An Opportunity to Focus
By Barry Dennis and Darin Vercillo
During a typical workday, we all are pulled in a myriad of directions – and that’s especially true in a hospital environment that can be siloed, disjointed, and can fluctuate instantly between moving at a snail’s pace to moving at the speed of light. Depending on your role, you could be focused on staffing issues, coordination of care, health equity, providing patient care, driving revenue, or any number of other things. In an environment like that, it’s easy to lose sight of the forest through the trees. And to be clear: Capacity management (managing beds, etc.) does not equal an influx of patients nor should it impede access to care. Patients are coming to the hospital regardless of open beds and hospitals will take care of those patients because it’s the right thing to do and is reflective of the mission healthcare is called to serve.
So, the question is: what are you called to focus on? As a doctor and a nurse, we feel called to focus on the patient. Patients are the core of the healthcare industry and the business. In fact, we think most people in healthcare would say the same thing, regardless of their role. Instead, we’re faced with the reality of making phone calls, making rounds, making sure we have enough CEUs, making sure we get reimbursed, making sure there are open beds, and yes, making sure patients are getting the care they need. We’re focused on clerical tasks and capacity management driven by our silos of care delivery within the health system rather than patient care and patient management – often at the expense of the patient. Everyone is trying their best to do what they were called to do, but friction in the system often prevents us.
For example, take this familiar situation into consideration:
A physician at a community hospital has a 47-year-old male with a BMI of 28. The patient is a type 2 diabetic but no other chronic conditions. While on a bike ride the patient crashed and hit his head. He came into the very busy Emergency Room of a small community hospital with uncomplicated superficial injuries to the forehead, face, and hands. The patient was brought in by his spouse and the spouse did all the talking during admission. The couple waits in the ER until they are called back to ER bay 8 a few hours later. The physician comes in and the patient is awake but clearly in pain and seems to be struggling with cognition. The physician suspects a neurologic issue, and a quick CT scan reveals a large subdural hematoma. She doesn’t have the capability to escalate care at her facility and will need to transfer the patient. As clinicians, you understand the risk and worry that the physician now feels. A stopwatch has just started in this physicians mind….every minute now matters and will impact the outcome for this patient. Life. Death. Quality of life. They all are at risk.
The physician calls an academic facility in the city, starting with a phone call to the hospital operator, who transfers her to the nursing supervisor. The call is routed to the supervision office, and the nursing supervisor doesn’t get the message until 1.5 hours later because he was dealing with staffing and ICU capacity issues. He states he will have to get a hold of the neurosurgeon on call but cannot commit to a time (5, 10, 20 min?) …. Meanwhile, the staff in the ER continues to check back in on the patient who is deteriorating and it’s now getting close to 11:30pm. Finally, the neurosurgeon calls back, discusses the case with the ER doc, and accepts the patient in transfer, but not before the hospitalist is called about admitting the patient. The nursing supervisor starts calling the charge nurses in multiple units in a search for a bed, which takes another 30 minutes. Finally the ER doctor is notified that they can accept the patient. At this point an EMS vendor is called and an ambulance is routed to transport the patient. It’s now 2:30am and the patient had the bike wreck at 5:30pm, multiple hours of needless waiting based on manual, clumsy processes fraught with delays.
There’s not just a better way to handle these situations; there’s a right way. And it’s not focusing on a piece of equipment. It’s not focusing on the trees in the forest. It’s not about the bed. It’s ABOUT the patient and time to care. And it’s time we remove the friction that’s preventing us from focusing on what we were called to focus on: the care and well-being of patients and their loved ones. What patients need is something to streamline communication and expedite their movement to the next, best care setting so they’re not sitting and waiting to be cared for – all the while getting acutely worse and potentially amassing long-term complications. They need something that will let their doctors and other clinicians spend more time with them so they can get the best possible care. And patients and hospital systems alike need something that will help reduce lengths of stay, readmissions, and costs while providing access to care for all patients. Fortunately, that solution is here.