some are easy and obvious like lowering the bed of a patient who is at risk of falling out of bed or giving antibiotics within a few hours of a patient who is obviously infected. Some you may not think about but are even more important fall under the control of highly specialized care like Neurosurgery, Critical Care Medicine or my own specialty, Endocrinology.
Nearly 10 years ago the governing bodies of Endocrinology became aware that diabetes treatment in the hospital was inadequate and was costing patients their health and sometimes their lives. Standards were agreed upon that outlined what a hospitalized diabetic needed in order to ensure the best possible outcome regardless of the reason for the hospital admission or who was responsible for their care. These recommendations were based on several publications that proved the benefits of these treatments over the care that hospitals were previously providing. It’s not often in medicine that doctors completely agree with each other when guidelines get published, but in this case it was nearly unanimous. Many endocrinologists, including myself approached hospital administrations all around the country volunteering their time and expertise to apply these new standards to our hospitals.
So what has happened? Many hospitals in the US still haven’t adopted these guidelines. Most patients are taken care of by doctors who are likely totally unaware of these recommendations. Why are hospitals allowing diabetic care to lag behind modern standards? It makes no sense to ignore these guidelines since the data supports a cost savings to the hospital when better diabetic care is given. Diabetics treated under these protocols have fewer adverse events like infections and ultimately have shorter length of stays. Even CMS (the agency that administers Medicare and Medicaid) has gotten onboard. CMS has given warning to hospitals who allow their diabetics to have adverse outcomes during or as a result of their hospital stay. For example, say a diabetic gets admitted for a routine surgery – the hospital doesn’t use a diabetic protocol as outlined by the endocrine societies and the patient gets infected or hypoglycemic during the hospital stay. Once the bill gets submitted to CMS, they may refuse to pay the hospital for the entire stay!
This seems like such an easy fix. Guidelines that are widely published with specialists readily available to help implement these and yet the hospital administrations keep turning a blind eye to the needs of their patients.