what might be learned from the case. The answer, in part, is that prudent psychiatrists and other therapists will want to be thoughtful about how they arrange follow-up care for patients whom they can no longer see.Sometimes a general suggestion that a patient seek follow-up care will be adequate. However, as the patient's condition warrants, clinicians might choose, in ascending order of time commitment, to provide the patient with the name of a particular practitioner or facility, to contact the facility to ascertain that a clinician is willing to see the patient, to help the patient make an appointment, or, with the patient's permission, to make an appointment on the patient's behalf. In some cases, it may be appropriate to ask for the patient's permission to contact his or her family to indicate a need for follow-up and to encourage the family to make sure that follow-up takes place. But of these approaches, no specific one will always be indicated, and the degree of assistance rendered the patient should be calibrated to his or her individual needs.

Steroids used after the first 3 to 4 days after injury do not affect wound healing as severely as when they are used in the immediate postoperative period.

Mild to moderate normovolemic anemia does not appear to adversely affect wound oxygen tension and collagen synthesis. However, profound anemia with 15% less hematocrit can interfere with wound healing

But another big factor is patient preference

have the knowledge and skills to help navigate the hospital system, explain your diagnosis in detail, and explain potential outcomes.  We are also here to help decipher the information from doctor visits, set up meetings with care teams, and organize home care, and medications

As with other forms of value-based health care, patient-centered care requires a shift in the way provider practices and health systems are designed, managed, and reimbursed. In keeping with the tenets of patient-centeredness, this shift neither happens in a vacuum, it driven by traditional hierarchies in which providers or clinicians are the lone authority. Everyone, from the parking valet and environmental services staff to c-suite members, are engaged in the process, which impacts hiring, training, leadership style, and organizational culture. Patient-centered care also represents a shift in the traditional roles of patients and their families from one of passive “order taker” to one of active “team member.” One of the country’s leading proponents of patient-centered care, Dr. James Rickert, has stated that one of the basic tenets of patient-centered care is that “patients know best how well their health providers are meeting their needs.” To that end, many providers are implementing patient satisfaction surveys, patient and family advisory councils, and focus groups, and using the resulting information to continuously improve the way health care facilities and provider practices are designed, managed, and maintained from both a physical and operational perspective so they become centered more on the individual person than on a checklist of services provided. As the popularity of patient- and family-centered health care increases, it is expected that patients will become more engaged and satisfied with the delivery of their care, and evidence of its clinical efficacy should continue to mount.

The concept of patient-centered care extends to the treatments and therapies clinicians provide. Not only are care plans customized, but medications are often customized as well. A patient’s individual genetics, metabolism, biomarkers, immune system, and other “signatures” can now be harnessed in many disease states — especially cancer — to create personalized medications and therapies, as well as companion diagnostics that help clinicians better predict the best drug for each patient.

Strict visiting hours and visitor restrictions are a thing of the past in a patient-centered care model. Patients are given the authority to identify who can visit and when. Family members (as defined by the patient and not limited to blood relations) are invited to visit during rounding and shift changes so they can be part of the care team, participating in discussions and care decisions. When not in the room with the patient, they are kept informed of their loved one’s progress through direct and timely updates. A patient-centered care hospital’s infrastructure encourages family collaboration through a home-like environment that not only meets the needs of the patient, but also meets the needs of family members. For example, maternity wards are being redesigned with family-friendly postpartum rooms that can accommodate the mom, new baby, and family members, who are encouraged to spend up to 24 hours a day together in the room to foster family bonding.

The primary goal and benefit of patient-centered care is to improve individual health outcomes, not just population health outcomes, although population outcomes may also improve. Not only do patients benefit, but providers and health care systems benefit as well, through: Improved satisfaction scores among patients and their families. Enhanced reputation of providers among health care consumers. Better morale and productivity among clinicians and ancillary staff. Improved resource allocation. Reduced expenses and increased financial margins throughout the continuum of care.

Patient- and family-centered care encourages the active collaboration and shared decision-making between patients, families, and providers to design and manage a customized and comprehensive care plan. Most definitions of patient-centered care have several common elements that affect the way health systems and facilities are designed and managed, and the way care is delivered: The health care system’s mission, vision, values, leadership, and quality-improvement drivers are aligned to patient-centered goals. Care is collaborative, coordinated, and accessible. The right care is provided at the right time and the right place. Care focuses on physical comfort as well as emotional well-being. Patient and family preferences, values, cultural traditions, and socioeconomic conditions are respected. Patients and their families are an expected part of the care team and play a role in decisions at the patient and system level. The presence of family members in the care setting is encouraged and facilitated. Information is shared fully and in a timely manner so that patients and their family members can make informed decisions.

In patient-centered care, an individual’s specific health needs and desired health outcomes are the driving force behind all health care decisions and quality measurements. Patients are partners with their health care providers, and providers treat patients not only from a clinical perspective, but also from an emotional, mental, spiritual, social, and financial perspective.

Experts suggest family engagement in care can improve safety for hospitalizedchildren

Deyo et al. (8) demonstrated a reduction in the adverse impact of inadequate health literacy in the neurosurgical field. The impact of an interactive videodisc program that informs patients of their treatment options for back surgery on patient outcome and surgical choices was evaluated. The program helped facilitate decision making and ensured informed consent. It also reduced surgery rates for patients with herniated disks. The authors of this study also implemented the use of patient-oriented multimedia to augment comprehension and advocated a similar strategy for other clinicians. Further commitment is needed to put health literacy at the forefront of improving health care and reducing health expenditures, especially in neurosurgery.

patient adherence