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TOPIC: Patient Outcomes Change Practice


Surgery and Delirium

From Mark Orringer, MD, past president of the Thoracic Surgery Directors Association, who challenged the organization to increase the extent to which geriatrics issues are addressed during residents’ training. A few years ago, I operated on the 80-plus year old father of a colleague. He had problems with his esophagus. The operative time was short, and the procedure went well. But after surgery, the patient was confused and put into restraints ‘to protect him.’ While restrained, he aspirated and ultimately died of pneumonia. Retrospectively, we missed the mark badly. There’s not a thoracic surgeon who hasn’t mismanaged delirium, because we have not been trained to recognize it and respond with appropriate measures.”

Excerpted from the John A. Hartford Foundation 1999 Annual Report


The Health care Maze

Barbara’s father, George, age 90, sent home from a Florida hospital after a bout with pneumonia, was not doing well. He complained of being unable to sleep, had trouble walking, and his mind was beginning to wander. His wife, age 88, called their local internist, who prescribed a sleeping pill. He also suggested she contact a physical therapist from the hospital to assist her husband in regaining his strength, but when the therapist arrived, George was too groggy to do any exercise. Barbara’s mother, overwhelmed, called her daughter, who lived in Pennsylvania, and urged her to come down to Florida to help get her father back on his feet. When Barbara arrived, she was shocked to discover that both of her parents had lost a great deal of weight because they weren’t eating properly, and that her father was self-medicating, taking more sleeping pills than prescribed because the initial dosage had not done the trick. Worst of all, the household was deteriorating and no one—neither their primary physician nor anyone from the hospital—seemed to be aware of her parents’ failing condition or in charge of coordinating the multiple healthcare and social services they now required.

Excerpted from the John A. Hartford Foundation 2000 Annual Report


The Health Care Maze

Barbara’s father, George, age 90, sent home from a Florida hospital after a bout with pneumonia, was not doing well. He complained of being unable to sleep, had trouble walking, and his mind was beginning to wander. His wife, age 88, called their local internist, who prescribed a sleeping pill. He also suggested she contact a physical therapist from the hospital to assist her husband in regaining his strength, but when the therapist arrived, George was too groggy to do any exercise. Barbara’s mother, overwhelmed, called her daughter, who lived in Pennsylvania, and urged her to come down to Florida to help get her father back on his feet. When Barbara arrived, she was shocked to discover that both of her parents had lost a great deal of weight because they weren’t eating properly, and that her father was self-medicating, taking more sleeping pills than prescribed because the initial dosage had not done the trick. Worst of all, the household was deteriorating and no one—neither their primary physician nor anyone from the hospital—seemed to be aware of her parents’ failing condition or in charge of coordinating the multiple health care and social services they now required.

Excerpted from the John A. Hartford Foundation 2000 Annual Report

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