This document discusses several issues in medical management and ways that computerized systems could help address them:
1) Current electronic medical records are more like notebooks than active management systems, leading to errors and inefficiencies. The author's company aims to develop "artificial intelligence" software to better utilize information.
2) Healthcare currently lacks upfront cost estimates, unlike other industries, leading to financial issues. All non-emergency services should provide estimates.
3) Online medical information raises security concerns but fingerprint/password access and encryption can protect data better than paper records.
That covers the high-level issues and goals discussed in the document in under 3 sentences.
Look and see how our Meds2Home program can help save you time and money with regard to your medication adherence. We deliver right to your door free of charge!
•What is Meds2Home….
•A program developed to be more proactive when it comes to Hospital and Skilled Nursing Facility Discharges.
•Designed to set each patient up for success by collaborating with each patients healthcare providers; Hospitals, Skilled Nursing, Home Health, and PCP.
•Meds2Home will make it easier and safer for each patient to make the transition back home, as well as lower the risk of readmission due to medication error
This document discusses patient-controlled health records and integrated care. It argues that patients should own their health data, not institutions, in order to truly integrate care across settings. A patient-controlled record system called PKB allows data to flow wherever a patient chooses, including to healthcare providers, researchers, insurers, and other stakeholders. This innovative approach starts with giving patients control and has enabled an integrated care network that spans geographical and institutional boundaries to provide the best possible care.
1. A pharmacist reviewed pharmacy operations in Broken Hill, NSW and identified issues with patients' medication management during transitions between the local hospital and nursing home. Medication lists were often incomplete or inaccurate.
2. The pharmacist proposed allowing the hospital access to the pharmacies' database of patients' medication histories to address this issue. A secure system was set up, with patient consent, to share medication information for nursing home residents with the hospital pharmacy and emergency department.
3. By providing the hospital access to complete and up-to-date medication lists, the new system aims to improve patient health and safety by reducing medication errors during transitions of care between facilities. Early signs indicate the system has positively impacted medication management
Nicole Younger is seeking a challenging position as a Registered Nurse. She has over 10 years of nursing experience including 4 years as a Nursing Supervisor. Her experience includes administering medications, IV therapy, documentation, and admissions/discharges. She is currently enrolled in an RN-BSN program at Liberty University and holds a Registered Nurse Diploma from Lynchburg General School of Nursing. Her skills include chart auditing, computerized documentation, time management, and teamwork.
The document discusses the benefits of a physician dispensing model where doctors can dispense medications directly to patients from their practice. Key benefits include improved patient outcomes and compliance through greater continuity of care. It also allows practices to generate additional revenue and profit from dispensing medications. Physician dispensing requires minimal time investment and reduces errors compared to traditional pharmacy dispensing. Many states allow physician dispensing if doctors obtain the proper licensing. Management firms can help set up and handle all aspects of operating an in-office dispensing program.
Melanie Flowers has over 4 years of experience in healthcare, including as a Business Analyst at Blue Cross Blue Shield analyzing health data and ensuring compliance. She has a Bachelor's degree in Social Science and a minor in Healthcare Management from the University of Maryland. Prior to her current role, she worked as a Referral/Patient Navigator and Lead Medical Records Coordinator. She is proficient in Microsoft Office, medical terminology, and managing electronic health records.
Look and see how our Meds2Home program can help save you time and money with regard to your medication adherence. We deliver right to your door free of charge!
•What is Meds2Home….
•A program developed to be more proactive when it comes to Hospital and Skilled Nursing Facility Discharges.
•Designed to set each patient up for success by collaborating with each patients healthcare providers; Hospitals, Skilled Nursing, Home Health, and PCP.
•Meds2Home will make it easier and safer for each patient to make the transition back home, as well as lower the risk of readmission due to medication error
This document discusses patient-controlled health records and integrated care. It argues that patients should own their health data, not institutions, in order to truly integrate care across settings. A patient-controlled record system called PKB allows data to flow wherever a patient chooses, including to healthcare providers, researchers, insurers, and other stakeholders. This innovative approach starts with giving patients control and has enabled an integrated care network that spans geographical and institutional boundaries to provide the best possible care.
1. A pharmacist reviewed pharmacy operations in Broken Hill, NSW and identified issues with patients' medication management during transitions between the local hospital and nursing home. Medication lists were often incomplete or inaccurate.
2. The pharmacist proposed allowing the hospital access to the pharmacies' database of patients' medication histories to address this issue. A secure system was set up, with patient consent, to share medication information for nursing home residents with the hospital pharmacy and emergency department.
3. By providing the hospital access to complete and up-to-date medication lists, the new system aims to improve patient health and safety by reducing medication errors during transitions of care between facilities. Early signs indicate the system has positively impacted medication management
Nicole Younger is seeking a challenging position as a Registered Nurse. She has over 10 years of nursing experience including 4 years as a Nursing Supervisor. Her experience includes administering medications, IV therapy, documentation, and admissions/discharges. She is currently enrolled in an RN-BSN program at Liberty University and holds a Registered Nurse Diploma from Lynchburg General School of Nursing. Her skills include chart auditing, computerized documentation, time management, and teamwork.
The document discusses the benefits of a physician dispensing model where doctors can dispense medications directly to patients from their practice. Key benefits include improved patient outcomes and compliance through greater continuity of care. It also allows practices to generate additional revenue and profit from dispensing medications. Physician dispensing requires minimal time investment and reduces errors compared to traditional pharmacy dispensing. Many states allow physician dispensing if doctors obtain the proper licensing. Management firms can help set up and handle all aspects of operating an in-office dispensing program.
Melanie Flowers has over 4 years of experience in healthcare, including as a Business Analyst at Blue Cross Blue Shield analyzing health data and ensuring compliance. She has a Bachelor's degree in Social Science and a minor in Healthcare Management from the University of Maryland. Prior to her current role, she worked as a Referral/Patient Navigator and Lead Medical Records Coordinator. She is proficient in Microsoft Office, medical terminology, and managing electronic health records.
The document provides an overview of the role of a Legal Nurse Consultant (LNC). It defines an LNC as a nurse consultant who offers advice on medical-legal matters. The primary role of an LNC is to evaluate healthcare delivery and outcomes and provide an informed opinion. LNCs assist attorneys by identifying standards of care, reviewing medical records, and educating on medical issues related to a case. They work in various legal settings, including law firms, and integrate nursing knowledge with challenges in civil and criminal litigation.
This document discusses eVisits, which are online medical evaluations between patients and providers. It provides an overview of eVisits, including relevant CPT codes, research on their efficiency and patient preferences, and stats on eVisit usage at HealthPartners and UPMC. The presentation notes that eVisits provide benefits to patients, providers, insurers and employers by increasing access and convenience while reducing costs compared to office visits. However, challenges include ensuring understanding of appropriate eVisit cases and aligning compensation with other care modalities like phone visits.
Robert Wood Johnson University Hospital in New Jersey has received several awards and national recognition for its clinical quality and patient safety. It was ranked #36 for heart surgery, #40 for cancer, and #50 for respiratory disorders by U.S. News & World Report in 2009. The hospital also strives to improve customer satisfaction and address any issues cited in surveys. It implemented a patient voice feedback system and employee engagement initiatives to better understand customer concerns. These efforts have helped improve satisfaction scores and the hospital has continued to receive quality awards such as the Malcolm Baldrige National Quality Award.
The document describes a proposed solution called WorkMeIn to streamline the patient referral process between primary care physicians (PCPs) and specialists. It aims to centralize referrals, provide a quick single transaction process, collect referral data, and give patients a say in their appointments. Currently, referrals take multiple days and 60-70% go unscheduled. WorkMeIn would allow PCPs to query specialists, let patients choose appointments, and include patient information with referrals. It could increase efficiency, referrals within networks, and provider profitability. The market potential is over $75 million annually.
The document discusses ethics and ethical principles in dentistry, including:
1) Key ethical principles like autonomy, beneficence, nonmaleficence, justice, and veracity that dentists should uphold in their practice.
2) Examples of ethical dilemmas dentists may face and how to reason through competing obligations.
3) Details about informed consent, confidentiality, conflicts of interest, and other ethical issues in dentistry.
Concierge Medicine Brave New World Of Health CareJames Kane
This document summarizes concierge medicine and specialty medical services tailored for individuals. Concierge practices offer enhanced services like same-day appointments in exchange for annual fees, though they remain small. Critics argue they could worsen healthcare access, while proponents say the current system is unsustainable. The document provides tips for what to ask if your doctor transitions to concierge care. It also discusses specialty services that can provide referrals to top specialists for complex illnesses and emergency care while traveling globally through virtual consultations.
Madison Pace is seeking a position in pharmacy and has over 7 years of experience as a certified pharmacy technician. She has a Bachelor's degree in Chemistry Education from Indiana University Southeast with a minor in Biology. Pace has worked as a senior certified pharmacy technician at Walgreens Pharmacy in New Albany, Indiana since 2011 and was previously a certified pharmacy technician at Kroger Pharmacy in Jeffersonville, Indiana from 2009 to 2011. She has also engaged in various academic, professional, and community activities.
This document discusses the hidden costs of healthcare in the United States. It explains that healthcare costs are obscured because doctors, hospitals, and other providers do not know the prices of tests, procedures, and medications they order or perform. This lack of price transparency has allowed costs to rise unchecked. The document aims to uncover healthcare pricing information and explain why costs are so high, with chapters addressing the costs of medications, office visits, hospital stays, diagnostic tests, and health insurance. It seeks to help consumers avoid overpaying for healthcare services.
Pathways to Patient Engagement: Insights from the Physician CommunityKathleen Poulos
The document discusses patient engagement based on a survey of 300 primary care physicians. It finds that while 61% of physicians participate in some engagement activities, websites and patient portals are the most common tools used. Increased patient involvement in their care is seen as the top benefit but time and costs are viewed as the biggest barriers. There is uncertainty around some engagement concepts and a need for broader engagement offerings and guidance on appropriate technologies and content.
The dental practice of Dr. Hart and Dr. Stern began using an antioxidant scanner to measure patients' antioxidant levels. This was well-received by patients and increased business for the practice. It generated scan fees and led some patients to purchase supplements. The scanner helped promote the practice as preventatively-focused and brought in new patients. It also motivated staff through bonus incentives. Within two months, scans and supplement sales increased, generating over $4,000 in revenue for the practice. The scanner received positive publicity that attracted interest from other dental offices.
This document is the October 2015 edition of the For Your Health magazine published by Martin Health System. The summary includes:
1) The magazine highlights women's health services, how a woman lost 100 pounds, and breast health navigation services.
2) It also provides news about Martin Health, including the expansion of the HealthSouth Rehabilitation Hospital and Tradition Medical Center.
3) An article profiles a radiation oncologist at the Robert and Carol Weissman Cancer Center and the advanced technology available to treat cancer.
The NPA's new report, Face to Face, brings together true life stories about the benefits of accessible, locally based healthcare, and shows the importance of face to face relationships between patients and health professionals. It's a reminder that the human touch matters in healthcare.
Patient groups and other stakeholders are invited to consider the policy and practice implications of this new report
Patient Engagement: Health Consumer Insights from Gen Xers and Millennials Kathleen Poulos
Patient Engagement: Health Consumer Insights from Gen Xers and Millennials
Pathways to Patient Engagement is a webinar series designed to foster collaboration and discussion between all involved in the healthcare process.
During the initial webinar we explored physician insights and found 40% of the primary care physicians surveyed were not participating in any patient engagement activities.
During this webinar we highlighted feedback from health consumers, specifically Gen Xers and Millennials. We found Millennials to be more patient engagement savvy than their Gen X counterparts.
Review the deck and to get a health consumer perspective on patient engagement.
Patient Resource: Medicare Observation Versus Admit DaysTerri Embry RN BS
This resource provides information a patient, their advocate or a health care professional can use to learn about this topic. Hyperlinks are embedded to allow for self guided research and is encouraged.
This document discusses a model for coordinating care for patients traveling long distances to an academic medical center. It proposes assigning each patient a "temporary medical home" based on their condition to coordinate all aspects of care during their episode of care. This includes assigning a dedicated nurse to coordinate appointments, financial clearance, and navigation through intake, treatment, discharge and follow up. The goals are to improve patient and provider experience, increase patient volumes and revenue, and support the institution's research mission.
- Independent Living Systems (ILS) provides care transition management services using its Post-Acute Support System (PASS) program to help reduce hospital readmissions and healthcare costs.
- The PASS program coordinates patients' transition from hospitals to home through home visits, follow-up calls, and education on medication, nutrition, physician follow-ups and symptom monitoring.
- ILS works with health plans, hospitals, and provider organizations to implement PASS and achieve improved outcomes like lower readmission rates while providing cost savings.
1) A large study found that home-based physical therapy for stroke patients was just as effective as facility-based rehab, cost significantly less, and had better compliance rates.
2) Medicaid programs are now required to deny payments for costs associated with treating health conditions acquired in hospitals due to poor quality of care. Several private insurers have also adopted these policies.
3) An audit found hundreds of Medicaid caregivers to be unqualified due to deficiencies, putting $724 million in payments at risk of being recouped. Proper documentation of compliance is important for revenue protection.
- The document proposes developing a system called VirtualNHS to standardize healthcare delivery in the UK. It describes the author's experiences identifying issues like misdiagnoses, inadequate physical exams, and overprescribing of antibiotics.
- The author developed assessment tools to help less experienced doctors. This evolved into the proposed VirtualNHS platform, where doctors could create customized diagnostic tools and offer remote care.
- The goal is to reduce unnecessary healthcare utilization by 70% while improving care quality and monitoring clinical practice. The system aims to save the NHS billions while preventing errors and "wrong doings."
Unit 2 DB Responses1.I enjoyed reading your post and I completel.docxshanaeacklam
Unit 2 DB Responses
1.
I enjoyed reading your post and I completely agree with your points. I would like to comment on one of your points regarding controlling the quality of care by using independent contractors. There are benefits to this initiatives, but there could be disadvantages too. The benefit of using teams of experts that you did not hire saves the organization costs associated with keeping full time employees, and patients are seen in a timely manner (In some cases). Many years ago, some departsments in a HMO that I work for had access problem such as patients having to wait 3-4 weeks when they need to see a specialist within the organization. No patient with ear infection or difficulty swallowing wants to wait for 3 three weeks to be seen.
We were sending patients outside for urgent MRIs, CT scans, as well as to different specialists even though the company has capabilities to perform some of these functions in house. Apart from the rising costs this created, the level of patients dissatisfaction went through the roof as some patients get to their appointments and were told that referrals that were to be autofaxed to the outside vendors were never received. Some patients were sent away (no referral, no service). Our Utilization Management department was bombarded with approving these external referrals. We have improved, regrouped, and expanded. State of the art facilities were built and still continue to be built, More physicians, nurses, and support staff were hired, and our patient satifaction rate has grown greatly. For example, we used to send our deaf patients to John's Hopkins Hospital for cochlear implants which cost way over hundred thousand dollars, but that's done in house now
2.
Quality of care is a very sensitive subject for every party involved in the healthcare system. They all have different perspectives, each looking at healthcare from a different lens. Patients see quality of care in the results of their treatment and whether their treatment was effective immediately. It can also be measured by how the provider thinks, If a provider were to say that a patient would heal in 2 weeks, the patient would check for the dulling of pain around 2 weeks after the visit. Providers, on the other hand, see quality of care as the credentials that they need to get in order to renew and keep their license to practice.
Quality has its place in the healthcare system, with its positives and negatives. The positives are that it creates an air of steady improvement within competing facilities, and that it encompasses the entire scope of the patient's feelings and their care, such as the friendliness of staff to the patient, and number of services provided. The negatives are that the rating system could list quality as bad for a number of reasons that culminate in the spirit of customer service, and that constant high quality for providers means that their licenses are constantly being improved with items that fit the demanding.
The UMMC Center for Telehealth provides affordable urgent care telehealth services to over 5,000 employees of corporations and colleges in Mississippi. Telehealth visits save employees an average of $262 compared to acute care visits, and save employers an average of $16,060 per year for a corporation with 500 employees. Employees report high satisfaction with the convenience of telehealth, being able to seek treatment without taking time off work. Healthcare providers also find benefits to telehealth, including being able to provide more focused care without distractions. Telehealth services complement primary care by allowing easy access to follow-up care and medication refills.
This case study describes a married couple's experience giving birth prematurely to twins at a hospital. Key details include:
- The couple was rushed to the hospital two weeks early due to risks of a multiple birth pregnancy.
- They received care from doctors, nurses and staff across various departments, including the maternity ward, delivery room, neonatal intensive care unit and more.
- The twins were born via c-section and immediately cared for given their premature status. They stayed in the NICU for 7 weeks before moving to other areas.
- The family experienced some issues between departments but overall received exceptional care for the babies as they progressed each day in the hospital over 9 weeks total.
The document provides an overview of the role of a Legal Nurse Consultant (LNC). It defines an LNC as a nurse consultant who offers advice on medical-legal matters. The primary role of an LNC is to evaluate healthcare delivery and outcomes and provide an informed opinion. LNCs assist attorneys by identifying standards of care, reviewing medical records, and educating on medical issues related to a case. They work in various legal settings, including law firms, and integrate nursing knowledge with challenges in civil and criminal litigation.
This document discusses eVisits, which are online medical evaluations between patients and providers. It provides an overview of eVisits, including relevant CPT codes, research on their efficiency and patient preferences, and stats on eVisit usage at HealthPartners and UPMC. The presentation notes that eVisits provide benefits to patients, providers, insurers and employers by increasing access and convenience while reducing costs compared to office visits. However, challenges include ensuring understanding of appropriate eVisit cases and aligning compensation with other care modalities like phone visits.
Robert Wood Johnson University Hospital in New Jersey has received several awards and national recognition for its clinical quality and patient safety. It was ranked #36 for heart surgery, #40 for cancer, and #50 for respiratory disorders by U.S. News & World Report in 2009. The hospital also strives to improve customer satisfaction and address any issues cited in surveys. It implemented a patient voice feedback system and employee engagement initiatives to better understand customer concerns. These efforts have helped improve satisfaction scores and the hospital has continued to receive quality awards such as the Malcolm Baldrige National Quality Award.
The document describes a proposed solution called WorkMeIn to streamline the patient referral process between primary care physicians (PCPs) and specialists. It aims to centralize referrals, provide a quick single transaction process, collect referral data, and give patients a say in their appointments. Currently, referrals take multiple days and 60-70% go unscheduled. WorkMeIn would allow PCPs to query specialists, let patients choose appointments, and include patient information with referrals. It could increase efficiency, referrals within networks, and provider profitability. The market potential is over $75 million annually.
The document discusses ethics and ethical principles in dentistry, including:
1) Key ethical principles like autonomy, beneficence, nonmaleficence, justice, and veracity that dentists should uphold in their practice.
2) Examples of ethical dilemmas dentists may face and how to reason through competing obligations.
3) Details about informed consent, confidentiality, conflicts of interest, and other ethical issues in dentistry.
Concierge Medicine Brave New World Of Health CareJames Kane
This document summarizes concierge medicine and specialty medical services tailored for individuals. Concierge practices offer enhanced services like same-day appointments in exchange for annual fees, though they remain small. Critics argue they could worsen healthcare access, while proponents say the current system is unsustainable. The document provides tips for what to ask if your doctor transitions to concierge care. It also discusses specialty services that can provide referrals to top specialists for complex illnesses and emergency care while traveling globally through virtual consultations.
Madison Pace is seeking a position in pharmacy and has over 7 years of experience as a certified pharmacy technician. She has a Bachelor's degree in Chemistry Education from Indiana University Southeast with a minor in Biology. Pace has worked as a senior certified pharmacy technician at Walgreens Pharmacy in New Albany, Indiana since 2011 and was previously a certified pharmacy technician at Kroger Pharmacy in Jeffersonville, Indiana from 2009 to 2011. She has also engaged in various academic, professional, and community activities.
This document discusses the hidden costs of healthcare in the United States. It explains that healthcare costs are obscured because doctors, hospitals, and other providers do not know the prices of tests, procedures, and medications they order or perform. This lack of price transparency has allowed costs to rise unchecked. The document aims to uncover healthcare pricing information and explain why costs are so high, with chapters addressing the costs of medications, office visits, hospital stays, diagnostic tests, and health insurance. It seeks to help consumers avoid overpaying for healthcare services.
Pathways to Patient Engagement: Insights from the Physician CommunityKathleen Poulos
The document discusses patient engagement based on a survey of 300 primary care physicians. It finds that while 61% of physicians participate in some engagement activities, websites and patient portals are the most common tools used. Increased patient involvement in their care is seen as the top benefit but time and costs are viewed as the biggest barriers. There is uncertainty around some engagement concepts and a need for broader engagement offerings and guidance on appropriate technologies and content.
The dental practice of Dr. Hart and Dr. Stern began using an antioxidant scanner to measure patients' antioxidant levels. This was well-received by patients and increased business for the practice. It generated scan fees and led some patients to purchase supplements. The scanner helped promote the practice as preventatively-focused and brought in new patients. It also motivated staff through bonus incentives. Within two months, scans and supplement sales increased, generating over $4,000 in revenue for the practice. The scanner received positive publicity that attracted interest from other dental offices.
This document is the October 2015 edition of the For Your Health magazine published by Martin Health System. The summary includes:
1) The magazine highlights women's health services, how a woman lost 100 pounds, and breast health navigation services.
2) It also provides news about Martin Health, including the expansion of the HealthSouth Rehabilitation Hospital and Tradition Medical Center.
3) An article profiles a radiation oncologist at the Robert and Carol Weissman Cancer Center and the advanced technology available to treat cancer.
The NPA's new report, Face to Face, brings together true life stories about the benefits of accessible, locally based healthcare, and shows the importance of face to face relationships between patients and health professionals. It's a reminder that the human touch matters in healthcare.
Patient groups and other stakeholders are invited to consider the policy and practice implications of this new report
Patient Engagement: Health Consumer Insights from Gen Xers and Millennials Kathleen Poulos
Patient Engagement: Health Consumer Insights from Gen Xers and Millennials
Pathways to Patient Engagement is a webinar series designed to foster collaboration and discussion between all involved in the healthcare process.
During the initial webinar we explored physician insights and found 40% of the primary care physicians surveyed were not participating in any patient engagement activities.
During this webinar we highlighted feedback from health consumers, specifically Gen Xers and Millennials. We found Millennials to be more patient engagement savvy than their Gen X counterparts.
Review the deck and to get a health consumer perspective on patient engagement.
Patient Resource: Medicare Observation Versus Admit DaysTerri Embry RN BS
This resource provides information a patient, their advocate or a health care professional can use to learn about this topic. Hyperlinks are embedded to allow for self guided research and is encouraged.
This document discusses a model for coordinating care for patients traveling long distances to an academic medical center. It proposes assigning each patient a "temporary medical home" based on their condition to coordinate all aspects of care during their episode of care. This includes assigning a dedicated nurse to coordinate appointments, financial clearance, and navigation through intake, treatment, discharge and follow up. The goals are to improve patient and provider experience, increase patient volumes and revenue, and support the institution's research mission.
- Independent Living Systems (ILS) provides care transition management services using its Post-Acute Support System (PASS) program to help reduce hospital readmissions and healthcare costs.
- The PASS program coordinates patients' transition from hospitals to home through home visits, follow-up calls, and education on medication, nutrition, physician follow-ups and symptom monitoring.
- ILS works with health plans, hospitals, and provider organizations to implement PASS and achieve improved outcomes like lower readmission rates while providing cost savings.
1) A large study found that home-based physical therapy for stroke patients was just as effective as facility-based rehab, cost significantly less, and had better compliance rates.
2) Medicaid programs are now required to deny payments for costs associated with treating health conditions acquired in hospitals due to poor quality of care. Several private insurers have also adopted these policies.
3) An audit found hundreds of Medicaid caregivers to be unqualified due to deficiencies, putting $724 million in payments at risk of being recouped. Proper documentation of compliance is important for revenue protection.
- The document proposes developing a system called VirtualNHS to standardize healthcare delivery in the UK. It describes the author's experiences identifying issues like misdiagnoses, inadequate physical exams, and overprescribing of antibiotics.
- The author developed assessment tools to help less experienced doctors. This evolved into the proposed VirtualNHS platform, where doctors could create customized diagnostic tools and offer remote care.
- The goal is to reduce unnecessary healthcare utilization by 70% while improving care quality and monitoring clinical practice. The system aims to save the NHS billions while preventing errors and "wrong doings."
Unit 2 DB Responses1.I enjoyed reading your post and I completel.docxshanaeacklam
Unit 2 DB Responses
1.
I enjoyed reading your post and I completely agree with your points. I would like to comment on one of your points regarding controlling the quality of care by using independent contractors. There are benefits to this initiatives, but there could be disadvantages too. The benefit of using teams of experts that you did not hire saves the organization costs associated with keeping full time employees, and patients are seen in a timely manner (In some cases). Many years ago, some departsments in a HMO that I work for had access problem such as patients having to wait 3-4 weeks when they need to see a specialist within the organization. No patient with ear infection or difficulty swallowing wants to wait for 3 three weeks to be seen.
We were sending patients outside for urgent MRIs, CT scans, as well as to different specialists even though the company has capabilities to perform some of these functions in house. Apart from the rising costs this created, the level of patients dissatisfaction went through the roof as some patients get to their appointments and were told that referrals that were to be autofaxed to the outside vendors were never received. Some patients were sent away (no referral, no service). Our Utilization Management department was bombarded with approving these external referrals. We have improved, regrouped, and expanded. State of the art facilities were built and still continue to be built, More physicians, nurses, and support staff were hired, and our patient satifaction rate has grown greatly. For example, we used to send our deaf patients to John's Hopkins Hospital for cochlear implants which cost way over hundred thousand dollars, but that's done in house now
2.
Quality of care is a very sensitive subject for every party involved in the healthcare system. They all have different perspectives, each looking at healthcare from a different lens. Patients see quality of care in the results of their treatment and whether their treatment was effective immediately. It can also be measured by how the provider thinks, If a provider were to say that a patient would heal in 2 weeks, the patient would check for the dulling of pain around 2 weeks after the visit. Providers, on the other hand, see quality of care as the credentials that they need to get in order to renew and keep their license to practice.
Quality has its place in the healthcare system, with its positives and negatives. The positives are that it creates an air of steady improvement within competing facilities, and that it encompasses the entire scope of the patient's feelings and their care, such as the friendliness of staff to the patient, and number of services provided. The negatives are that the rating system could list quality as bad for a number of reasons that culminate in the spirit of customer service, and that constant high quality for providers means that their licenses are constantly being improved with items that fit the demanding.
The UMMC Center for Telehealth provides affordable urgent care telehealth services to over 5,000 employees of corporations and colleges in Mississippi. Telehealth visits save employees an average of $262 compared to acute care visits, and save employers an average of $16,060 per year for a corporation with 500 employees. Employees report high satisfaction with the convenience of telehealth, being able to seek treatment without taking time off work. Healthcare providers also find benefits to telehealth, including being able to provide more focused care without distractions. Telehealth services complement primary care by allowing easy access to follow-up care and medication refills.
This case study describes a married couple's experience giving birth prematurely to twins at a hospital. Key details include:
- The couple was rushed to the hospital two weeks early due to risks of a multiple birth pregnancy.
- They received care from doctors, nurses and staff across various departments, including the maternity ward, delivery room, neonatal intensive care unit and more.
- The twins were born via c-section and immediately cared for given their premature status. They stayed in the NICU for 7 weeks before moving to other areas.
- The family experienced some issues between departments but overall received exceptional care for the babies as they progressed each day in the hospital over 9 weeks total.
Test Bank -Medical-Surgical Nursing Concepts for Interprofessional Collaborat...rightmanforbloodline
Test Bank -Medical-Surgical Nursing Concepts for Interprofessional Collaborative Care 11th edition (All chapters complete 1 - 74, Question and Answers with Rationales).
1. The document discusses social determinants of health for patients served by the Anderson Free Clinic, including poverty, lack of stable housing and healthy living conditions, lack of transportation, and poor nutrition due to low income. The clinic aims to address these social factors and provide medical care for related illnesses.
2. As a nonprofit clinic relying on donations, the Anderson Free Clinic must focus on cost-effectiveness to survive. It operates with a small paid staff and many volunteers. Resources are limited and carefully managed to keep services like low-cost medications and free medical/dental care accessible to patients.
3. During an internship at the clinic, the author observed nursing coordinator Elizabeth Young and her exemplary patient care
Professional Development Exercises Assignment 4.docxwrite5
1. A nurse was suspected of diverting narcotics based on discrepancies between electronic records and handwritten records. She was suspended. Other nurses testified they often did not document medications properly.
2. The hospital did not have a clear policy on documentation when two nurses administered medications. Additional questions around medication administration practices were raised.
3. The court would need to determine if the nurse's suspension was justified given the evidence and testimony from other nurses about documentation issues. Liability for the facility would depend on addressing gaps in policies and oversight of medication practices.
Professional Development Exercises Assignment 4.docxsdfghj21
1. A nurse was suspected of diverting narcotics based on discrepancies between electronic records and handwritten records. She was suspended. Other nurses testified they often did not document medications properly.
2. The hospital did not have a clear policy on documentation when two nurses administered medications. Additional questions around medication administration practices were raised.
3. The court would need to determine if the nurse's suspension was justified given the evidence and testimony from other nurses about documentation issues. Liability for the patient's death depended on responsibilities around supervision and appropriate patient assignment.
1. The nurse was suspended for discrepancies between the electronic medication records and handwritten records. Other nurses testified they often completed documentation later.
2. Additional questions around hospital policies on documentation and who is responsible when multiple nurses care for a patient should be addressed.
3. How the testimony of other nurses affected standard practices could impact the outcome.
1) The document discusses the potential benefits of a virtual family health team (vFHT) compared to traditional brick-and-mortar family health teams.
2) A vFHT uses remote telehealth providers who can provide 24/7 care through online and phone access at a lower cost than physical clinics.
3) Some barriers to vFHTs like maintaining continuity of care and privacy can be addressed through assigning patients to specific providers while also having backup providers available at all times to handle overflow calls.
A voluntary, Internet-based reporting system for neonatal healthcare providers recently revealed that a broad range of medical errors occur in the NICU.[3] The most frequent error categories reported were wrong medication, dose, schedule, or infusion rate (including nutritional agents and blood products; 47%); error in administration or method of using a treatment (14%); patient misidentification (11%); other system failure (9%); error or delay in diagnosis (7%); and error in the performance of an operation, procedure, or test (4%). Errors in patient misidentification, for example, were a common cause of feeding a mother's expressed breast milk to the wrong baby.[3]
Memorial Healthcare System created a patient-friendly daily hospital medication schedule to empower patients and their families by providing knowledge about the medications the patient will receive during their hospital stay. This increases patient and family involvement in care and allows them to partner with the healthcare team. The schedule is developed from the nursing medication administration record and uses patient-friendly language. It has been well-received by patients and families, who report that it helps them learn about and discuss medications with doctors. Providing the daily schedule to all patients has also helped catch potential medication errors.
Memorial Healthcare System created a patient-friendly daily hospital medication schedule to empower patients and their families by providing knowledge about the medications the patient will receive during their hospital stay. This increases patient and family involvement in care and allows them to partner with the healthcare team. The schedule is developed from the nursing medication administration record and uses patient-friendly language. It has been well-received by patients and families, who report that it helps them learn about and discuss medications with doctors. Providing the daily schedule to all patients has also helped catch potential medication errors.
Memorial Healthcare System created a patient-friendly daily hospital medication schedule to empower patients and their families by providing knowledge about the medications the patient will receive during their hospital stay. This increases patient and family involvement in care and allows them to partner with the healthcare team. The schedule is developed from the nursing medication administration record and uses patient-friendly language. It has been well-received by patients and families, who report that it helps them learn about and discuss medications with doctors. Providing the daily schedule to all patients has also helped catch potential medication errors.
Memorial Healthcare System created a patient-friendly daily hospital medication schedule to empower patients and their families by providing knowledge about the medications the patient will receive during their hospital stay. This increases patient and family involvement in care and allows them to partner with the healthcare team. The schedule is developed from the nursing medication administration record and put into patient-friendly terms. It has been well-received by patients and families, allowing them to better understand new medications, discuss medications with doctors, and help catch potential medication errors. The key to its success was input from a patient and family advisory board, piloting the schedule before full implementation, and receiving ongoing feedback from patients, staff, and hospital leadership.
Memorial Healthcare System created a patient-friendly daily hospital medication schedule to empower patients and their families by providing knowledge about the medications the patient will receive during their hospital stay. This increases patient and family involvement in care and allows them to partner with the healthcare team. The schedule is developed from the nursing medication administration record and uses patient-friendly language. It has been well-received by patients and families, who report that it helps them learn about and discuss medications with doctors. Providing the daily schedule to all patients has also helped catch potential medication errors.
Memorial Healthcare System created a patient-friendly daily hospital medication schedule to empower patients and their families by providing knowledge about the medications the patient will receive during their hospital stay. This increases patient and family involvement in care and allows them to partner with the healthcare team. The schedule is developed from the nursing medication administration record and uses patient-friendly language. It has been well-received by patients and families, who report that it helps them learn about and discuss medications with doctors. Providing the daily schedule to all patients has also helped catch potential medication errors.
Telehealth offers convenient virtual care that can reduce costs while improving outcomes. It allows patients to access care remotely through video or phone instead of visiting physical offices. This saves money by reducing unnecessary emergency room visits and tests. It also improves productivity and wellness by making care more accessible. Telehealth is highly satisfactory to patients and can help prevent medical issues by facilitating preventative care. Its 24/7 availability makes telehealth a valuable option for employers and insurers to include in health plans.
1. What was the reasoning for enacting the EMTALA2. Should medi.docxpaynetawnya
1. What was the reasoning for enacting the EMTALA?
2. Should medical advice be dispensed on the telephone? Explain your opinion.
3. Discuss why you think the prescribing, control, administration, and monitoring of medications has become a major area of legal concern for health care professionals.
4. Describe the difference between the certification and licensing of a health care professional.
1. Describe the organization, responsibilities, duties, and legal risks of a governing body.
2. List some of the major provisions of SOX
3. Describe the meaning of the legal doctrine respondeat superior.
4. Describe the term corporate negligence.
5. Why is the Darling case described as a benchmark case?
6. Does the legal doctrine respondeat superior apply to an independent contractor? Explain your answer.
Chapter 11
Hospital Departments & Allied Health Professionals
LEARNING OBJECTIVESDescribe a variety of negligent errors by allied health professionals.Discuss the purpose of certification, licensure, and reasons for revocation of licenses.Describe helpful advice for caregivers.
PROFESSIONAL ETHICS Standards or codes of conduct by specific profession. Created in response to actual or anticipated ethical conflicts.ExamplesFalsifying recordsSexual improprietiesSharing confidential patient information
ChiropractorStandard of care requireddegree of care, judgment, & skill exercised by other reasonable chiropractors under like or similar circumstances.
Emergency DepartmentObjectives of Emergency Caretreatment must begin as rapidly as possiblefunction is to be maintained or restoredscarring & deformity are to be minimizedtreatment regardless of ability to pay.
Jury Returns Largest Medical Malpractice Verdict A man arrived at the ER with severe neck pain and numbness in his arms and legs. A doctor diagnosed his condition as neck strain and released the man from the hospital. A few hours later, the man became completely paralyzed from the chest down… The jury awarded the plaintiff $15 million; $10 million of which was for non-economic damages. −Mark Bello, The Legal Examiner, December 30, 2012
No Duty to Patient
Who Left ED UntreatedIn a wrongful death medical malpractice action alleging negligence, the trial court properly granted summary judgment because under Ohio law, an emergency room nurse had no duty to interfere with an individual who left the ED without telling anyone and who refused treatment.
−Griffith v. University Hospitals of Cleveland
Failure to AdmitPhysician was found negligent in failing to hospitalize the patient or failing to inform her of the serious nature of her illness. The trial court found that had the patient been hospitalized on her first visit, her chances of survival would have been increased.
−Roy v. Gupta
Documentation Sparse & ContradictoryED physician failed to evaluate the patient & to initiate care within first few minutes of patient's entry into the emergency facility. The e ...
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1. Diary of Medical Management Issues
1.
When healthcare uses the word “computerized” this means healthcare providers using
technology as a “notebook” to transfer previously handwritten clinical information into
electronic documentation. This is not only an ineffective effort that falls short of our
technology capabilities but can actually increase manual demands for computer entries.
When software engineers and internet companies use the word “computerized” their
industry means something far more useful… that electronically stored information is
“actively managed” to replace costly workforce, connect and unify services and products,
decrease marketing budgets, providing reliable monitoring that the incidence of human
error cannot achieve This is a successful use of today’s technology that our healthcare
system has not utilized. Our software (Medrok, Inc.) product melds healthcare expertise
with technology expertise; a type of “artificial intelligence” that uses the stagnant
“notebook” information to produce solutions. For example, a hospital requires nurses to
engage in computer entries every two hours on multiple screens replacing previously
handwritten notes. Some of this information is still recorded in paper charts. Dividing
electronic and paper documentation only leads to further incidence of errors and
omissions. Another example is regarding pharmacy prescriptions. Currently a physician
must write a paper prescription that the patient must take to the pharmacy or the
physician’s office has to call the pharmacy to place a prescription. Many times there are
delays or miscommunications in these phone calls or written prescriptions that delay the
initiation of proper treatment for the patient. Such delays can precipitate further medical
deterioration which increases cost of treatment. Our system utilizes computer entry of
prescriptions that with a secure authorization will allow pharmacies to retrieve electronic
prescriptions and refills online.
2.
Ask yourself why our auto industry is required to provide estimates and reveal costs of
auto repair upfront prior to providing services and our healthcare providers and insurers
are not. Providers and insurance companies do not inform the patient of their costs
before expensive procedures, surgeries, treatments and demand that patients sign
“blanket” statements making them legally responsible for amounts that they are not
capable of paying. This means the provider of services such as physicians, clinics,
hospitals, pharmacies are not reimbursed by the patient thus our healthcare system falls
deeper into deficit and collapse. All healthcare services and products (except for
emergency services) should be pre-authorized and an upfront estimate provided to the
patient. It is unacceptable that we are managing our auto repair industry more
responsibly and efficiently than our healthcare.
2. 3.
One of the main and understandable concerns of online healthcare information is security
breaches. Personal Health Information is protected by strict governmental guidelines
known as HIPAA Regulations which impose severe criminal punishment. Due to
technological advances that allow the fingerprint and further password requirements to be
to access restricted online information, along with advanced encryption capabilities and
“shelving” or inactivating online information, our software system will protect healthcare
information more rigorously than phone calls, faxing or paper trails. We will complete
the programming of our software utilizing government supervision on every level and
obtain a HIPAA Compliant Status.
4.
A personal example regarding poor medical follow-up and how it increases costs.
Recently, I contracted a urinary tract infection. I went to a clinic and a urine culture was
taken and I was started on an antibiotic and an anti-spasmolytic. By the sixth day my
symptoms were not improving and I called the clinic multiple times to request my culture
results and to inform the physician that I was developing a fever, chills, nausea and flank
pain. These are all indicative of a urinary tract infection progressing to a kidney infection
which can require hospitalization and IV antibiotics. The office staff took my
information and it took them over a day to call in a change of antibiotics to the pharmacy.
They NEVER gave me my culture results. The physician never spoke with me directly
despite my repeated efforts to reach her. This is not uncommon. Due to the fact that the
physician never followed up with me (and thank goodness I am in the healthcare field
and know the signs and symptoms of a kidney infection and repeatedly called them for
further treatment) I could have developed a serious, costly kidney infection. The change
in antibiotics resolved my symptoms after a 10 day course but I literally had to sit at the
pharmacy waiting for the physician’s office to call in the prescription change sweating
and in severe discomfort. With our computerized system, I would be able to check on my
culture results and enter in how my treatment was progressing. This could have
electronically alerted the physician to pay particular attention to my situation and
electronically enter a prescription that could be filled immediately. Multiply my incident
by thousands nationwide and imagine the cost of such negligence.
5.
Reviewed patient who was a couple of days post-op hysterectomy. She also had an
underlying seizure disorder for which she was on Dilantin, a medication used to control
seizures. When I reviewed her on a Thursday, I noted that her Dilantin level was only 2
(therapeutic levels are 10 to 20). I checked the most recent MD orders in the chart and
did not see where anyone had addressed this very low Dilantin level. I had to track the
nurse down who was extremely busy and asked if she or the MD were aware of the low
drug level. She said no. I asked her to inform the physician. The next day, on a Friday, I
reviewed the patient again and noted that the physician had ordered an increase in the
patient’s Dilantin dose. Satisfied that the patient’s issues were being met, I completed
3. Continued…
her assessment. When I returned on Monday, the patient was still in-house. When I
reviewed her chart I found that she had actually been discharged home Saturday with a
Dilantin level of 3 (still extremely low). On Sunday at home, she suffered a grand-mal
seizure, fell down during the seizure and had fractured both of her shoulders. She had to
be re-admitted on Sunday. The Emergency Room had given her several doses of
intravenous Dilantin to get her level back to a therapeutic range. Due to the fact that this
patient was discharged with such a low, ineffective Dilantin level, she now required 2
separate surgeries to repair her shoulders.
6.
With my company Priority Healthcare I was called by an LA Hospital social worker who
requested assistance with a skilled nursing level patient that they had been trying to place
in a skilled nursing facility bed for over a week without success. They could not find any
facilities to accept the patient. I arrived at the hospital and reviewed the patient and could
not find any glaring issues that would keep this patient from being accepted. So I called a
couple of the skilled nursing facilities and “firmly” insisted that they tell me why they did
not want this patient. They told me that the patient was on a medication that cost nearly
$400.00 per month. I put the facility on hold and asked the social worker who the
physician for this patient was. The physician just happened to be making his rounds and
was in the nursing station. I informed him of the issue regarding the cost of the
medication and he immediately and simply told me he could change the patient’s
medication to an equivalent but lower cost medication. When I informed the skilled
nursing facility about the change in medication, they immediately accepted the patient
who was discharged that day. So this patient had been sitting in-house for over a week
costing the hospital and insurer unnecessary costs.
7.
I was contacted by many hospitals to speak with patients & families who were resisting
discharge to a lower acuity facility because they were very distrustful of their family
member leaving the hospital. At times, the patient and family would resist for
days/weeks. Generally I would sit for about 45 min. with the patient & family explaining
to them in detail the care and services of a lower care facility. 98% of the time, the
family was reassured, with their concerns and questions answered and would then
cooperatively participate in getting the patient to a lower acuity facility.
4. 8.
Every morning our offices (as Priority Healthcare) phoned the discharge facilities to
record what kind of open beds were available with the purpose of filling those beds.
Frequently, the facilities admission department would not be able to tell us. We would
have to call back several times and even then it was hard to find someone who could give
us an accurate list. Currently, the discharge facilities hire marketing people to go out to
hospitals with cookies and candy, but still no record of what actual beds they might be
marketing. Once again, can you imagine the airline running seat reservations like this?!
9.
My office staff would call RN’s each morning on every patient to discuss the clinical
state and daily plan of care with the goal of transferring the patient to lower cost bed.
Our organized, current updates were so efficient that the physicians began calling us for
information on their hospitalized patients instead of the hospital case manager and nurse.
The hospital case managers were so inefficient with clinical issues that I insisted that my
staff spoke directly with a bedside nurse. The hospital’s issue with speaking to the
bedside nurse was that we were interrupting their focus on patient care which is why we
need to computerize the morning shift report and electronically manage clinical
information.
10.
Many times I was called by hospital case managers for assessment of subacute level
discharge. The patient would not qualify for subacute level due to issues such as too high
of an oxygen setting on their breathing machine or mild fluctuations in temperature or the
patient was on dialysis as well as a breathing machine. So I had to suggest to them the
changes that would have to occur for subacute level admission or I would suggest an
acute long term level admission which WILL allow for higher oxygen levels, mild
clinical deviancies and dialysis.
11.
At an LA Govt. Hospital I was reviewing a patient for discharge. The patient was very
agitated and had to be restrained (tied down by both wrists). The patient was subacute
discharge level with a tracheostomy and trach collar oxygen delivery. Subacutes do not
accept agitated, restrained patients as there is a serious risk of the patient getting loose
and pulling out their airway. I spoke with the physician who was very eager to get this
patient out and we discussed the patients sedative schedule. We discussed putting the
patient on a low routine dose of Ativan with intravenous doses as needed. or to call in a
Pain Management Consult. The physician decided he wanted to manage the sedation
without a pain consult so I told the physician and nurse I would be back in the morning
and if the patient was calm and un-restrained I could get him to a discharge facility.
5. Continued…
I called the night nurse around 9 pm to make sure the schedule was being followed and
the nurse told me that the physician had NOT written the change in Ativan, the patient
still agitated and restrained. I asked the nurse to call the physician to get a phone order
because if the patient wasn’t stabilized by morning I would not be able to get him to a
discharge facility. When I showed up in the morning, the physician had still not ordered
medication changes and the patient was still restrained. The physician was very upset
that the patient couldn’t go out so I had to have another conversation with him about the
sedation schedule. Finally, he wrote the orders. The following morning the patient was
calm, unrestrained and was discharged to a subacute.
12.
Some patients are prescribed Epogen for low blood levels (hemoglobin/hematocrit). It is
a medication that stimulates the body to produce more red blood cells. It is a VERY
expensive medication. I cannot even count the times that I reviewed a patient who was
on Epogen whose blood levels had corrected themselves (and were healthier numbers
than my own blood count!) but were still on the drug. I would inform the physician and
more often than not, the physician would take the patient off of the drug because they
didn’t need it any longer.
13.
At an LA Hospital (prior to their bankruptcy and closing) I evaluated a patient in the
Intensive Care Unit. I noticed that the patient’s bleeding/coagulation times were severely
elevated (meaning the blood is very thin). The patient had been on Coumadin (a blood
thinner) so I immediately asked the nurse if the Coumadin had been stopped. The nurse
told me the Coumadin had been stopped 3 days ago. I was relieved but realized that the
patient’s bleeding/coagulation levels had not dropped after stopping the drug for several
days which was not normal. The nurse told me that the attending physician had ordered
the patient to go to a telemetry bed and out of the ICU. I called the attending physician
three times waiting nervously for a return call. Then I decided I would try to contact the
neurologist who was on the case. When I spoke with him he was pretty alarmed
(apparently he had not noticed the abnormal labs). He told us not to transfer the patient
out of the ICU and to call a hematology (blood issues) consult right away. As soon as I
hung up the phone with the neurologist, the nurse beckoned me into the patient’s room.
The left side of her neck was swelling up and I questioned the patient on her airway (if
she was having a hard time breathing). She turned her head to the left where we were
standing and suddenly went into cardiac arrest. We began resuscitation efforts for over
45 minutes. She was “bleeding out” due to her thin blood The frequency at which lab,
culture and significant clinical states is missed is truly alarming.
6. 14.
When I was reviewing for Insurer, I was called by the hospital case manager about a
patient whose hospital days were being denied by the Insurer (almost a week worth).
The Insurer physician reviewer had even spoken with the patient’s hospital physician to
try to get clinical information that would authorize payment. Apparently (and occurs
often) the hospital physician did not give the insurer MD clinical information that would
authorize payment.. So at the request of the hospital case manager (which usually the
case would have gone into claims and never paid or delayed for months), I reviewed the
case. Approximately 5 days prior the patient had suffered a cardiac event and her
troponin levels (which if elevated means you suffered cardiac damage) were STILL
elevated. So I called the Insurer MD myself and let him know of this clinical information
and he immediately authorized payment.
15.
Many times I reviewed culture results and if I could not find them on the computer or in
the chart, I would have to literally knock on the laboratory door to have them look up
paper documentation as to whether a patient had any positive cultures. This is especially
important when reviewing a patient for a discharge facility because the Health Dept can
close them down if they put a patient with a certain infection with an uninfected patient.
With some disconcerting frequency, I would find a positive culture that the infectious
disease physician had not been informed of. So the patient would have to stay another
several days to be treated for the infection and then transferred to a discharge isolation
bed.
16.
I was called by a case manager from a San Fernando hospital regarding transferring a
patient out of the ICU and into a subacute level bed. When I arrived, I spoke with the
bedside nurse who told me the patient had over 600 cc of diarrhea in the last 12 hours. I
asked the nurse if the physician had been informed of this and she said no. I noticed
there were no stool cultures (usually if a patient is having such large volume stools, the
physician will want to rule out c. diff). Also, the patients veins were so poor that the
nurse had placed an IV in the patient’s foot. This is a precarious location for an IV and
more concerning, the patient was a diabetic. Diabetics do not heal well so great care has
to be taken with skin integrity. The foot IV could dislodge and/or ulcerate. Using
Priority Healthcare medical checklist, I documented the issues and gave a copy to the
bedside nurse, the hospital case manager and the physician. The MD put a hold on the
patient’s transfer, ordered a c. diff stool culture, reviewed the tube feeding formula
(which can cause diarrhea) and ordered a PICC line to be inserted. A PICC IV line is a
larger vein, can be left in longer than a regular IV line. Two days later, the issues were
resolved and the patient was transferred to a lower cost subacute bed.
7. 17.
Morbidly obese patients are difficult to place in a discharge facility due to the fact that
their weight puts a strain on the nursing staff to reposition in bed. Their weight can cause
bed sores requiring freq repositioning in bed and wound care. Also, the patient may need
to be in a special bed (which is more expensive than a regular bed) to fit their size and to
decrease pressure on their skin. Sometimes these patients sit for months in the hospital
because the hospital case manager does not know how to problem-solve. So the
algorithm for this type of patient is to record weight loss, document mobility with
physical therapy notes, place a “trapeze” device to allow the patient to assist the nurse in
repositioning, may need plastic surgery consult for severe bed sores or stress to
discharge facility that the patient has no wounds, hospital may consider renting a special
bed for the patient for 6 months to a year (which is still saving them thousands of dollars
to get the patient to a lower cost facility) and sometimes the bed companies will comp a
patient bed as a form of marketing to the hospital for perhaps a year. Once these issues
are addressed, the patient will be much more “attractive” to a discharge facility.
18.
One of Priority Healthcare clients was a subacute (that also had skilled nursing level
beds) in Santa Monica. Subacute level patients need to be evaluated carefully as
oxygenation and how it is administered are key assessment issues. Skilled nursing
patients are much more stable although, they too, should be clinically evaluated prior to
transfer out of acute inpatient care. I evaluated a skilled nursing level patient who had
just had his tracheostomy plugged and then removed. He was on nasal cannula oxygen
and very stable. So I OK”d his transfer to skilled nursing level of care. That same
evening I received a panic call from the facility that the patient had deteriorated as soon
as he was wheeled into the discharge facility and had to be coded (Code Blue
resuscitation) and returned to the hospital. Apparently, just before the patient was
discharged from the hospital, he de-compensated and had to re-insert the trach and place
an oxygen collar. I was very concerned because the facility should not have accepted the
patient with such a drastic change in respiratory status. The hospital staff as well were
responsible for the discharging an unstable patient. This type of poor care or discharging
inappropriately will increase costs due to re-admissions. This just illustrates how
important discharge assessment is. This is another feature of our system, to evaluate
clinical discharge states just prior to discharge.
19.
While I was evaluating gyn/obstetric surgical patients for an Insurer, I noticed that a fair
number of these patients were being re-admitted 5 to 7 days after discharge with small
bowel obstructions. The industry standard (Milliman) allows for a 2 day hospital stay for
excision of fibroids and hysterectomy. If the patient, on the second or third day was
having flatus (meaning gas) which is an early indication of the return of bowel function
by industry standards the patient should be discharged. I spoke with the Insurer relaying
my observations and that perhaps keeping these patients in 1 more day to make sure the
8. Continued…
patient had a bowel movement (with the aid of stool softeners or laxatives/enema) this
would save expensive re-admission and need for bowel surgery. This is another process
of our system to evaluate re-admissions and encourage pro-active cost-saving industry
changes.
.
20.
Insurers hire multiple RN case managers, discharge planners, claim processors, physician
reviewers, hospitalists and intake center personnel to manage millions of patients
nationwide. The hospital hires multiple RN case managers, discharge planners, claim
processors, hospitalists and admission department personnel as well. This workforce
adds up to billions of dollars a year in replicated, inefficient services. One can liken this
process to the 1950’s college fad of piling over 22 people into a phone booth. NO ONE
is going to be able to place a phone-call in these cramped conditions. Our system will
create job opportunities in IT, Clinical and Medical arenas WHILE improving healthcare
service delivery and saving the system trillions of currently wasted dollars.
21.
Our government is focusing on placing electronic medical records on-line with a taxpayer
funded 30 billion dollars. Of course, easy access to medical records is a useful endeavor
but will not resolve the faulty processes of our healthcare system. Physicians, hospitals
and insurers already have access to medical records albeit in a sluggish manner. The crux
of our healthcare problem IS HOW THE CLINICAL INFORMATION IS MANAGED
DAILY on a molecular level. What the government is proposing is like putting icing on
a burnt cake. We need to make sure the batter of this cake and how it is baked deserves
the effort of icing it. Covering up the REAL issues will only serve to push us further into
deficit. At this level of financial disintegration, we need to start watching every penny,
every dime, every billion. This takes experience in medicine, clinical processes and
knowledge of current flaws on every level. Medrok’s system addresses these core issues
and consistently, actively resolves our “bad habit” of wasting pennies, dimes and billions.
22.
There are no subacute level dialysis services. The patient either has to be acute long term
or skilled nursing level. Otherwise, the patient remains in the hospital for months. We
need to CREATE subacute level dialysis facilities in order to decrease cost of such
patients. We need to invent protection devices that keep agitated patients from pulling
out their airway without restraining them or tying them down. We need to invent electric
bed pulleys which reposition the patient saving the nurses from back injuries. We need to
use kiosks in hospitals that can be used to educate patients & family members. We need
to create less costly integument (skin) products to decrease the millions of dollars spent
on decubitis ulcers/wound care, expensive air-beds e.g. fluctuating gel pads, painting the
skin with silicone to protect skin from acidic urine and stool. We need a portable home
9. Continued…
health monitoring device which takes blood pressure, heart rate, temperature, blood
glucose levels all at once, with this information plugged into the PC for an RN to review
daily, in addition to auto-medication administration to monitor medication compliance
keeping the patient more stable, out of the hospital, with fewer home health nurse visits.