Guest Author : Patient Perspective (2)

My inpatient care experience is a little bias because if my age when I experienced it. I was 13 years old and had never had to spend the night in a hospital setting before. Besides being afraid of people seeing me in my open backed gown and hair net I was sort of calm going into the operating room. While sitting in my room waiting for the operation to happen. The nurse came in and proceeded to give me an IV, and I say proceeded with a hint of anger behind it because after the third time sticking me with the needle I had to ask for someone else because as she claimed, “it feels like a little bee sting”, and that’s great because I hate bees and have just been stung in the right hand 3 times.

After the IV I was administered anesthetic and wheeled to the operating room to have tubes put in my ears as well as have my tonsils and adenoids taken out. This whole experience was pretty enjoyable; the staff was humorous and very caring about how nervous I was. After the surgery I woke up in a panic as my face was face down in a pool of blood all over my pillow, no one was around and this caused me to have a bit of a freak out and since I had stitches in my throat screaming only made the blood pool and have to be regurgitated out of my esophagus. After a few minutes of panic and anxiety a nurse came in and told me to calm down and that the blood was just from where they took out the tonsils and adenoids and the blood was completely normal.

The surgeon soon came in and told me that the procedure went smoothly and that in a few weeks I would be just the same as when I went in and that I may have permanent holes in both eardrums from the tubes and that I may not be able to go swimming as much as I would like anymore for the rest of my life and that talking without tonsils and adenoids due to how big they were, may take some getting used to. Since that day on I have never been able to talk the same, due to the air that seems to leak out of my nose when I say words that have the N and certain S sounds.

This whole experience of inpatient care was a relatively good one but it made a difference who was taking care of me and how they went about it. The one nurse who “stung me three times”, was an older woman who had an attitude about her as if she has done this a million times and was just going through the motions. All she really said to me was that her sticking me with a needle was going to feel like a bee sting. And just stuck me over and over again, no remorse, no sorry I missed your vein, or my bad, she just pulled the needle out then shoved it right back in as I sat there wincing in pain before the younger nurse who was setting up the anesthesia came over and held my hand before giving me the IV one and done.

I think a lot of how peoples experiences rate with in patient care is that it all depends on who is taking care of you, there are always those people who are book smart and came out of med school with the straight A’s and talking to them is like talking to a stump in the middle of the woods. There is no connection and they don’t care about you. But then you have the ones who have a decent amount of people skills and can relate and actually care about how the patients are and want them to have a good experience. It’s the doctors and nurses who are just worried about the paychecks and when they can punch off the clock. They are the ones who are responsible for the bad experiences with their patients. Who wants to have a nurse who acts like she doesn’t want to be doing what she is doing especially when it comes to working with younger kids who need patience?

Guest Author - A Healthcare Worker on the Electronic Record

Guest Author- A Healthcare Worker on Electronic Health Information
I have been working in the healthcare industry for the last 9.5 years. The last 4 years I have worked in health information management. I have worked with the transition of the hospital’s paper record to an electronic system. Currently, the new patient records are 90% electronic. But old records are still paper and are currently being scanned into an electronic format.
First, I would like to define terms regarding electronic records. EMR – The Electronic Medical Record is a record of a patient’s visit. It is a computerized legal clinical record of the medical care delivered by the hospital, doctor, and any other services on a particular date.
The Electronic Health Record (EHR) encompasses a broader range of health-related data. It contains patient input and access spanning episodes of care across multiple organizations. The data can be used to look at health care issues for a community, region, or state.
Second, there are two current initiatives driving the electronic records program; the federal stimulus initiative for electronic records by 2014 and Wisconsin Governor Jim Doyle’s initiative to have electronic records by 2012.
More information on these two initiatives can be found at: Wisconsin.gov/ehealth/EHR/index.htm and ehealthboard.dhfs.wisconsin.gov.
Third, I would like to share some of the problems that the medium size hospital I work for has encountered. The first version of the “electronic record” went live in July of 2009.
The first problem we encountered was the idea of what an electronic record (for our hospital) was. Physicians and outside health care providers assumed that the whole record was electronic. Along with this assumption was the idea that the record would be available immediately. To appreciate this dilemma let me outline the record keeping forms that our hospital supports for medical records. From the 1940’s through 1950’s the records are on reel-to-reel tapes. From the middle 1950’s to 1995 the records are on microfiche. From 1996 to 2003 the records are on CD. Records from 2004 to 2007 are paper and currently being put on CD or being scanned. Records from 2007 to current are almost completely electronic. Currents records are further broken down by dictated/transcribed, point of service, and scanned portions.
The second problem was training staff to access a record. All new records are scanned into an electronic format as soon as possible which makes the record available quickly and to all departments and clinics within our campus. However, now staff, nurses, and physicians have access to medical records. These personnel had to be retrained on how to encompass this into their daily routines and workloads. There was a lot of reluctance on the part of this group of individuals, who main goal is patient care, to now be an active part of the patient’s record retrieving process. It is still difficult for some clinicians to change the idea of a patient visit . Now the visit has been adjusted to include viewing records either with the patient or before anyone sees the patient and also includes dealing with the records when the visit is over. Traditionally, some of this work was done by other areas of the organization.
The third problem is use of the electronic record. HIPPA has many standards for protection of patient information. As this information becomes more accessible, it has to also become more trackable. Currently, we cannot release records in certain formats because the organization cannot guarantee the security of the format. (Such as email) Therefore, it limits the use of information for outside agencies such as pharmacies, labs, and offsite research institutions. In my opinion, this will be one of the most difficult problems to surpass to put together the EHR, as organizations struggle with keeping patient information confidential and secure, yet available.
The electronic record has streamlined our billing and coding processes. It has made accessing a patient’s record quicker and allows a greater continuity of care in our organization.
Given the struggles still to come with electronic records, I feel that it would be of great benefit to the patients and health care providers to have access to health information as quickly and securely as possible no matter where the patient is.

Guest Author- A Patient's Perspective

Due to many health ailments, inpatient care is something that I am all too familiar with as a patient. Generally, my experiences while an inpatient at the local hospital have been pleasant in terms of the quality of care. My most recent experience in the hospital, which occurred at the end of January, was quite the opposite. I was an inpatient for 7 days and throughout the majority of my stay, I was frustrated by the quality of care that I was receiving.
In my opinion, the economy was the main cause of my lack of satisfaction with my recent stay in the hospital. The poor quality that was provided was due to the lack of staff that was working at all times. It was evident that these nurses and CNA’s were overworked because they were constantly on the go. They were so busy that my wife needed to apply an ointment to my back because the nurses never came to do it. Additionally, the hospital room was not cleaned daily as it had been in the past. It is the responsibility of the hospital to ensure that their hospital is well staffed and they clearly didn’t consider this factor when making budget cuts. Had there been enough health care workers to provide adequate care, I believe my experience in the hospital would have been much more bearable.
Staffing was not the only issue that contributed to the lower quality of the inpatient care that was provided during my recent hospital stay. The lack of supplies and cost-saving techniques such as hiring hospitalists were also factors contributing to the poor quality of care. In terms of the lacking supplies, my wife had to go home and get some of my medications that the hospital pharmacy didn’t have for some reason. One of these medications being as simple as Nasonex®, a nasal spray that is quite common and every health care establishment should have access to. During my past inpatient stays, the hospital has never had a problem with being able to provide me my medications and I found it absurd that my wife had to retrieve my medications for me. What would have happened if I wasn’t married and wouldn’t have had anyone to retrieve my medications for me?
The other factor that contributed to poor inpatient care quality was the particular health care professionals that I saw. When admitted to the hospital, I was put under the care of a hospitalist. This hospitalist was not very familiar with my past medical history and therefore the proper care took longer to receive. It was only after my wife insisted that something was wrong that the hospitalist decided to look further into the issue. Additionally, there was one instance where the hospitalist actually spoke quite harshly to me because I confused two things she told me. This hospitalist demonstrated poor customer service skills and instead of reacting in a harsh manner, she should have calmly re-explained the issue to me.
Personally, I think there may be a solution to the quality issues that I experienced during my stay in the hospital. First, I think there needs to be some type of policy that mandates a certain level of staffing per patient at any given time. Had a policy existed during my hospital stay, I would suspect that I would have received a higher level of care. I do not think that health care workers should be standing around waiting for patients, but I feel that the hospital staff during my stay was quite overworked and an additional person or two would not have resulted in large amounts of wasted time.
Additionally, I feel that all hospitals should be responsible for obtaining all medications that a patient should need. I would hope that they would keep a stock of the most common medications that are dispensed, and Nasonex® should be one of them. If a hospital does not have a medication on hand, it should be the job the of hospital pharmacy, not the patient to ensure this medication is obtained. No patient should suffer due to a hospital’s lack of supplies.
Lastly, I feel that hospitals should not be switching to the mindset of utilizing more hospitalists. While some patients may have positive encounters with these medical staff, it’s a way of cutting corners and the patient’s own doctor may be more efficient. I’m not saying it’s essential to eliminate all hospitalists, we just need to limit the number we employ.