Talking the Talk, Walking the
Walk: Looking at Transitions of
Health Care in Louisville
Aaron Burch
T
he experiences of the sick or injured and their families, the
knowledge of physicians and nurses, the technical and clinical research done in this case or similar cases prior: these are
the basic stepping stones to solving an ailment of any kind. When
any part of this trifecta becomes unreliable, communication is
damaged. Helping the patient becomes harder. Mistakes are made.
A 2010 survey conducted by the Center for Disease Control
found 35.1 million patients were discharged from hospitals over 365
days - just under one million patients per day. In Kentucky alone,
patients spend approximately 3 million days per year in hospital
beds, being waited upon and examined by nurses and doctors,
specialists and surgeons, techs and aides. The amount of information required to operate and maintain our health care system at the
highest level is staggering, and the only people who can shoulder
the burden are the health care professionals already in the system.
This is why it comes as no surprise when the needs of a patient or
two slip through the cracks.
Do these bandages need to be changed three times a day, or four?
Does the doctor really need to be bothered at this time of night?
Is that treatment really appropriate for this situation? The patient
doesn’t know these answers. Only the people on the other side of
the hospital gown decide what’s best. And, more often than not, the
patient will trust their doctor. So, how do hundreds upon hundreds
of health care professionals save their sanity and their patients, faced
with the information they’ve got – or lack totally?
“I don’t know what the cure is,” said Russell Williams, MD, a
general surgeon at Jewish Hospital in Louisville. “I see people in
my office from nursing homes. The ambulance people can’t tell
you why they’re here. The patient can’t tell you why. There’s nothing on record. You don’t have phone numbers or you try them and
the nurse is off. Sometimes people come in, and I don’t even know
what to do for them.”
Dr. Williams was part of a recent Greater Louisville Medical Society work group designed to strengthen transitions of care for patients
from facility to facility, doctor to doctor. The group determined one
of the most helpful things possible to accomplish was to create a
standardized form for all Louisville and then Kentucky facilities
which could follow each patient around with basic transitional facts.
“That project’s done. Baptist has already implemented it statewide.
It’s in their electronic health records,” said Dr. Williams. “Kentucky
One is supposed to be implementing it and Norton Healthcare is
now putting it into their system.”
Dr. Williams said this implementation will have a major effect on
the thoroughness of patient care. “This form makes it so much easier.
When a patient comes in here and I have their basic information
on a two page sheet, I don’t have to go sifting through thick stacks
of papers to find what I need.”
Despite the advantages of the form, the proper transition of
care is an ongoing issue. No physician is immune to these slips of
responsibility. “I’m not on call tonight. And in a perfect world, I’ll
call up the doctor on call and tell them what’s going on with each
of my patients. The nurse leaving her shift would do the same, in a
perfect world,” said Dr. Williams. “But often times, I’m tired. I still
have a good hour or two of rounds to make. I wonder if this other
guy is already at home having dinner. Do I want to bother him? All
my patients are doing great, and I don’t anticipate any problems. I’m
sure he would call me if there was an issue. So maybe they feel the
same way, and don’t bother me. Things can get dropped.”
Dr. Williams attributes these mistakes to two things: physicians
and nurses being increasingly busier and also a lack of personal
interaction with patients. “It used to be the doctor went to the
hospital, saw their patients, went to the office, had their clinic in
the office. Now you get admitted and a nurse takes care of you. The
office doctors hardly come to the hospital anymore.”
Rick Rowe, MD, an emergency room physician who also participated in the GLMS work group and transition form, agrees. “Let’s
say a facility has a doctor only in at night. He admits a patient but
may never see them again. Plus, whoever sees them the following
day might never see them again. When the patient goes home, their
family doctor resumes responsibility for them, not to mention any
consultants. The transitions have become too fragmented,” he said.
Dr. Rowe is one of countless people with a personal example
of slips in care. His father was in the hospital several years ago
undergoing surgery for brain cancer. “While he was in, my father
was seen by a well respected oncologist who told him he needed to
have chemotherapy, but he wouldn’t need to drive so far, there was
an outpatient clinic near where he lives. So my dad went to see the
other doctor, who told him not only did he not need chemotherapy,
but it might kill him if he had it. These doctors had the same information, but entirely different outcomes.”
Dr. Rowe’s father survived without undergoing chemotherapy,
but the example remains. “Perhaps if my dad’s first doctor had
communicated better and explained why H