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1/ Reminds me of last July, when my 75 year old mother in law, living alone in Brooklyn & just back from visiting family in rural Northern California, checked herself into the ER of a @usnews top hospital in NYC.
2/ She'd had >1 week of sleeping most of the time, rash, minimal oral intake, and severe all-over aches. The attentive doc at her local Brooklyn hospital had diagnosed her (wrongly, as it turned out, but no matter) with Rocky Mountain Spotted Fever, and prescribed doxycycline.
3/ Early in the morning 3 days later, rash gone but otherwise feeling worse, she checked herself in to New York's Greatest Hospital ER. At first, all good--blood drawn, IV fluids, antibiotics started, attention from nurses, every specialist in the house coming to check her out.
4/ (It's a big day when presumed Rocky Mountain Spotted Fever walks through the door of a hospital in NYC)
5/ Creatinine 2.3 (up from baseline of ~1), BUN 32, white count 23,000, albumin 2.1 (non-clinicians: these are not happy numbers)
6/ By 10:30 am, on a gurney in the corridor but comfortable, told she's going to be admitted. All seems to be going ok. In her words: 
7/ But as morning became afternoon, things took a turn for the worse. In her words again:
8/ Picture an elderly woman, lying alone on a gurney in the corridor of a Manhattan hospital, when you read this:
9/ At about 6 pm, worried by the panicked texts my wife was getting from her, we called & spoke to the ER attending, reminding them of the woman they seemed to have forgotten and advocating that she be moved to the inpatient unit ASAP. 11 minutes later, she was upstairs.
10/ So what happened? Once she was "admitted," the ER team no longer viewed themselves as responsible. But until she arrived on the ward, the inpatient team didn't see themselves as responsible either. So there she was, stuck between the cracks, the responsibility of no-one.
11/ At its best, health care in America is phenomenal. But too often, it's a complete disaster. And the worst care can happen in our "best" places.
12/ It's tempting to blame the people, but that shouldn't be our first response. As the patient safety movement has taught us, every system is designed to achieve precisely the results it actually achieves.
13/ We must design systems that work for, and are centered on, patients. We can't rely on the daughters and @hshanawaniMD's of the world, or on individual heroic PTs and nurses, to compensate for the flaws of the systems in which they work or seek care.
14/ Finally--just because @usnews thinks highly of you doesn't mean you're a great hospital. It's about the patient, not about the ranking. /fin
