Mt. Sinai Lays Out Plans for Better Transplant Ward

[NRSKarenRN, BSN, RN]

mt. sinai lays out plans for better transplant ward

a plan of correction delivered to state health officials says new york's mt. sinai hospital will no longer allow residents and summer interns to work in its transplant department, among other changes. the hospital has come under attack for procedures that contributed to the death of a man who had donated part of his liver to his brother.

new york times, march 22, 2002

by susan saulny

http://www.nytimes.com/2002/03/22/nyregion/22sina.html

responding to criticism over the death of a healthy donor following a liver transplant, mount sinai hospital said yesterday that it would no longer allow residents and summer interns to work in the transplant ward.

the hospital, in a "plan of correction" delivered to state health officials, also said that hospital staff members would be told to answer electronic pages within five minutes and that patients would be seen by teams of doctors on rounds every day.

mount sinai came under public scrutiny in january after the death of a man who had donated part of his liver to his brother. although the operation was completed without complications, the donor died three days later, and a state investigation blamed poor postsurgical care. the donor who died was one of 34 being cared for by one inexperienced first-year resident, the inquiry found, and other doctors were slow to respond to the patient's worsening condition.

mount sinai is widely known as a leader in the field of adult live-donor liver transplants, and the patient was the first live donor to die there. the hospital was fined $48,000 and banned from performing live-donor operations for six months, and has not challenged the inquiry's findings

in its report to the state, the hospital said it had already made some changes to improve patient care, including upgrading the method used to chart patients' progress and adding a second physician assistant to the transplant ward. it said it planned to hire more physician assistants.

since the donor's death, the state has broadened its investigation of the transplant ward, and is now examining 20 cases involving 16 deaths. robert kenny, a spokesman for the state department of health, said all of the new requests for investigations of deaths have come from the families of transplant recipients, however, not those of donors.

mr. kenny also confirmed that the department had received the report but said state officials could not discuss it because of the ongoing review. it will be made public at the end of the investigation, he said.

in writing the report, mount sinai officials consulted outside experts, including the german doctor who performed the first successful live-donor operation and the chief of transplants at u.c.l.a., which has the country's largest program.

"i think, unfortunately, it sometimes takes a tragedy to force people to review and to look at things and make changes that may have been overdue," said dr. myron schwartz, the director of the adult liver transplant unit at mount sinai. "we all have to acknowledge that the transplant program here had gotten to be an extremely large, busy unit. and not all aspects of how we functioned kept up with the growth. i think we had to step back and reassess."

dr. gary rosenberg, mount sinai's senior vice president, said the hospital was working as fast as possible to put into place all the changes outlined in the plan of correction. "there is already a tangible difference in the feeling on the floor," he said.

hospital officials said they hoped to be able to perform live-donor operations again as soon as possible. any decision to lift the ban before the six months are up would be made by state officials

"we really feel like the living-donor program is a very important thing," dr. schwartz said. "the number of people coming in has gone up but the number of cadaver donors has not. live-donor is one way we have of doing a transplant when it needs to be done

dr. rosenberg added: "the hospital is cooperating with the state and yes, the ban will be lifted. the question is, when? we should give them more than enough time to consider it, and we trust that the state will do the right thing at the right time."

"in its report to the state, the hospital said it had already made some changes to improve patient care, including upgrading the method used to chart patients' progress and adding a second physician assistant to the transplant ward. it said it planned to hire more physician assistants.

they still don't get it do they that nurses along with the transplant surgeons keep patients alive. not one mention of beefing up nursing ratios.

physicans assistants are not the answer...a few nurse practioners would greatly help, imo. it this the picking up of subtle clues and piecing together that is important, not the hit me in your face information---and in transplants, knowing what to do with the info is crucial. this was a healthy donor that died as a result of surgery--- nicking the bowel when liver removed.!!!

[oramar]

I first read this article over at Healthleaders and like Karen I was completely dismayed over the fact that it does not mention nursing care. You can have a thousand MDs circling the hospital with cell phones in hand and if no one calls them because no one identified the fact that a patient had a problem what good will it do? The failure to mention nursing and it's effect on patient outcomes tells us a lot about this hospitals attitude towards it's nursing staff. Maybe it also tells us something about the public's attitude toward nurses.

[-jt]

Too bad they chose to censor the entire interview they did with the staff RN who is the president of the NYSNA union of nurses at that facility & who discussed the stafffing shortage & need for laws to force the employers to pay attention - and chose to ignore the fact that the nurses have been protesting staffing shortages for a long time- including picketing the hospital over it. And forgets the fact that the hospital laid off 70 other workers at Christmas 2000 & their union has been protesting the decline in the hospital because of it. And that in the midst of all this, the hospital announced that it is going ahead with plans to lay off another 450 workers - including eliminating vacant RN positions. So instead of correcting the current staffing shortages, the hospitals answer to poor staffing is to get rid of more staff. Instead of recruiting RNs, the hospital has chosen to reduce the number of available RN positions. All because the Hunter Group recommended that in doing so, the hospital will save $25 million a year. They may save money, but they sure arent going to be saving many pts without staff. You dont have to be Mr Spock to realize how illogical this all is.

Also, the MD who operated on the donor never once checked him post-op. Somehow, I dont feel any sympathy:

LIVER DOC'S TEARS NO SOLACE FOR KIN

http://www.nypost.com/seven/03242002/news/regionalnews/44158.htm

[oramar]

There is evidence that emotional demonstration deter families from suing. I hate to be cynical but I can't help being suspicious of this guys motives. In this case it won't work. My guess this case will be settled out of court because the surgeon will have trouble justifying not seeing patient post op.

[NurseDennie, BSN, RN]

Oramar -

That was my question exactly. I've read about this in a couple of different places, and it sounds like there were NO nurses involved. Can this be true?

Love

Dennie