A Fun Little Quiz

1. What is the meaning of distal occlusion?

  1. there’s a dangerous blockage in the IV line
  2. the patient’s elbow is bent
  3. the patient’s blankets are on top of the IV tubing

2. How many of my visitors thought that a book of logic puzzles would be the perfect gift to help me occupy my time?

  1. One of them
  2. Two of them
  3. All of them
  4. None of them

3. What is a good response when a patient’s IV alarm goes off repeatedly?  Which choice did my nurses make?

  1. Ignore it.  It doesn’t really matter how much of that stuff patients get.
  2. Discover the cause and fix the problem.

4. How long does it take for a nurse to ignore hospital policy and teach a patient when and how to reset the IV pump?

  1. one hour after inserting the IV
  2. five hours after inserting the IV
  3. fifteen minutes into the second shift with that patient and the alarm is still an issue

5. How long does it take for a CNA to ignore hospital policy and give a patient pen & paper, and request that the patient empty their own hat as needed and just keep track of the volume?

  1. one day
  2. two days
  3. five days

6. What is the best way to have the nurses check on you and make sure you’re okay?

  1. Snap at them about their idiotic, inefficient procedures first thing when they meet you
  2. Have pizza delivered for them
  3. It doesn’t matter; they’ll treat everyone the same

    (If you chose #3, wrong. Try again.)

7. You are given three meal trays.  Based on their contents, identify which meal is breakfast, which meal is lunch, and which one is dinner:

  1. Chicken broth, black tea, green jello, grape juice, apple flavored Ensure
  2. Chicken broth, black tea, red jello, cranberry juice, orange popsicle
  3. Beef broth, black tea, green jello, apple juice

8. What are the odds of four doctors convincing me to have my gallbladder removed?

  1. 100% – nobody needs a gallbladder
  2. 0% – nobody should ever have surgery
  3. Slim - less invasive treatments should be tried first
  4. Better with major advancements in rheumatology:

GI cleared me to go home.
Now waiting on my family physician, who is waiting on my rheumatologist.
Maybe by tonight!

Efficient Use of Resources

Reading medblogs, it doesn’t take long to realize that many doctors, nurses, and others in the healthcare field feel as if they’re being required to do too much with too few resources.

I suspect that might be true.  Looking at my current experience as a hospital patient, though, it didn’t take long for me to spot areas that could easily make the workflow more efficient.

  1. Computers are tools that are supposed to make everyone’s work easier.  It’s that way in every other industry.  If computers make your work harder in healthcare, then there is a serious problem with your software and it needs to be addressed immediately.
     
    The hospital I’m in uses a different computer system in the emergency room than on the floors.  Even though the ER people did a fabulous job and I can’t say enough good things about them, the same can’t be said about my experience when I was taken to a room.  The things I saw would not have happened if the computer system was being used the way other industries use a computer system.
      
  2. Do not duplicate efforts.  Assign one person to a job and require the person to do it efficiently and effectively.
      
    In no other industry would you send one person in to talk to a client, then send a second person in to ask those same questions plus a few others, then send a third person in to ask questions that the first two people had already asked.  That would be a waste of employee resources, and would cause the client to think you couldn’t get your act together.  If you are so obviously inefficient in the first five minutes of serving a client, you’re probably not that efficient in the rest of your operation, either.
      
    That’s what happened here at the hospital, though.  I hadn’t even transferred from the wheelchair to a bed when someone arrived with a clipboard asking me questions.  That person left and another person came in asking many of those same questions plus a few others.  Before that person was done, a third arrived with another clipboard and the same questions.  I’m ashamed to admit that at that point I blew up:  “Do you people even talk to each other?!  I just answered all those questions!  Twice!  And the ER already had all that information in your computer system so you shouldn’t have asked at all!  Do you even bother to look at your computer?”
      
    Yes, I confess it wasn’t one of my finest moments, and I quickly apologized for snapping at them.  The point is still valid, though.  What on earth were the hospital administrators thinking when they designed such an incredibly inefficient process?  Those three people could have all done three different tasks instead of duplicating work that the ER had already done.  They feel short-staffed, yet are running around in circles!  Even if there’s a valid reason for separating the ER’s computer from the rest of the hospital (which I doubt), the ER could easily print a report of the pertinent information and send it along when the patient is admitted.  This isn’t rocket science.  My address, phone number, meds list, and other basic information didn’t change in the last hour, and you’re wasting everyone’s time and abilities with such inefficient protocols.
      
  3. Reward people who do a job well and teach others to emulate them.  Fire people who don’t do their job well.  The techs who work on my floor provide a good example of this basic business principle.
      
    People who work in hospitals are obsessed with bodily functions.  For instance, they track the amount that goes in my IV, and track the amount of output.  This means that although I get to use the bathroom, there’s a “hat” in the commode to catch everything.  Somebody has to record the volume before disposing of the hat’s contents, but nobody told me any of that!  After watching the first tech glance into the bathroom, dump/flush/leave multiple times, I decided to make things easier for everyone by dumping and flushing on my own.  Before long I simplified the process by setting the hat aside entirely.  The tech had a tizzy fit!  That’s  when I discovered the true process.  It could have saved a couple of people a lot of grief if the process had been explained to me!
      
    The tech the following day, however, didn’t check/dump/etc. unless I specifically told her that it was full.   Finally I wrote on the dry-erase board hanging in my room (there is a place on the board for patient/family concerns), “Please empty hat before it overflows.  I emptied it when it got full.  Twice.”  The tech saw my note and got all snippy, “I have nine patients to take care of!  I can’t do everything!”
        
    Since I’m stuck here a few more days, it wouldn’t be smart to make the workers mad so she didn’t get to hear my real answer:  “Guess what, sweetheart?  It would take an extra two seconds to dump the hat when you empty the trash from that bathroom, and another couple of seconds to write down whatever it is you need to write down.  Watch how others in your position do their jobs and you might pick up a few pointers.  You make it take longer by avoiding it and assigning it special status.” 
      
    The tech this afternoon has managed to dump the thing three times in four hours without making a big production out of it.   Plus, he’s cheerful and says hello when he comes in, which is really nice when you’ve been stuck alone in the same room for days.  Management should reward him and fire the first lady.

 

As things stand, I can only wonder at the way this place is run.  If things that are so elementary are obvious to patients, how many other policies are in place that make the worker’s jobs harder instead of easier?

We all know that doctors and nurses care about their patients and want to help.  The running of a hospital, though, is most definitely like running a business.  Basic business management strategies might go a long way toward giving people more time to do their jobs and making the hospital a better place for the employees to work and patients to heal.

My Doctor Is Wonderful

Yesterday I felt trapped in an impersonal hospital room.  I was miffed at being ignored.  Sure, the hospitalists are busy, but ordering lab tests and looking at consult notes without ever seeing the patient doesn’t seem like the best of care to me.  Having nurses and techs who don’t respond to alarms and call lights, and don’t respond to requests for medicine, is miserable.

Fortunately I have my cell phone. I phoned my family physician’s office to cancel my biopsy appointment.  My family physician follows his own patients in the hospital and doesn’t use hospitalists, so the receptionist told me that my doctor would be by to see me.  Later a nurse popped her head in to say that my doctor would be in after he was done seeing all his patients in clinic.  He didn’t make it, but I felt more hopeful just knowing that he knew I was here.

This morning he came to see me.  It is so nice to have someone in charge of my care who knows me and can coordinate everything.  When he came in, I told him that I think I would’ve preferred the biopsy to this.  He grinned back and said he’d been thinking that this was a pretty extreme way to avoid having a biopsy.

He asked me questions, did an exam, and explained what the tests have shown so far.  When he learned that I requested more pain medicine at 3:00, but didn’t get any until after 7:00, he was not happy about it and wrote new orders.  Now the nurse is supposed to give meds regularly whether I ask or not, and can give extra if I need more before then.  That is a much better system.

My doctor told me I’ll be here at least a few more days.  Even though the CT showed tons of gallstones, the EGD didn’t find any stuck anywhere and my liver function tests look good, so the gastroenterologist believes that my sulfasalzine is responsible for the pancreatitis.  This is a bit of a problem for me, since last time my rheumatologist took me off ssz I could barely walk.   My family physician will talk with my rheumatologist and figure out what to do long-term.  Everyone else has been pretty vague, and I love finally getting some straight answers and feeling like I have someone looking out for me.

Thanks for reading.
I appreciate your support!