Going to disagree hard here, numerous studies have shown checklists improve patient outcome. Similarly, they improve safety in numerous industries. And requiring two person sign off on dangerous actions in the hospital also improves outcomes. Sure, following these practices is helpful in a lawsuit, but primarily because they are best practices.
I'm pretty sure that the person you're replying to isn't making a claim about the utility of checklists but the content of the enumerated checklist items.
>The only reason is people love to sue for anything in this country
People "love to sue" in this country because the court system was designed to be THE place where problems are solved. Can't have a federal agency who's job it is to make sure hospitals don't kill people, that would be tyranny, better make everyone sue them instead.
This affects everything in the US. It only affects hospitals worse because the US cost of healthcare is so stupidly artificially inflated that you have to sue for very minor things so you can pay the $40k it takes for some basic physical therapy.
They didn't say that, they said the checklist is there for liability reasons and not for genuine care reasons.
The "won't let mom walk to the door" thing is a great microcosm of that—it's a blanket policy applied to all mothers regardless of need.
My wife had our youngest at home but we had to take her to the hospital afterward because her lungs were a little sticky and she needed a respirator for ~4 hours. I took our daughter in and my wife followed a few hours later, walking all the way into the hospital.
The NICU wouldn't discharge us for two days (which is a whole liability > care story of its own), but when they finally did they insisted that my wife—who had had the baby at home and driven to and walked into the hospital while mere hours postpartum—needed to be in a wheelchair to the curb.
We liked that shift of nurses, they clearly cared, but no one in that room looked at my wife standing by the warmer and thought "she needs a wheelchair". They had a checklist and they were going to be darn sure they followed it.
You can always refuse. They can't kidnap you or the baby if for whatever reason you don't want a wheelchair, and it's almost always illegal to block the exits without a court order or documented altered mental status.
I appreciate your willingness to push for your rights here. But the situation is surprisingly similar to refusing to let a cop search your trunk. You can say no, but that K-9 unit is going to take four hours to get there from the station 20 minutes away. They will make your life hell.
I've definitely been in hospital situations with my children where I was honestly afraid (perceived or real threat, I still don't know) that they were going to report me for child abuse if I took my kids home and refused care. People with authority are kinda scary, and while I love for us to all choose rights over security, sometimes I just don't want to have to fight for everything.
> You can say no, but that K-9 unit is going to take four hours to get there from the station
Holding someone for longer than the traffic stop requires to wait for a drug dog is illegal in the USA. That's not to say it never happens, but it's grounds to exclude any evidence found, and for a lawsuit.
How long the drug dog needs is irrelevant; if they want to use a dog without consent or probable cause to search, they need to get it there while they still have legal grounds to detain the suspect. A traffic violation is grounds to detain someone long enough to issue a citation, but not longer.
The judge won't be amused if the police say it took them 45 minutes to write a speeding ticket.
But for the judge to be amused would require the affected person to have the legal intelligence, moral fortitude and general life "legalness" (because maybe you doubt your US legal status even if your life is mostly above board) to pursue one shitty officer's stop.
I've definitely been detained for what seemed to me an acceptable amount of time for a traffic stop, but who's to say the cop can't come up with myriad reasons it had to take that long? Is 35 minutes too long? Is 38 minutes? Who's keeping time, and who's word is taken as truth?
Yes, police have a lot of power and can sometimes get away with doing illegal things. The probability increases when the victim is somehow marginalized. Most people won't bring it to court, but if the search is fruitful, it's guaranteed to end up in court.
The increased use of car and body cameras makes this particular abuse harder to get away with. A request to search denied followed by a call for a dog, followed by unusual delays recorded on dashcam leads to a challenge even the most overworked public defender would raise.
The success rate will not be 100% when the searches actually finds something illegal. Most of them will take a plea, but on occasion, one won't.
I'm not saying it never happens, but the legal risk is too high for most cops to do it often. They may try to get you to think they will, but it's usually a bluff.
I've been detained 12 hours or so without arrest, including imprisonment, by feds. Pulling my FBI report confirms no federal arrest record, so it was just a detainment.
After 48 hours of putting up with hospital rules in order to avoid an AMA discharge, we were just happy to be done. They certainly didn't frame it as optional, and it wasn't worth the fight.
None of what you said supports that checklist following is only for decreasing liability and not towards patient wellness. It may be the case but it doesn't really follow though.
It doesn't prove anything, but I consider it to be a strong anecdote supporting the argument that individual wellness is not the primary motivation for these checklists.
I can see an argument that it's about increasing average wellness across all people ever taken care of by that NICU, but from the perspective of an individual patient there's no difference between the two motivations—the point is that your own care is not the important thing to the hospital at that time, what's important is the rules and regulations.
In our case, we both felt that our care was actually actively hampered by NICU discharge rules that were designed for premature babies and were completely inappropriate for our late-term baby. The wheelchair was just the last hurrah of the situationally-inappropriate hospital regulations.
But your not being taken care of by a person. Your being taken care of by the system. The nice nurse goes home in 3 hours, the nice doctor has 9 other patients. The secretary relies on the information in The computer. The people may very well care a lot. The system does not.
Checklists have been demonstrated to improve care quality because when it's the not-so-nice nurse that's on shift, and the doctor's been awake for 60 hours straight, the stuff that's on the checklist still gets done.
One can be forced to mindlessly perform ridiculously constricting duties that have everything to do with limiting liability and nothing to do with outcomes, while also caring about babies.
Re: Understanding the cynicism: For example it is intriguing that they insisted on using a wheelchair to get in the car, but not to get out.
But what's even more revealing is that the child had to be in a car seat while on his mother's lap.
Everyone in maternity wards is underpaid and overworked, and the checklist is there and rigorously followed so we don't have mothers with c-sections tearing open on the way out because no one brought a wheelchair.
I don't understand that one very much. If walking is going to tear them open, isn't it better to have that happen at the hospital instead of half an hour later at home? I don't think much healing is going to happen in between.
Is the risk sufficiently on a per-step basis to make that worth it?
Have you seen the itemized bills for giving birth in an American hospital? They'll even try to mutilate an infant boy and charge you for it unless you emphatically opt out.
I want to see the criminals in the medical ethics community who ever greenlit this nonsense to have justice served upon them. Europeans would jail American doctors for what they do to babies here.
They'll schedule it by default and often argue with parents who try to cancel it. It's about money for the hospital and they don't care about the suffering it causes, nor the completely unnecessary financial burden it places on young families.
For them to be so soulless when it concerns infants, you can be sure they aren't any better when they're just dealing with adults. Greedy psychopaths are overrepresented in the medical industry.
Is go further and say that all doctors who work in those wards and perform male genital mutilation must hate babies, otherwise I have no explanation for how they can ignore the fact that their European peers would throw most American doctors in jail for the things they do to newborns.
...which might still be socioeconomically correlated. People who make half a million a year can afford lawyers. People who make $50K/year generally cannot.
The interesting point here is about how so many institutions become so much sloppier when the legal system becomes unaffordable for a majority of residents. Unsurprising, but it has pretty far-flung consequences if you're trying to root-cause why so much of America seems like a 3rd-world country today.
I get tired of the constant deferral to socioeconomics as an excuse. It's pretty simple, we don't allow people to be born with zero documentation in the US. This would be a massive fuckup, and it doesn't matter if the kid is poor, they still need a birth certificate to get a social security number. They've had a long time to put whatever systems in place prevent that from getting missed, even in the poorest zip codes.
And as far as safety, it's not always legal liability. I'm sure a good portion is, but we're talking about newborn babies right now. Most people don't want to have any part in a newborn being harmed, so it's trivially easy to get employees to take that stuff seriously.
>Most people don't want to have any part in a newborn being harmed
And nobody is ever the bad guy in their own story. During my sister's birth, she got stuck, and the doctor, instead of doing the normal and accepted and standard fix of breaking one bone, broke a different one instead. This damaged nerves in her arm and permanently disabled her. Turns out, he did the exact same thing to another kid in town a few years later. ALSO turns out, he had to stop practicing medicine in a different state because he kept doing that to a bunch of babies, so instead of retiring or retraining because he obviously did not know what he was doing, he moved to bumb-fuck nowhere so he could keep doing it. I bet he even thought he was a good doctor.
It is never trivially easy to get someone to do something they don't want to do, like admitting they fuck up, or that they are careless about something they don't think is important.
We only got $10k in the malpractice suit, which doesn't even cover like a year of physical therapy, for a lifelong and entirely avoidable disability of her dominant arm. She had to learn to be left handed. If our family didn't have state employee insurance, we would have never seen a doctor, like most people in poverty.
Nobody's excusing anything. It's an
explanation. You're comparing apples to oranges: things that are free and done by the state compared to things that cost done by for-profit corporations.
We do let millions of people in without documentation, and they are nearly all poor. The underclass somehow manages while the upper class ducks everything up.
