Vulnerable Population in the Rehabilitation Hospital - Essay Example

 Vulnerable Population in the Rehabilitation Hospital Abstract Rehabilitation facilities for vulnerable populations go a long way in helping these patients recover and run normal lives again. Within these facilities there are barriers to the decrease in health disparity for these populations (Leiyu Shi and Gregory D. Stevens, 34) Spinal cord injury patients for instance are a vulnerable population that stands threatened and the care that entails their full recovery is detailed and closely monitored both in rehabilitation hospitals and at home. However, due to barriers decreasing of health disparities like disease, at times full recovery doesn’t occur. This paper is a discussion of spinal cord injury patients as a vulnerable population at risk of autonomic dysreflexia in numerous Casa Colina Centers for rehabilitation. Vulnerable Population in the Rehabilitation Hospital Autonomic dysreflexia (AD) (also known as autonomic hyperreflexia) is a condition that is life threatening and is considered a medical emergency that requires immediate and emergency medical attention. It is closely identified with spinal cord injury patients with spinal lesions above the T6 (6th thoracic vertebral) spinal cord level. It is a result of reaction the involuntary nervous system to overstimulation. It can be treated with anti-hypertensive and removal of the triggering stimuli. The condition can at most times be managed successfully (Lynne C. Weaver, Canio Polosa, 12). Casa Colina centers for Rehabilitation is an acute medical and rehabilitation hospital. It is designed to provide an optimal environment to regain physical and cognitive function and reclaim ability to live again. It has specialized physicians in physical medicine and rehabilitation, specialists therapists and nurses. Here, spinal cord injury patients are given closely monitored attention until full recovery. It provides these victims with the opportunity to maximize their medical recovery and rehabilitation potential efficiently through dignity and self esteem as they strive to enhance the dignity and quality of life of every patient. (Casa Colina Hospital for rehabilitative Medicine Spinal Cord Injury Rehabilitation Program, 2) There are barriers to decreasing health disparity in every vulnerable population naturally and this is not different in the case of spinal cord injury patients in Casa Colina at the risk of AD. The most evident barriers is physician actions and attitudes. This was well documented in the Institute of Medicine (IOM) report “To Err is Human” by Kohn L.T Corrigan J.M., Donaldson M.S. It highlighted the problem of medical errors in the U.S. hospitals, focusing its attention on reducing error rates. It estimated that between 44,000 to 98,000 people pass on each year due to medical errors. From the report, too often errors go unreported due to the stigma such events would carry. Naturally, house officers will jitter towards confronting their errors and instead try to cover them up hence creating a bigger problem. In the report by Wu and colleagues, only 54% of the house officers interviewed in an anonymous questionnaire had discussed a mistake with their attending physician. Only a meager 24% had told patients and family (Kohn L. T. et al, 4). With this in mind, there are definitely instances where mistakes have been swept under the carpet in Casa Colina leading to AD. Medical officers of all levels at Casa Colina have high expectations for themselves and are well trained hence it is not surprising to find that it is difficult for them to acknowledge their errors openly. There are other numerous factors that lead to hospital staff failing to report their mistakes and errors. Legal concerns are among reasons why physician attitudes and actions are barriers decreasing the health disparity in spinal cord cases hence risking AD. They have the understandable fear of litigation in the case that they disclose their mistakes. Casa Colina being a reputable rehabilitation facility has created a name for itself; naturally, staff would not expose their errors due to the fear of tarnishing the hospital image. (Kohn L. T. et al, 4) As such, the IOM asserts that a comprehensive strategy is needed to improve patient safety. We need to create a culture that encourages hospitals to identify errors and exploit them as learning opportunities rather than dismissing practitioners who err in the line of duty. Learning from mistakes should be a priority; it is the closest it gets to ‘experience being the best teacher’. There should be an establishment of voluntary and confidential reporting systems to reveal system defects and weaknesses. (Kohn L. T. et al, 6) Among other barriers is difficulty in identifying a case due to knowledge deficit. An AD attack could go unnoticed and hence unattended in time. Unless a house officer has in depth knowledge of such cases, he/she would not realize the implications of symptoms. (Weaver and Polosa, 56). Many residents lack formal education on cognitive processes. This could lead to even a T10 case suffering AD. External barriers beyond resident practice that could predispose a spinal cord injury victim to AD include an influx of patients which could be a barrier since with many spinal cord injury cases reported and no additional workforce, patients would not get the required attention. Lack of enough patient history is also a barrier. Past drug use is a predisposing factor for spinal cord injury victims to contract AD. Lack of such crucial patient history is a barrier to the health disparity (Weaver and Polosa, 39) Action Plan for increasing awareness of vulnerability based on autonomic dysreflexia on spinal cord injury victims Barrier Action steps Facilitator(s) Timeframe Procedure Physician actions and attitudes. Knowledge deficit. Establishment of a voluntary and confidential report system within the rehabilitation center. In house training and refresher courses. A dedicated spinal cord injury response unit. Hospital administration. Hospital administration. Hospital administration. Three (3) months. Every one (1) year. Six (6) months. The administrators should source consultancy on the same then take its staff through the counseling to assure them that that is a working system to make the hospital even better. Residents should be rigorously trained on AD and how to handle spinal cord injury cases. The hospital should focus on hiring and training a dedicated unit for spinal cord injuries only. In conclusion, if Casa Colina would institutionalize such recommendations, it would be a first in the right direction in breaking the barriers to health disparity among its vulnerable population of spinal cord injury patients. References Casa Colina Hospital for rehabilitative Medicine Spinal Cord Injury Rehabilitation Program, Understanding Spinal Cord Injury, Casa Colina Centers for rehabilitation, 1990. Leiyu Shi, Gregory D. Stevens, Vulnerable Populations in the United States, John Wiley & Sons, December 2010. Lynne C. Weaver, Canio Polosa, Autonomic Dysfunction After Spinal Cord Injury, Gulf Professional publishing, 2006. Kohn L.T., Corrigan J.M., Donaldson M.S. To Err Is Human: Building A Safer Health System. Washington (DC): National Academy Press; 2000. Read More