Anecdotes+of+Inefficiency

=Anecdotes of Inefficiency and impact on patient care=

How inefficient is your current medical system insofar as technology and medical records is concerned? This question must be asked before considering what efficiencies could be realized by instituting or upgrading technology solutions. Lynette Wilson, R.N., B.S.N., O.C.N., has been an Oncology Nurse for over 15 years. For ten of those years she dealt with outpatient Cancer Patients at Yale New Haven Hospital in New Haven, CT and has a unique perspective as a clinician. In addition, as all of us do, she gets to view the medical spectrum from the perspective of being a patient. Following are some of her observations:

Case 1: Inpatient vs. Outpatient at Yale New Haven Hospital (Perspective as a clinician)
Yale New Haven Hospital (YNHH) is the second largest hospital in the state of CT and has the largest outpatient chemotherapy infusion room in the state. As an Oncology Nurse at YNHH, Lynette administered chemotherapy to outpatient cancer victims. As you might imagine, many of the patients would oscillate between inpatient and outpatient status depending on the severity of their disease and associated complications. Depending on their cycle times (time between chemo treatments), patients could have an episodic event that required a stay in the hospital. Where the problem arises is that the patient often times will not tell the outpatient chemo nurse that they recently had a stay in the hospital.

When a patient is scheduled for outpatient chemotherapy, the appointment and requisite medication were entered in Yale's outpatient computer system. What is amazing is that Yale has a separate inpatient computer system, and the two systems are not integrated; to wit, not only do they not exchange information, the inpatient system is not accessible to most of the outpatient staff !! This can lead to a multitude of problems such as conflicting or duplicate dosing, failure to identify new relevant allergies, or chemotherapeutic latency due to conflict with newly prescribed medication. In addition, other medical indications may have been determined in the inpatient setting but not added to the outpatient record. Not only is this potentially dangerous to the patient, but it increases the possibility of liability to both the healthcare provider and the hospital. An integrated system would help alleviate this conflict, create a safer environment for the patient, and streamline the clinicians workload.

Case 2: A recent experience with exchange of medical information (Perspective as a patient)
As a patient, Lynette recently had first-hand experience of the inefficiencies of our current medical system. For several years, she has had her annual mammograms performed at St Francis Hospital in Hartford, CT. It should be noted that St. Francis has the ability to digitize the mammograms as well as utilizing the traditional film images. Unfortunately, her most recent mammogram showed an area of "suspicious activity". Her physician wanted to follow up by sending her to Hartford Hospital's Jefferson X-Ray, where a more advanced mammography machine was available.

Subsequent to the advanced screening, the Radiologist at Jefferson X-Ray requested that her previous films be sent over from St. Francis so that he could compare them. Lynette signed the requisite release and began to wait. Needless to say, when you are awaiting results that may indicate whether or not you have cancer, anxiety becomes a major issue. After a week, she had not heard from anyone at Jefferson X-Ray and called to find out what the status was. Jefferson X-Ray indicated that they had faxed the request but that they still had not received the films from St. Francis. Lynette then called St. Francis who stated they had no record of the request. So began the telephone back and forth to attempt to get the films over to Jefferson X-Ray. Finally, Lynette requested that St. Francis make a copy of the films available for her pick up, and she would deliver the films to Jefferson X-Ray personally.After two long weeks of waiting, that is what happened.

Fortunately, this incident had a positive outcome; the area of activity was not cancerous. However, it illustrates not only the frustrations and unnecessary stress placed on a patient, but also the very real question of whether or not those two weeks of delay may have caused a less than desirable outcome had it actually been cancer. What is more vexing is that there was no reason at all that the digitized films could not have been sent electronically. What should have happened in a manner of moment took over two weeks to transpire.