Overhauling the intensive care unit

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Overhauling the intensive care unit

“The intensive care unit killed him instead of saving him,” Son Hae-seon says of her husband, who died at a hospital in Seoul.

She claims that his intravenous needle fell out on a number of occasions, and that the medical staff failed to detect that his condition was worsening. But it’s not just the patients’ families who are complaining. Medical staff members are also frustrated. “Each nurse is in charge of 10 beds and has to take care of other responsibilities, like disposing of medical waste. It’s a miracle to end a day without an accident,” said one nurse at a Gwangju hospital.

Most intensive care units (ICUs) are just waiting rooms before death. Hospitals spare investing in ICUs if they are not profitable, and nurses and doctors often don’t have enough time to provide proper care. The government, on the other hand, turns a blind eye to the reality. The medical law has an ambiguous clause that states that ICUs can have exclusive doctors who don’t necessarily have to work full time. And while medical charges have increased, it’s not enough to induce investment in ICUs, unlike with emergency rooms and cancer wards.

Furthermore, many ICUs lack proper medical systems, and the choice of hospital - often determined by the paramedics - can potentially change a patient’s fate. The death rate among critical patients at domestic hospitals varies drastically.

And since performance isn’t noted, proper evaluations aren’t conducted. There’s no official nationwide evaluation for ICUs. The Health Insurance Review and Assessment Service is conducting the first experimental assessment, in which these units are evaluated over 13 categories, and a partial result will be made public next year. The death rate for each hospital is not included in the evaluation, though the ratios of patients to medical staff and equipment are assessed. Specific standards for grades have not been determined, but one inside source said the assessment would focus on understanding the current situation.

In the United States, a hospital evaluation by the federal government includes the ICU. They are graded on a scale of one to five stars, and the result is made public in the media. Dr. Augustine Choi, who works at Cornell Medical College, said making the list public ups competition among hospitals and gives patients more choices.

ICUs desperately need to update their facilities and pad their staffs. They must also undergo strict evaluation, with the results made public. Patients and families must be informed about which hospitals neglect their ICUs due to a lack of profits. ICUs must not merely be waiting rooms before death. Rather, they must serve as safe places in which patients can come back from the brink.

The author is a national news reporter
for the JoongAng Ilbo.

JoongAng Ilbo, Sept. 1, Page 33


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