After spending nine hours in the emergency department with abdominal pain (Part 1: Biomed Process Improvement from the Other Side of the Bed), I began my stay as a hospital inpatient. As an engineer, I continued to lean on my analytical “tool box” to notice areas for “process improvement.”
I observed the “floor” as a warren of patient rooms interspersed with staff areas for equipment, food, supplies, and a pharmacy dispensing system. There was a central desk, which is the location of the blessed-and-cursed “nurse call” system. I say “blessed” because, at the push of a button, the patient can summon assistance. The “curse” is due to the delayed response and a constant beep beep beep as other patients sought help.
I was placed in a semi-private double room. The trend in new construction is to go with single-patient rooms for both privacy and infection control, despite the higher cost per square foot. Over the next few days, I overheard my bunkmate’s conversations and those of his medical care team despite my best efforts. Once the lights were turned off, the coughing and loud snoring of the “B-bed patient” was disturbing and a potential personal septic disaster for me. There were no options or choices. “It is what it is” applied to my situation.
I tried to fall asleep, but the constant alarms (remember alarm fatigue?) thwarted that effort with beeps, squawks, and trills all night long from infusion pumps, bedside monitors, nurse calls, and the mélange of devices. If this wasn’t bad enough, the nurses or medical assistants came in every two-to-three hours to check vital signs or change IV bags. Obviously, this was an exercise in sleep deprivation.
Process Improvement: Single patient rooms are the industry “norm” and will be available in the new hospital now under construction.
There are presently available monitoring systems that can obtain vital signs data without disturbing the patient. I would be a supporter, even if they cost more, due to improved patient satisfaction.
After a sleepless night, someone from patient services came by to see me. It’s never too soon to discuss the magnitude of the patient’s bill, after all. He reviewed some forms and asked for a signature. I had no idea of what I was signing in my pain-addled, fuzzy-brained head. When I re-read it a few hours later, I saw that I was being informed that the first hours of my stay were for “observation and evaluation” and that the charges and billing responsibility could be different than those for an “in patient.”
Healthcare is in a special—or differentiated—place when it comes to money. If you buy a loaf of bread, a car, or a new frock, you ask how much the item costs and are told a price. You decide to accept it or reject it. When it comes to hospital bills, it depends on your insurance, the negotiated discount, and other pricing elements that are hidden from you. Be prepared: billing will be divided in “hospital” and “professional” parts. Both can be sizable. You accept, in good faith, that the billing will be reasonable and fair. It may or may not be. Again, “it is what it is!”
Process Improvement: Have a “rainy day” fund set aside for unexpected expenses such as illness or other calamity.
Hospitals know the expected costs of care. They should be more transparent. Do we need health care reform? Yes. Our system of health care is: complex, cumbersome, difficult to navigate, and clearly not what is intended by healthcare organizations, insurance companies, or consumers. It doesn’t have to be this complex. I believe that efficient, cost-effective healthcare can be achieved with good outcomes. Then again, as our president once said, “Who knew healthcare could be this complicated?”
Process Improvement: This is a paradigm shift, major re-think of how healthcare is done in this country. It will be difficult, but what we have now is inefficient, costly and doesn’t have to be this way.
Despite the issues, I have nothing but praise and good thoughts for my physicians, nurses, medical assistants, dietician, nurse managers, housekeeping, and beyond. Their dedication, focus, knowledge and articulation was amazingly good.
I didn’t want to hear I was being evaluated and seriously considered for a surgery. I even had the audacity to ask for a consult with a gastroenterologist. At first, there was some pushback. I was already on the “pharmacology train” with IV therapy, and the next stop would be an operating room if things didn’t go well. Eventually, I did get a visit as a second opinion. This turned out to be helpful. I was given a review of the underling physiology and disease process, as well as a confirmation that my surgical team was on the right track. In the end, having teams with a diverse make up are stronger and may come up with alternatives that an individual may over look.
Process Improvement: Core teams should be diverse, have a leader, but open to input from different disciplines and have five plus-or-minus three members.
Remember, I originally expected an overnight stay. But, each day, my care team would review the white blood cell count, look at my swollen belly, and sadly shake their heads that I was not well enough to go home. Emotionally, this was very hard to take. “What did I do to deserve this?” “What can I do to reduce the pain and heal my body?” The answer, simply, was just to wait. Again, “it is what it is.”
Process Improvement: Lower your expectations and you won’t be disappointed.
I requested a visit by the hospital chaplain, because I was starting to feel low. He stayed with me for about 45 minutes. The visit was a moment in time and perhaps the most valuable 45 minutes I’ve ever spent. I’ll tell you all about it in the final blog post.
Eben Kermit is a biomedical engineering supervisor at Stanford Health Care in Palo Alto, CA.