Lewis, a 15 year old child, was admitted to the Medical University of South Carolina’s Children’s Hospital for a minimally invasive and low risk surgery to correct a sunken chest. That night, after hours of pain and struggling, he suffered cardiopulmonary arrest and died. Throughout the night, the resident on call attended to Lewis but just assumed his stomach complaints were caused by gas from the surgery and never called an attending doctor. Had Lewis experienced these complaints and symptoms during the day, his bleeding ulcer would have been recognized and treated, and he would have lived. The hospital settled the parents’ claim, without a lawsuit, for $950,000.
“A 2005 study of 3.3 million births in California found that babies born late at night were 16 percent more likely to die than those born in the daytime. Other recent research found that patients going into cardiac arrest at night were more likely to die. In a review of pharmacy and patient records, significantly more medication errors were made at night. Daytime deaths can also be attributed to nighttime hospital errors: An analysis of 5 pediatric intensive care units found that children admitted to the units at night were more likely to die within 48 hours.”
What a scary thought! It isn’t because the staff and doctors tending to the patients don’t care, because most of them do. But hospitals keep lower staff numbers at night and most doctors are on a rotation. Workers with the most seniority tend to get first choice of daytime positions, leaving workers who are newer and less experienced to work the nighttime shifts. Hospital staffs also work notoriously long hours; it is common for residents and interns to work 24 hour shifts and 80 hour weeks. Combine that fatigue with the natural fatigue which occurs at night and you have a recipe for disaster.
Lewis’s mother has been working as a patient advocate since the death of her son. She was instrumental in the passage of the Lewis Blackman Hospital Patient Safety Act which requires all physicians in South Carolina to wear identification badges with their rank. Hospital staffs are also required to call attending physicians if requested to do so by the patient or family member.
Medical schools, such as the University of Minnesota, are now working to foster doctors and hospital staff to work as teams, and manage crises better. The University of South Carolina Medical Center has also started a statewide initiative to educate and train medical staff to manage simulated crises. Dr. Jerry Reeves, dean of the college, said “This way, you don’t get out of it until you’ve proven you can actually manage it, even if it takes a hundred times.”