Caren had the nurse start paging the residents at 9am and asked her to page them 2-3 times an hour until they finally arrived at 11am. They obviously weren't very happy with her. We had given up on making friends and influencing people four days earlier, so no great loss. When they finally arrived, he two of them played a good cop-bad cop game with us. Little did they know, Caren had the bad cop-psycho-ninja, doctor killer roles all wrapped up into one. After some fairly tense moments, we got the discharge plan ironed out. Then the waiting started all over again.
The Team had to see the rest of the patients before they updated anyone's orders in the "system" or wrote discharge notes. It seemed ludicrous to me that the "system" would be so slow to evolve. What if there was a drastic change in a patient's treatment plan and they were the first patient to be seen? We've already established that the nurses will not deviate from the treatment plan in the "system". That patient could receive inappropriate treatment in the window of time that the Team is updating the "system". What complicates the "system" even more is the sheer number of doctors on the Team and the lack of communication therein. Caren's Lovenox (a blood thinner) therapy started a half day later than it should have because a Team-member didn't enter the order to start it. They didn't catch it until the next set of rounds later that day, then debated in the hallway outside the room who the guilty party was. In my mind, the simple solution is, enter the orders immediately after seeing the patient, then move on. Or, jump into the 21st Century, and use a bedside tablet or computer to enter the orders real-time, as you see the patient. I'm sure some hotshot accountant can find a decent return on investment for the initial cost of implementation. There has to be some way to calculate the value of increased efficiency in the "system".
Since I'm on the topic of efficiency, the fact that they wait so long to discharge patients (we finally got out around 2pm) creates huge logistical issues for the facility. I'm not sure how often the hospital runs at capacity, but I seriously doubt that Caren's bed was scheduled to sit empty for any length of time. If there are patients coming out of surgery or waiting to be admitted form the emergency Department, they wait and wait until the beds are empty upstairs. The sooner they can get the outgoing patients out, the smoother the "system" will run. There's really no reason why they couldn't see the patient's to be discharged first, maybe after any critical cases in ICU, and get them on their way. Just my thoughts. Sometime this week I plan on outlining my vision of the perfect hospital, what it NEEDS, what it should really have, and anything that should be ever-absent from inside it's walls.
This entire experience was extremely eye opening for both Caren and me. Some of our assumptions about a large, teaching hospital in NYC were completely absurd. We also came to see our local, community hospitals in a different light. Yes, they are smaller, and lack some fo the fancy specialties, but they are doing some things very good. The big guys could stand to learn something from the small-town approach.
Caren is resting uncomfortably right now. It was a long night. Getting the pain managed without our friendly neighborhood PCA pump is proving a little complicated. I'm sure we'll figure it out and she'll be sleeping most of the day. Off to eat something before the boys and I get to playing!
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