Vaad Refuah: Improving The Quality Of Hospital Care

Question: Where do you turn for help if someone is hospitalized? Answer: Vaad Refuah.

Mrs. Shapiro spent her last days in a hospital with constant attention from her devoted family. Her children took turns sitting by her bedside, wiping her brow and cooling her parched lips with ice. When she passed away, the family at least had the satisfaction of knowing that they had done everything possible to relieve her suffering and alleviate her pain. What they didn’t realize, however, is that despite their loving vigilance, Mrs. Shapiro was not receiving adequate medical care.

The chevra kadisha, while washing the body, discovered that yet another patient had passed away with Stage III or IV bedsores. These are deep, black craters usually in the sacrum, back or ankles where the skin, muscles, or bone have been eaten away. Mrs. Shapiro, along with 1 million other Americans, half of whom are over 70, was suffering from excruciating, but largely avoidable, decubitus (bed sores). Elderly patients who are confined to bed are at the highest risk due to their thinner skin and weaker circulation and immune systems. Had this family been aware of this potential problem, they would have made a simple request to the nurses to turn her every two hours and check her body for early signs of bedsores to prevent this painful complication.

Bedsores, unfortunately, are not the only problems that call for extra attention from the families of patients who are staying in a health care facility. At least one study shows that 5-6% of all patients acquire nosocomial infections in hospitals each year. These infections are usually highly resistant virulent strains. It is within the patient’s rights and responsibility to ask respectfully if the health care worker has washed his or her hands. There are also times when a family should discreetly ask that the patient be moved due to the danger of cross infection from a roommate. In addition, errors in prescription drugs for hospitalized patients have recently soared. If the patient was not informed that his doctor changed his medication, he should immediately request confirmation. The number of unnecessary surgeries and the resulting greater need for second opinions also warrants consideration.

How are the family members, who are already over-strained, worried, and tired, able to assume this role of guarding the patient from medical error without knowing the ‘ins and outs’ of the hospital process? To address this problem, a team of rabbonim, askonim, medical professionals and volunteer workers has created a patient advocacy group, Vaad Refuah. Vaad Refuah does not give medical advice. They only guide the patient and his family through the maze of health care bureaucracy in order to increase the quality of health care for all patients.

Mrs. Krausz, who supervises 14 volunteers who are on call through Vaad Refuah’s helpline, offers the following advice to all patients and their families:

Appoint a friend or family member to be a spokesperson to liaise with the hospital staff. Even a patient who can take responsibility for his own health care still needs a spokesperson to act as his advocate.

The spokesperson is invited to contact the Vaad Refuah helpline about how to avoid preventable complications and how to effectively intervene with hospital staff.

With polite respect, the spokesperson should try to resolve all care problems with the local nursing or care-giving workers.

Medical problems should be discussed with the doctor who is managing the case. In those instances where there is no managing doctor, the spokesperson should communicate with all the appropriate doctors who are involved in the case.

If any problems arise, the spokesperson should be in touch with Vaad Refuah. For Lutheran, NY Methodist, Long Island College, and Maimonides hospital, Vaad Refuah has established communication channels where, if necessary, they will intercede to help acquire the appropriate cooperation from the hospital. For patients in other hospitals, Vaad Refuah can advise the spokesman how to talk to the hospital and, where possible, the Vaad may be able to facilitate communication.

The Vaad will maintain a database of problems encountered in each hospital. The information collected will be provided to the management of each hospital to assist in effectuating needed improvement. Unclean conditions, employee neglect of duties, and other violations should all be reported to the Vaad. (Forms can be obtained at www.vaadrefuah.org.)

Positive feedback, either general or relating to the actions of specific staff, should be reported to the Vaad, who will pass praise along to the hospitals. This will create a culture of caring in which the efforts of conscientious staff will be made known. Conversely, the Vaad will apply pressure on the hospitals to change by publicizing negative data when necessary.

All information given to the Vaad is kept in strict confidence. There is no need to fear retaliation from hospital employees.

The Vaad has thus far made several major changes in local Brooklyn hospitals. They have convinced hospital management to improve emergency room procedures, establish more hand washing stations, implement stricter hand washing compliance, improve the staff/patient ratio, provide more diligence in turning patients, and computerize bed availability tracking. Future plans include expanding the Vaad’s computerized patient satisfaction program to more hospitals, introducing more medical prevention practices, and educating the community and health workers about the most effective methods of communication.

The Vaad performs these services through its network of volunteers in order to help our local communities secure the best possible health care. For more information or to join the volunteer staff, call 1-877-REFUAH, 1-877-973-3824 or visit www.vaad
refuah.org.

Vaad Refuah Meets Maimonides Trustees. On June 24, an historic conference took place in Borough Park between the Rabbinical board of Vaad Refuah and the Trustees of Maimonides Medical Center to tackle healthcare concerns facing the Borough Park/Flatbush/Bensonhurst communities.

The roster of esteemed attendees included: Rabbi Yisroel Tzvi Brody, Manchester Dayan; Rabbi David Eichenstein, Burshtyner Rebbe; Rabbi Shloime Gross, Belzer Dayan; Rabbi Shraga Hager, Kosover Rebbe; Rabbi Yakov Horowitz, Rav Telshe Minyan, Rosh Hayeshivah, Beis Meir; Rabbi Yechiel Kaufman, Rav D’khal Anshe Sefard; Rabbi Yakov Perlow, Novominsker Rebbe; Rabbi Yisroel Reisman, Rav Agudath Yisroel Madison Branch, Rosh Yeshivah Torah V’daas; Rabbi Yechiel Mechel Steinmetz, Skverer Dayan; and Rabbi Chaim Yakov Tauber, Bobover Dayan. The other participants were board members of Vaad Refuah, along with community representatives on the Maimonides Medical Center Board of Trustees including Abraham Biderman, Moshe Hellman, Andrew Kohen, Chaim Leshkowitz, Peter Rebenwurzel, Alfred Schonberger and Rabbi Aaron Twersky.

Concerned with the quality of healthcare our families receive at local hospitals as well as the need for the various community organizations to work together to ensure the best possible service within halachic parameters, the rabbonim initiated this meeting as a follow-up to a prior meeting held between the Vaad Rabbinical Board and Hatzoloh representatives. At the conference, attendees were updated on the efforts the Vaad has made to date on infection control, respiratory care patients, wound-care and decubiti (bed sores/pressure sores).

The Vaad has a close working relationship with the Bikur Cholims of Borough Park, Flatbush and Bensonhurst. It also meets regularly with Hatzoloh, sharing information of common concern and coordinating activities to maximize community efforts for the improvement in the quality of healthcare service delivery.

While the Vaad has made great strides in assisting individual patients and their families by helping them navigate hospital bureaucracy, advocating on their behalf and intervening to expedite their needs, effecting systemic changes is significantly more laborious and requires the close cooperation and assistance from the Hospital Board of Trustees.

The community representatives on the Maimonides Medical Center Board of Trustees expressed their eagerness to assist in this effort by collaborating with the Vaad in assuring that the Maimonides Administration continues to pay proper attention to community concerns, responds promptly to issues raised by the various community organizations, and implements needed changes in a timely fashion. The Vaad highly commended Maimonides Medical Center Board of Trustees for their commitment to partner in this vital mission.
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