Death at St. Luke’s highlights security challenge for hospitals
By Tim Darragh, The Morning Call (Allentown, Pa.) | |
McClatchy-Tribune Information Services |
That day,
The rare, tragic event illustrates a major challenge facing hospitals around the country: How can a therapeutic institution provide needed care and reasonable access while ensuring the safety of all patients, including some who may be panicky, psychotic or brain-damaged and want to leave against medical advice?
It is an enormous challenge, not only because sometimes a patient like Hanchick leaves without warning and dies, but also because it can lead to costly lawsuits, increased regulatory scrutiny and a threat to the hospital's
Doctors cannot simply strap down or anesthetize an unruly medical patient for long periods of time as they once could, said
Now, hospitals can restrain patients only as a last resort, according to the Joint Commission, the health-care accreditation agency. If restraints are used, they can only limit movements that could harm the patient or caregiver, and must be removed as soon as the threat of harm is over.
St. Luke's officials have declined to answer questions about Hanchick's case.
What is known from police reports, Hanchick's family and a statement issued earlier by the hospital, is that Hanchick was involved in a motorcycle accident
Those incidents, as well as his head injury, should have been a red flag that Hanchick was a risk for further "elopement," a term used in hospitals for situations when a patient leaves against medical advice and without telling medical personnel, said
"Brain injury can be an increased risk for elopement," he said.
While confused or delirious patients may wander off, he said, "exit-seeking" patients often try to leave repeatedly.
"They're sitting by doors, waiting for the door to open; they may go out a window," Meek said. "The exit-seeking is a much higher risk for elopement than a patient who is a wanderer."
Speaking about elopements in general,
"Patients can have changes in behavior," Szydlow said. "Their mood, attitude and behavior can change by the hour. The need and ability to restrain patients changes accordingly."
St. Luke's has control stations on every nursing unit. Security and front-desk staff are trained to observe comings and goings in their areas, he added.
The hospital's elopement policy states that competent patients or their surrogates have the right to have the patient discharged against medical advice. Whenever possible, it says, the patient's attending physician or advanced practitioner should be contacted to explain the ramifications of leaving and then present the patient with a form acknowledging that he would be leaving against medical advice. The departing patient also should get care instructions with "an open-ended invitation to return to the hospital."
But before things get to that stage, hospitals try to keep patients where they need to be. Patients who are not on mental-health-care floors, which have separate safety rules, can be monitored with tracking devices and alarms, Hollier said.
In many places, a sitter will be assigned to the patient, she said.
Attorney
"The issue from their perspective is, they were told the hospital had people watching him all the time, 24-7," McClain said. "How could this have happened if he was being watched?"
Hanchick apparently found opportunity and privacy by going into a bathroom and breaking a window, McClain said.
Thomas Smith, a health industry security consultant from
That's a potential problem that many hospitals have eliminated by not having windows that can be opened or unlocked, Hollier said.
"Hospitals have to be really careful with windows," she said. "In the new ones, they don't build them to open."
State
"There is no requirement that the window must be operable, but if it is, the window must be restricted such that the operation of the window inhibits possible escape or suicide," said
Windows in patient rooms at St. Luke's are double-paned, bolted and locked, Szydlow said.
Hanchick's family has said they don't believe he wanted to die, and
According to McClain, something or someone failed at St. Luke's.
"They believe it shouldn't have happened," he said, "and it didn't have to happen."
The hospital issued a statement of condolences, adding that it would not discuss the incident out of respect for Hanchick's and his family's privacy.
Health experts have only estimates on how often elopements occur. Those that result in death or permanent disability are so-called "sentinel" events that require immediate investigation and response by the hospital, according to the Joint Commission. The reporting of those events, however, is voluntary.
In a 2009 survey of 166 hospitals, Smith, the security consultant, reported that 11 percent of responding hospitals reported no elopements, 70 percent reported from one to 50 elopements and 10 percent reported between 50 and 300 elopements for the year. His survey didn't indicate how many of those events resulted in deaths.
Smith also said some hospitals in the survey likely miscategorized more benign events, such as patients going outside for cigarette breaks, as elopements.
"I don't think there's anyone who has a really good idea how often it happens," he said.
Over the past six years, St. Luke's has had one in 2,000 patients elope, Szydlow said. With around 55,000 patients admitted or brought in for observation at its hospitals in
There are other consequences from elopements, aside from the tragedy of patient deaths.
The
The report showed several breakdowns in the system, besides the maintenance issue.
The department took hospital officials to task for not having an interdisciplinary plan of care for a patient who had dementia and was known to wander.
Martin's family is in litigation with the hospital,
Those incidents highlight that teams of clinicians and hospital maintenance, security and other staff need to be communicating when a potential elopement patient enters the hospital.
A legal review in the journal Healthcare Risk Management about the
"It is only when the failures aggregate ... that serious events with disastrous consequences occur," it said. "This patient's death occurred because of multiple latent failures in two seemingly unrelated systems -- clinical judgment and routine maintenance."
Elopements are not inevitable but some will occur, Meek said: "In a therapeutic environment, you cannot honestly prevent every elopement."
"These accidents are foreseeable and that's what makes them so tragic," Navitsky said. "Because if they're foreseeable, they're preventable."
Twitter @timdarragh
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ELOPEMENTS RESULTING IN DEATH OR PERMANENT LOSS OF FUNCTION
Events voluntarily reported by health care institutions and reviewed by the Joint Commission
1995: 0
1996: 1
1997: 1
1998: 8
1999: 12
2000: 4
2001: 7
2002: 7
2003: 8
2004: 7
2005: 11
2006: 5
2007: 5
2008: 11
2009: 8
2010: 14
2011: 4
2012: 10
2013: 9
--Reporting of these events to the Joint Commission is voluntary and represents a only a small proportion of actual events. No conclusions should be drawn about the actual relative frequency or trends over time.
Source:
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